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Had a TP biopsy this morning.

User
Posted 07 Feb 2019 at 18:27

So feedback for anyone due to have one of these, as I sit here in my baggy jogging bottoms!

Remarkably ok, general anaesthetic which makes it easy so to speak!

I’m 54 and my PSA is quite low still even though higher than normal. Was 3.9 with no symptoms but crept up to 4.1 and mpMRI showed nothing but consultant said better safe than sorry since 4.1 and clear MRI statistically means I have a 10% chance of it being cancerous.

He offered me the trans perineal biopsy as less infection chance etc...

So really I’m just posting for anyone maybe concerned about having a TP biopsy.

Early days and peeing stings like a bugger because of the cathetar they use during op and a little blood in urine for a couple of days apparently, but for me, mostly clear. 

User
Posted 19 Feb 2019 at 10:52
I would echo the comments - mine was easy and pain free.

I had a long wait on the day - I was on the afternoon operating list and the number waiting in the room for a wide variety of operations got fewer and fewer as they were slowly called down. Then several operations got cancelled as there wasn't time to complete them, and I suspected it wasn't going to happen. Finally I was the last person left, and taken down to the op.

Walked in to the operating theatre, laid on the table and chatted to the anesthetist whilst I was hooked up to ECG and blood pressure monitor and cannular inserted into my hand, and had some sort of pre-med which made me a bit light headed but still chatting. Also chatted to one of the surgeons (there were two). Anesthetist apologised that the anesthetic would heart and I recall saying it didn't, and then I woke up in recovery.

First thing, they offered me a cup of water and a chicken sandwich. I'm not sure if I felt hungry, but I hadn't eaten for about 13 hours at this point, so I took it. I had trouble chewing and swallowing it which it took me a moment to work out. I had no saliva - I could eat it only providing I swilled each mouthful down with water. That resolved itself within an hour, but it wasn't a side effect I had ever heard of. I was drinking loads of water, partly because I told I must, and partly because I thought I must be really dehydrated (I wasn't).

I was told I would have a catheter, and it would be removed the next day. I carefully peered at the little fellow, and, no catheter. I asked about that when I saw the surgeon the next day, not that I was complaining, and he said they decided I didn't need one.

I had elected to stay overnight beforehand, because it turned out to be a bad day to arrange for someone to be with me overnight after the general anesthetic. So after a hour or so on recovery, I was wheeled to the ward. The nurses had obviously been told I would be in pain and needing painkillers, and they kept coming in and offering, but I had no pain whatsoever, so I declined. By this time it was midnight, and I was as alert and wide awake as ever, and would be totally unable to sleep so I didn't even bother to try. Don't know if that was the after-effect of the general anesthetic, but I walked around and talked with my brother on the phone for an hour at about 1am - he was driving home from a late event and was also pleased to talk with someone at that time. The nurses wanted me to pee into bottles so they could monitor how much and if excessive blood. First time, flow rate was very slow and there was blood staining in the first few CC's, but flow rate improved over successive pees, and the blood was too little to see in the bottles. I had been put on Tamsulosin 3 days before the op, to continue for 2 weeks afterwards, to help urinary flow and make sure any clots were flushed out, but I never saw any clots in the urine. I was actually quite pleased I elected to stay in overnight, as they were monitoring me every 2 hours, and I did eventually get some sleep.

The big plaster was sticky around the edge and was covering the perineum and arse, and the sticky had also caught the scrotum which was a bit uncomfortable. However, it quickly fell off the scrotum and perineum, but remained firmly stuck on the arse cheeks. It had some dried blood in it, but there was no bleeding after I came around from the op - that was all from beforehand. I had taken a hand mirror in with me, and checked around perineum and arse, and there was no sign of any injury or marks or scabs or swelling left by the biopsy needles whatsoever. Just a little red bruising. I had trimmed the hair on perineum and scrotum as short as possible with a beard trimmer beforehand, but I didn't trim my arse cheeks, and this plaster was stuck very firmly to the hairs on my arse! It took a long time to gradually ease it off, and left me with a slightly rectangular patterned waxed arse cheeks. It also left a lot of sticky behind on my arse cheeks which meant they stuck to my underpants.

At 10am next morning, I was checked out, and went home by bus. It was slightly uncomfortable sitting on the bus seat, particularly when the bus was stationary and the idling engine had the whole bus vibrating, so I tended to tilt slightly onto one arse cheek or the other, to keep the perineum off the seat.

