PA vs Dr doing Biopsy

@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

@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/)

@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.

@brianjarvis
You did active surveillance for 9 years ?
Did you have a few lesions and at first biopsy they were a Gleason 6 or negative ? What was found on your last biopsy to move to treatment ?

I go for for my first biopsy in a few days.

@indyguy Yes. Despite my urologist’s recommendation to have surgery, with a localized, 6(3+3), PSA of 4.2, there was no medical necessity to treat.

I had 2 lesions, both 3+3, one on either side of my prostate. Since it was only a 3+3, there was no need to panic or rush to a hasty treatment decision; I had time on my side and chose active surveillance (AS).

I was on AS for 9 years, which bought me time to get referrals, evaluate all available treatment modalities, and take advantage of medical and technological advances, so that if/when the time ever came to make a treatment decision (which it eventually did), I’d be ready to pull the trigger (so to speak).

But, I made a commitment that should (1) my Gleason ever reach 7, or (2) my PSA ever reach 10, or (3) a biomarker test ever return unfavorable results, that I would then seek active treatment.

Eventually, my Gleason reached 7(3+4), and a Prolaris biomarker test indicated that I had “exceeded the threshold for active surveillance.” (PSA was only 7.976.) That Gleason score and the unfavorable biomarker result were my cues to leave AS and seek active treatment.

What were your MRI results that led to you getting a biopsy?