PA vs Dr doing Biopsy

@dribbles I've had 3 transrectal biopsies and will not have another, but I've never questioned or been concerned about having the oral and IM antibiotics prescribed by my doc. I know there is concern about developing an immunity to them, but I've not heard the phrase 'preserve my biome'. Can you explain why this is a concern for you?

You are at the Mayo Clinic. If they recommend the antibiotic I would go with it.

My thoughts are that Mayo would have highly qualified PAs performing that procedure; I had a transrectal biopsy in 2022 with no issues and while I think before taking antibiotics in general, I would definitely take them for the procedure if recommended.

I was required to take antibiotics before dental procedures following hip replacement, which has some controversy, and had no carryover effects, and have ceased taking them currently, after a few years of doing so.

Best wishes.

@twhite33
thanks for response.
Its not the immunity issue for me.
I'm not an expert on gut health but I have consciously been working on my diet this past year with lots of attention paid to intake of fiber, and foods that promote a good bacteria community in my intestines. I dont do supplements its all fruits , vegetables, fat free yogurt , omega 3 foods, low sugar ,etc. I feel so much better since I started this. The "gut health" craze is growing and I'm not really into all the propaganda but I do know my gut has to be in really good shape and I dont want to wipe it out if I dont have . It takes a couple months ( I've read on the internet haha) to restore. Now, I may be heading for use of more antibiotics if my biopsy reveals significant disease, but if not, I would prefer to remain intact.

@jcf58
Thanks, yes my wife leans the same way. I dont think my gut biome is high on their list of concern and risk /reward for them is obviously in favor of antibiotic. Its not a deal breaker for me but with the extremely low infection rate thru the perineal it should have been a discussion point,

@dribbles
You need to keep in mind that the extremely low infection rate is with recommended antibiotics. Without them, all bets are off.

@jc76 As I’ve posted before, I had 4 transrectal biopsies while I was on active surveillance (2012-2021) and had no infection-related or recovery issues (beyond what was advised - blood in stool, urine, and semen for differing periods of time). There were no surprises.

I took antibiotics exactly as prescribed; did the enema exactly as directed. Also discussed with the urologist about using as much lidocaine (or whatever the numbing agent is called) as was allowed The biopsies were relatively uneventful.

(As has been pointed out, risk of infection is much less with the transperineal method for obvious reasons.)

For my first transrectal biopsy, I drove myself there and back home. Yes, for my first experience it was quite unnerving, but not terribly traumatic (with enough Lidocaine!). For my fourth (& final) transrectal biopsy before receiving active treatment, I invited my wife to be in the room where the MRI-guided transrectal procedure was being done. I wanted her to see that it wasn’t as painful as she was imagining. She said ok; the urologist said ok. So she sat in the corner of the room (towards my head) during the entire procedure.

(Surprisingly, in this 2015 paper, there were higher incidences of needle-tract seeding identified with transperineal prostate biopsies than with transrectal: https://pubmed.ncbi.nlm.nih.gov/24958224/)

@mjp0512
That is also a very strong point, thanks.

@dribbles you are NOT going to wipe out your intestinal flora with a single 500 mg Cipro - no way.
The antibiotic is given to prevent bacteremia - a blood infection which is usually transient (if at all) after biopsy. However, transperineal biopsies have about a Zero chance of this since the bacteria laden rectum is avoided completely.
I had no antibiotic administered after my TP biopsy. The worst part was hurriedly ripping the Band Aid off my taint the next morning when I realized it was still there just before a BM…OUCH!!!
Phil

@brianjarvis
My hat is off to you. You have much stronger mental ability with things like this than I. I also did not want the extra 2% increase in infection. I have read post from posters that did get the infection from transrectal and although rare just not something I wanted to chance.

I came down in 2015 with diagnosed PTSD that evolved into anxiety/panic disorder. It was caused by several traumatic events in my life and won't take up space with typing them.

So with me I try to do whatever is less stressful for me in life. I was already dealing with the stress of PC so I chose the less stressful as possible with biopsies options. We are all different and have to do what is best for us like you did also.

Your medical providers are the only ones who have your medical and mental health history and also can guide you. My wife cannot even help me with band aids as she too has been diagnosed with anxiety/panic disorder. She would have laughed at me if ever suggested being in room with any surgical procedure.

Again I applaud you for your ability both physically and mentally.

When I had the Markers and Space/Oar done it was done transperineally but without anesthesia. They (UFHPTI) gave me a sedative, laughing gas, and Lanicane to area so had no pain. But the procedure for me was very stressful and I sucked on that laughing gas as much as possible. Even with this procedure they did a smear to determine which antibiotic to do and was not transrectal.