It was 2 days before I could do a number 2. I thought I was constipated but I wasn't - it was probably due to not eating for a day and I think my bowels well emptied themselves before the op in anticipation, so there was simply nothing to feed through. I thought it would be painful, but it wasn't at all. Wiping afterwards was though!

I tried and erection 2 days afterwards, and it was fine and not in any way painful or uncomfortable, and not reduced in length. The consultant had said no need to wait at all, but I figured I'd had loads of needles pushed though the erectile base of the penis in the perineum - I'll not try pressurising it immediately afterwards. There was very little semen (possibly due to the Tamsulosin which causes retrograde ejaculation) and no blood first time, although there was blood on subsequent times, but much less than for my previous trans rectal biospy. I only ever saw blood in the first few cc's when peeing, and that only lasted for 3 days.

In the next days, the bruising came through much more and the perineum, anus, and scrotum went dark brown. At least the dark brown indicated old blood, not new bleeding - it was just moving around inside. It wasn't painful, but it did itch a lot in the scrotum which was noticeably bigger, and I don't think it was just due to trimmed hairs. That took a couple of weeks to go away.

4 days afterwards I was back on my exercise bike, and 8 days afterwards on the road bike (could have been sooner but weather was bad).

Anyway, based on my experience, I would have no fears if it had to be done again (unlikely in my case, as it found cancer in 12 out of 33 cores).

User
Posted 07 Feb 2019 at 20:31
Glad to hear that the biopsy went OK, Steve. You'll probably develop a quite spectacular bruise on your perineum which may make it uncomfortable to sit down for a few days, but the worst is now over.

It's normal to have a little blood in the urine for a few weeks, and your semen will be full of blood for perhaps a couple of months.

Best of luck with the results,

Chris

User
Posted 19 Feb 2019 at 09:49
Hi Steve,

Great news you have the all clear. You need to keep pumping out the semen (one way or anotherđŸ˜‰) for it to change from strawberrry back to vanilla!

Cheers, John.

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User
Posted 07 Feb 2019 at 20:31
Glad to hear that the biopsy went OK, Steve. You'll probably develop a quite spectacular bruise on your perineum which may make it uncomfortable to sit down for a few days, but the worst is now over.

It's normal to have a little blood in the urine for a few weeks, and your semen will be full of blood for perhaps a couple of months.

Best of luck with the results,

Chris

User
Posted 19 Feb 2019 at 08:56
Hi Steve, had my second template biopsy yesterday and was looking for a thread to be able to feel some solidarity with those of us pre-definitive diagnosis!

After my first one I seemed to leak blood for about 10 days afterwards. Not just in urine but totally involuntarily so I was apprehensive this time, but so far so good.

My top tips for anyone concerned about a template biopsy:

Take a good book - I've waited robed up for 4 hours both times

You will never taste toast as good as the toast they give you after you come round

Drink some tea to help you pee (and the stinging is worth it as no pee = catheter)

I came home and went to bed in incontinence pants which saves worrying about blood on the sheets

Keep drinking water to flush it all through

An Epsom salt bath is good

All the best for your results.

Andy

User
Posted 19 Feb 2019 at 09:26

Hi Andy,

Lots of valuable advice in your post there!

For me the 'catheter sting' went away after about a day, I kept drinking lots of water!

Without being too graphic (although we're all men on here pretty much!!), the blood in the semen was the biggest source of 'Oh my God!' from me (and my wife). It's kind of stopped any desire to do that again until it's gone away! laughing

I saw my consultant a week later and all my samples were clear so he's discharged me (no pun intended!).

I was quite matter of fact and 'fine, good, bye then' with the consultant but my wife got quite tearful. I guess I underestimated how any worry affects those around us, and shouldn't be taken for granted as us men are typically quite stoic about stuff!

May I ask why you're having to have a 2nd TP biopsy, is this years apart or something more recent and they think they might have missed something?

All the best,

Steve.

User
Posted 19 Feb 2019 at 09:49
Hi Steve,

Great news you have the all clear. You need to keep pumping out the semen (one way or anotherđŸ˜‰) for it to change from strawberrry back to vanilla!

Cheers, John.

User
Posted 19 Feb 2019 at 10:52
I would echo the comments - mine was easy and pain free.

I had a long wait on the day - I was on the afternoon operating list and the number waiting in the room for a wide variety of operations got fewer and fewer as they were slowly called down. Then several operations got cancelled as there wasn't time to complete them, and I suspected it wasn't going to happen. Finally I was the last person left, and taken down to the op.

