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Just how painful IS a transperineal biopsy?

User
Posted 19 Jan 2022 at 09:27

Greetings - brand new to the forums so please be gentle with me!

With a rising PSA level I can foresee another MRI followed by a biopsy on the horizon. I've heard conflicting reports about how painful the biopsy is. Some say it's the most painful thing they've ever endured, are still traumatised by it and would never, ever have another - other's say it's no big deal. Surely if it's that painful it should be done under general anaesthetic? Any reassurance would be most welcome! Thanks.

User
Posted 21 Jan 2022 at 07:40

I would think, Microcolei, that is the case. I am sure there is a maximum number of cores that can be taken under a local anesthetic. I had 13 cores taken under my local and 19 under a general 3 months later. There are more risks to the patient if a general anesthetic is given which is why, perhaps, when first assessing whether a patient has prostate cancer most undergo a local anesthetic biopsy.

Interesting to note that my local anesthetic biopsy only found cancer in a very small area on the right hand side of my prostate (even though core samples were taken from both sides) whereas the general anesthetic biopsy found that the cancer was throughout my prostate. I keep meaning to ask the consultant whether that was because the general anesthetic biopsy needles go in deeper.

 

Ivan 

User
Posted 21 Jan 2022 at 15:02
Dave, the local anaesthetic is injected by the same device that does the sampling. I'm sure you would have had one!

Cheers,

Chris

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User
Posted 19 Jan 2022 at 20:00

Well, I have had 2 TP's, one in June 21 which was under a local anesthetic and one in September 21 which was under a general anesthetic. Now everybody is different, but I had no issues with either of mine at all. No pain or side effects- apart from blood in the urine and semen for a few days/a week. It is true to say that I could feel, in the sense of a sensation, the needles going into my prostate when under a local anesthetic but, for me, it was not painful. Being totally asleep when I had the general anesthetic  biopsy meant that I felt absolutely nothing- pain or sensations.

 

It is worth pointing out that the local anesthetic biopsy (13 cores taken) only found cancer in one small area on the right hand side of my prostate whereas the general anesthetic biopsy (19 cores taken) found it all over my prostate.

That is when I decided to undergo treatment.

 

Ivan

User
Posted 19 Jan 2022 at 20:18

My biopsy under local aesthetic was not painful nor any major issues afterwards.
Granted I have only ever had one, diagnosis and treatment followed.

(Laid back and thought of England !!)

P.

Edited by member 19 Jan 2022 at 20:19  | Reason: Not specified

User
Posted 19 Jan 2022 at 21:07

When I had mine, it was under local anaesthetic. It was uncomfortable rather than painful - the 'tool' makes a sound like a stapler, which can be a bit off-putting at first. I was given 2 different types of penicillin to take for 3 days, and was not allowed to leave the hospital until I had proved that I could pee - about 30 minutes after the procedure. When I did manage to pee, the blood and clots in the urine were a bit disconcerting! But really, it's not that big a deal - unpleasant, rather than painful.
Hermit.

User
Posted 19 Jan 2022 at 22:22

I had a TPB way back in 2016 under a general anaesthetic and another last year, again under a general anaesthetic, and had no pain afterwards with either. Like others a little blood in my urine for a few days.

User
Posted 19 Jan 2022 at 22:40

My multi-core template biopsy was under general anaesthetic and thus painless.

Can you have any part in deciding about the type of biopsy and the level of anaesthesia?

I had an alarming amount of blood in my urine for some time afterwards, about which I hadn't been warned but it settled down eventually and was a "normal" side effect.

Jules

 

User
Posted 19 Jan 2022 at 23:00

My biopsy was uncomfortable rather than painful, and far from the worse thing I've ever undergone.

I wasn't offered any anaesthetic.

I had 13 cores taken, 8 one side then 5 the other. i've since wondered if they stopped at that point because I was whinging, but suspect rather more likely was that it was because they'd biopsied all the areas indicated as suspect by the MRI.

I had one episode afterwards of blood in the urine, but it was a slight discolouration not bright red urine.

For me the procedure was far less of a problem than my imagination had built it up to be beforehand.

User
Posted 20 Jan 2022 at 00:16
I have had 2 TP biopsies. The first under General Anaesthesia, the second last year under Deep Sedation. Both were painless and after the DS one I was almost immediately eating a sandwich and drinking a cup of tea. There was slight discomfort afterwards where needles had taken cores which ended after a week. The first one was more tender, probably because many more needles were used. After the second one, I was driven 200+ miles from the hospital to my home without problem. The day after the procedure there was a little more discomfort, probably because of bruising coming out.
Barry
User
Posted 20 Jan 2022 at 09:15

Thanks everyone, I appreciate the replies.

DaveHz - NO anaesthetic?! That sounds barbaric! (shocked face)

Yes, I imagine the thought of needles 'down there' is maybe worse than the procedure itself.

Seems to be a mix of local and general being used. Would still prefer a general!

Let's see what happens after the next blood test.

Stay strong folks.

 

User
Posted 20 Jan 2022 at 09:15

MY Tp Biopsy was under a General A. 18 cores. No pain but quite a lot of discomfort whilst sitting for the next 3 months or so. I mentioned this to the surgeon prior to the RP operation where I was told I would be 50% nerve sparing. After the Op the surgeon informed me that I was very lucky as there was considerable "stickiness" around one side the Prostate caused by the Biopsy. Luckily for me this was on the side of planned nerve removal. If not the OP would have been total nerve removal.

