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How to prep for transperineal biopsy?
good morning gents. I am scheduled for a transperineal prostate biopsy on Monday at Mayo Jax. Wondering what if anything I need to do to prepare. I’ve stopped my daily baby aspirin routine per doctors orders, but have not received any other instructions. I’m 66, 4 years post-liver transplant and am immunocompromised. Rising PSA levels gave rise to prostate MRI which identified a small lesion that they want to biopsy. I ride my exercise bike most mornings, and I understand that saddle pressure on the prostate can result in elevated PSA levels. Wondering if I should refrain from that exercise prior to the biopsy. I also have BPH 80g prostate and take daily tadalafil and tamsulosin every other day to manage those symptoms. Since I am immunosuppressed, I am at higher risk of all kinds of cancers, so Mayo is being proactive - which I appreciate. Thanks
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I was instructed to take an enema before the procedure. They will use a rectal probe for the sonogram part of the festivities.
Phil
@gerryp Assume your urologist and the folks at Mayo Jax are fully aware of your medical history, getting off the baby aspirin may be all you need to prepare. I've had 2 transpireneal biopsies in the last couple years with no issues. Local anesthesia (lidocaine), fully awake and chatting with urologist during, minimal discomfort during, took 10-15 minutes both times. Drove myself to both procedures. Good luck!
@heavyphil
Thanks Phil. Yes an enema for breakfast. Just learned it will be general anesthesia- so hopefully I won’t see the probe!
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1 Reaction@tdgillett yes thanks. they are very familiar with my history as I was transplanted here. Mine will be general anesthesia which I think I will prefer. Hopefully results will be negative 🤞
@gerryp, how did the biopsy go? Now that you've been through it, what do you wish you'd known? What tips would you offer to other preparing for a transperineal biopsy?
Hi @colleenyoung. Had the biopsy a week ago Monday, 16 cores, and got results yesterday that all showed no indication of PCa. The pathologist did indicate that several cores show evidence of PIN (Prostatic Intraepithelial Neoplasia) which the doctor indicated can be pre-cancer. I’m researching this and waiting for direction from urology team as to next steps. Doc indicated that it’s typically follow-up PSA & MRIs to see if any change in status of these abnormal cells.
The procedure itself was painless, I was told to expect blood in my urine & semen. Turns out I have a “friable prostate” and bled like a stuck pig for about a week every time I peed. Much more than expected - which was pretty disconcerting. Since I have had BPH for years, I just wish I knew that this was a possibility. Evidently a friable prostate can be the result of BPH. Plus my ability to pee was much more difficult, I think because of the angry prostate. So I had to have some follow-up voiding tests and they wanted to give me a catheter. Managed to get them to avoid doing that to me.
The doc used general anesthesia which I appreciated. I had no discomfort after the procedure other than the urinary symptoms. The bleeding didn’t really start until about 24 hours after the procedure. The first day was minimal - so I thought I was out of the woods.
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1 ReactionYou don't offer why you and/or your physician chose the transperineal biopsy vs the more traditional rectal ultrasound guided method. If it is fear, then fear not. The ultrasound probe only goes in your rectum about 2 inches. The 12 core samples are taken in rapid succession, and you are done in about 20 minutes or less. And it doesn't really hurt. You feel a mini-second of the pressure into the prostate, but the needle inserts and retracts so fast, it is over before you have time to be uncomfortable. Just wonder why you are going that transperineal route? Good luck to you.