Walked in to the operating theatre, laid on the table and chatted to the anesthetist whilst I was hooked up to ECG and blood pressure monitor and cannular inserted into my hand, and had some sort of pre-med which made me a bit light headed but still chatting. Also chatted to one of the surgeons (there were two). Anesthetist apologised that the anesthetic would heart and I recall saying it didn't, and then I woke up in recovery.

First thing, they offered me a cup of water and a chicken sandwich. I'm not sure if I felt hungry, but I hadn't eaten for about 13 hours at this point, so I took it. I had trouble chewing and swallowing it which it took me a moment to work out. I had no saliva - I could eat it only providing I swilled each mouthful down with water. That resolved itself within an hour, but it wasn't a side effect I had ever heard of. I was drinking loads of water, partly because I told I must, and partly because I thought I must be really dehydrated (I wasn't).

I was told I would have a catheter, and it would be removed the next day. I carefully peered at the little fellow, and, no catheter. I asked about that when I saw the surgeon the next day, not that I was complaining, and he said they decided I didn't need one.

I had elected to stay overnight beforehand, because it turned out to be a bad day to arrange for someone to be with me overnight after the general anesthetic. So after a hour or so on recovery, I was wheeled to the ward. The nurses had obviously been told I would be in pain and needing painkillers, and they kept coming in and offering, but I had no pain whatsoever, so I declined. By this time it was midnight, and I was as alert and wide awake as ever, and would be totally unable to sleep so I didn't even bother to try. Don't know if that was the after-effect of the general anesthetic, but I walked around and talked with my brother on the phone for an hour at about 1am - he was driving home from a late event and was also pleased to talk with someone at that time. The nurses wanted me to pee into bottles so they could monitor how much and if excessive blood. First time, flow rate was very slow and there was blood staining in the first few CC's, but flow rate improved over successive pees, and the blood was too little to see in the bottles. I had been put on Tamsulosin 3 days before the op, to continue for 2 weeks afterwards, to help urinary flow and make sure any clots were flushed out, but I never saw any clots in the urine. I was actually quite pleased I elected to stay in overnight, as they were monitoring me every 2 hours, and I did eventually get some sleep.

The big plaster was sticky around the edge and was covering the perineum and arse, and the sticky had also caught the scrotum which was a bit uncomfortable. However, it quickly fell off the scrotum and perineum, but remained firmly stuck on the arse cheeks. It had some dried blood in it, but there was no bleeding after I came around from the op - that was all from beforehand. I had taken a hand mirror in with me, and checked around perineum and arse, and there was no sign of any injury or marks or scabs or swelling left by the biopsy needles whatsoever. Just a little red bruising. I had trimmed the hair on perineum and scrotum as short as possible with a beard trimmer beforehand, but I didn't trim my arse cheeks, and this plaster was stuck very firmly to the hairs on my arse! It took a long time to gradually ease it off, and left me with a slightly rectangular patterned waxed arse cheeks. It also left a lot of sticky behind on my arse cheeks which meant they stuck to my underpants.

At 10am next morning, I was checked out, and went home by bus. It was slightly uncomfortable sitting on the bus seat, particularly when the bus was stationary and the idling engine had the whole bus vibrating, so I tended to tilt slightly onto one arse cheek or the other, to keep the perineum off the seat.

It was 2 days before I could do a number 2. I thought I was constipated but I wasn't - it was probably due to not eating for a day and I think my bowels well emptied themselves before the op in anticipation, so there was simply nothing to feed through. I thought it would be painful, but it wasn't at all. Wiping afterwards was though!

I tried and erection 2 days afterwards, and it was fine and not in any way painful or uncomfortable, and not reduced in length. The consultant had said no need to wait at all, but I figured I'd had loads of needles pushed though the erectile base of the penis in the perineum - I'll not try pressurising it immediately afterwards. There was very little semen (possibly due to the Tamsulosin which causes retrograde ejaculation) and no blood first time, although there was blood on subsequent times, but much less than for my previous trans rectal biospy. I only ever saw blood in the first few cc's when peeing, and that only lasted for 3 days.

In the next days, the bruising came through much more and the perineum, anus, and scrotum went dark brown. At least the dark brown indicated old blood, not new bleeding - it was just moving around inside. It wasn't painful, but it did itch a lot in the scrotum which was noticeably bigger, and I don't think it was just due to trimmed hairs. That took a couple of weeks to go away.

