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biopsy problem

Posted 26 Jan 2020 at 22:26

I had a negative MPMRI - ie 2 on the scale. However the consultant suggested a biopsy just to make sure there were no significant problems. I have a complex medical condition which can turn a simple infection into life threatening very quickly so I am loathe to have a transrectal biopsy. However the consultant said he could not offer the safer transperineal biopsy. I came across an online report of a large scale consultation of urology and radiology experts who were trying to reach a concensus on the implementation of MPMRI throughout the UK in 2018. In it they agreed that where a patient had a clear MPMRI but a biopsy was advised then that should only be by the transperineal method and not the transrectal as the latter had no better a detection rate than the MRI. Any advice ?

Posted 26 Jan 2020 at 23:51

Ask to be referred to somewhere else that does transperineal biopsies.

Note there are two types:

There is the transperineal version of TRUS, doesn't yet have a universal name but often called LATP (local anesthetic transperineal), which is an outpatient procedure. (This was not available in 2018, except possibly in a couple of trial centres.) It is rapidly replacing TRUS, with many centres no longer doing TRUS at all.

There is a transperineal template biopsy, which is usually done under general anesthetic, and is more thorough with more samples being taken. Sometimes used when the mpMRI doesn't give clear guidance where to sample, and most likely what your 2018 report is referring to.

Posted 27 Jan 2020 at 10:02
In the words of one of Britain’s top prostate cancer oncologists, ‘the trial has shown us that the TRUS biopsy is as bad as we thought it was’.

So avoid that at all costs. Transperineal is the way to go and if your health precludes you from having a general anaesthetic, there are more and more hospitals abandoning TRUS and doing transperineals under local or epidural anaesthetics. Find a hospital that does that. It’s only a day case procedure.

That’s if you can cope with the indignity of your arse in the air, your bollocks taped to your belly, a medicinal dildo stuffed up your bum, and around forty needle punctures, all whilst wide awake! 😂😂😂😂

Best of luck.

Cheers, John.

Posted 27 Jan 2020 at 10:56

I had the transpereneal targeted template biopsy under local - or to be more precise many locals. I need to avoid general anaesthetic as much as possible due to my poor lung capacity and old polio after effects.

i don’t care about the dignity issues as it fine and all medics so who cares. The main thing is that it is a bit more painful than some give reposts of but tolerable and I had no problems apart from aching for some days after but no pain as such. I lost count at about 8 local injections. Better than general though and went home same day.

 The other issue I often think is when your awake surgeon are maybe less aggressive in their task, but also you need to be calm enough to let them do the best job. 

Edited by member 27 Jan 2020 at 10:57  | Reason: Not specified

Posted 28 Jan 2020 at 19:37

In the circumstances, it seems ridiculous to suggest you have a TRUS biopsy following a clear mpMRI - they may as well stick pins in your eyeballs.

Edited by member 29 Jan 2020 at 00:37  | Reason: Not specified

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