4 days afterwards I was back on my exercise bike, and 8 days afterwards on the road bike (could have been sooner but weather was bad).

Anyway, based on my experience, I would have no fears if it had to be done again (unlikely in my case, as it found cancer in 12 out of 33 cores).

User
Posted 19 Feb 2019 at 12:42
My TRUS biopsy came up all clear, but symptoms and PSA persisted so I was sent for a template biopsy. I was offered a spinal anaesthetic, which also came with a recommendation so I thought I'd try that. Not had one before, so it made a change. It took a while to get the levels sorted, then battle commenced. Interesting times, watching the team at work while I'm lying on my back with my legs in stirrups and medicos poking around in my nether regions.

All went well, and I was wheeled off to the recovery room. It sort of went wrong at that point. I was given water (and the toast!) which I drank a lot of. My thinking was get everything moving again so I can go home. It turns out that with the spinal injection, all muscles stop working. Who'd have thought?! This meant that no matter how many times I took myself to the toilet for a wee, nothing happened. Unfortunately, the pressure and ensuing pain were really quite extreme as nearly a litre of water built up and I couldn't get rid of it.

I was facing catheterisation, when I gave it one more go. Finally, the anaesthetic was wearing off and I could produce the pain relieving duties. All cleared from there over the next hour. Top tip - if you decide on the spinal rather than general anaesthetic, don't drink lots immediately after! Would have been handy if the medics had told me that...

Anyway, results were prostate riddled with stage 4 and 5 cancer. And the TRUS found nothing.

User
Posted 19 Feb 2019 at 13:39

Hi Steve,

Second trans was due to a PSA of 28.6 in Jan. Had my first in Feb 2018 after a steadily rising PSA and 'suspicious areas' on MRI, which found nothing. MRI this time was clear but we thought that such a raised PSA probably warranted a second trans. Although you've been discharged from the hospital, to be on the safe side if I was you I'd go and get my PSA checked in 6 months. That's what I did and after wrangling with my GP over who was responsible (GP or hospital) I had a PSA of 20.8 in September. The odd thing is I also have recurrent very mild UTI's and I've been on Tamsulosin for about 18 months to try to help. Thinking at the moment is those infections may be causing the PSA rise.

On the other hand, I've also been told that PSA tests are notoriously unreliable but other than biopsies and MRI, they are the only thing as an indicator. Some GP's are reluctant to test PSA as it can lead to over-investigaton. It can be a bit of a Pandora's box.

I'll hopefully hear back soon and get a diagnosis, be that cancer or BPH, I just want to get on with a treatment plan.

Andy

User
Posted 19 Feb 2019 at 13:59

Hi Andy,

Yes, consultant did discharge me but gave me another blood test form and said 'get checked in 6 months and come and chat with me again'

I think fair to say I'm going to keep a close eye on those levels until they drop. I notice that they tested again as part of the hospital bloods while I was in having the TP and they are still around the 4.16 mark.

Saying that, of course our poor prostate gets jabbed all over the place with a needle so I imagine that in itself would cause PSA to be a little high.

Hope you get an answer to your problems. As you say, PSA can be unreliable, but it's the only un-invasive check we have.

Cheers,

Steve.

User
Posted 19 Feb 2019 at 15:27

Originally Posted by: Online Community Member

The big plaster was sticky around the edge and was covering the perineum and arse, and the sticky had also caught the scrotum which was a bit uncomfortable. However, it quickly fell off the scrotum and perineum, but remained firmly stuck on the arse cheeks. It had some dried blood in it, but there was no bleeding after I came around from the op - that was all from beforehand. I had taken a hand mirror in with me, and checked around perineum and arse, and there was no sign of any injury or marks or scabs or swelling left by the biopsy needles whatsoever. Just a little red bruising. I had trimmed the hair on perineum and scrotum as short as possible with a beard trimmer beforehand, but I didn't trim my arse cheeks, and this plaster was stuck very firmly to the hairs on my arse! It took a long time to gradually ease it off, and left me with a slightly rectangular patterned waxed arse cheeks. It also left a lot of sticky behind on my arse cheeks which meant they stuck to my underpants.

I was advised that the best way to get the plaster off was to sit in a hot bath for 20 minutes, and that worked nicely. It just peeled off with no discomfort and no residue.

Chris

 

 
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