Regarding colouration of semen. The longer you leave ejaculation after Biopsy the more the semen will go from red wine to Iron Filings ( 6 weeks in my case). Best of luck.

User
Posted 20 Jan 2022 at 09:29
I aborted my TP biopsy under local as it was too painful. Urologist doing it told me only 1 in 20 men could not tolerate the biopsy under local so that made me feel special. I rebooked under general and didnt feel a thing. I recommend a general !
User
Posted 20 Jan 2022 at 11:46

Out off 10 found it a 7 it hurts but over in no time mine was under local and found to be Gleason 9 but after radiotherapy and hormone therapy 1 year later PSA 0.01 from a starting point off 24.9 before treatment feeling really well  and back full time at work  gaz 👍

User
Posted 20 Jan 2022 at 12:38
Uncomfortable, but certainly not painful. They use the same local anaesthetic that dentists use to numb your mouth when you have a filling.

Cheers,

Chris

User
Posted 20 Jan 2022 at 18:12
I had a mine under local, just a wince when the the first injection goes in, then just lie back and take it. The worst part for me was up until that day I had only seen male consultants. Walked into the room for the biopsy and immediatly wondered why there were three women there. Drop your trousers and underwear and make youself comfortable on the chair she said. Feet up in stirrups and away she went. It's not painful but you leave your dignity outside the door when you walk in.
User
Posted 20 Jan 2022 at 19:59


Hi Brentmeister,

I had my Biopsy at the end of a very busy day, including a DRE, an MRI, the Biopsy and the issuing of Bicalutamide tablets as well as meetings with various consultants, doctors and nurses.

I do remember being given antibiotics for the biopsy, but I'm wondering now if someone slipped me a local anaesthetic somewhere along the way, but if so I genuinely don't remember it.

After reviewing everyone else posting having had local or general, and only me claiming no anaesthetic I'm starting to feel like an unreliable witness.

Edited by member 20 Jan 2022 at 20:30  | Reason: Not specified

User
Posted 20 Jan 2022 at 21:20

Appreciate all the responses, they have settled my mind a little should I need one.

DaveHz, yes, perhaps there was a local anaesthetic in there somewhere! 

(if only one could insist on a general though!)

 

 

User
Posted 20 Jan 2022 at 23:34

I'm wondering if the higher core rate TP's use a general anaesthetic where the lower core rate samples might use a local.

If so, you would be better off with a higher core rate both because it will give a better sampling and possibly guarantee you a general anaesthetic.

Hard to know how these things work. It would be cheaper to not have to give a general anaesthetic though perhaps because of pain, it might not be possible to take a high core rate sampling with a local anaesthetic.

Any thoughts people?

Jules

Edited by member 21 Jan 2022 at 08:22  | Reason: Not specified

User
Posted 21 Jan 2022 at 07:40

I would think, Microcolei, that is the case. I am sure there is a maximum number of cores that can be taken under a local anesthetic. I had 13 cores taken under my local and 19 under a general 3 months later. There are more risks to the patient if a general anesthetic is given which is why, perhaps, when first assessing whether a patient has prostate cancer most undergo a local anesthetic biopsy.

Interesting to note that my local anesthetic biopsy only found cancer in a very small area on the right hand side of my prostate (even though core samples were taken from both sides) whereas the general anesthetic biopsy found that the cancer was throughout my prostate. I keep meaning to ask the consultant whether that was because the general anesthetic biopsy needles go in deeper.

 

Ivan 

User
Posted 21 Jan 2022 at 11:29

I had 20 cores taken under local anaesthetic. Half way through I did feel an uncomfortable scraping sensation when one core was taken but another shot of the local fixed it for the remainder. I did not pass any blood afterwards, but peeing wasn't fun for a while. Drove home after 30 minutes rest but sat in a soft chair for rest of the day. All that said, I would go for local again. 

User
Posted 21 Jan 2022 at 15:02
Dave, the local anaesthetic is injected by the same device that does the sampling. I'm sure you would have had one!

Cheers,

Chris

User
Posted 22 Jan 2022 at 18:19
I was under a general anaesthetic, so I felt nothing. 42 samples taken.

I woke up on the recovery ward, all OK. My first two micturitions were like pissing razor blades, but no problems after that.

I discharged myself around 2pm that day, and had no further problems thereafter.

I did have a massive multi-coloured bruise on my perineum subsequently, and the inevitable blood clots in my urine and strawberry semen for a few weeks after.

So to answer your original question, the scale of my pain / discomfort after the surgery would be 3/10.

Best of luck.

Cheers, John.

User
Posted 14 Feb 2022 at 18:00

I had biopsy under local had 32 samples taken. As others have said discomfort rather than pain. By the time of the biopsy I'd lost all worries about modesty which was just as well 😏. As with all my appointments I found staff both kind & very professional.

Edited by member 14 Feb 2022 at 18:01  | Reason: Not specified

User
Posted 24 Feb 2022 at 17:06

It’s worth reading the conversations on here  about blood in the semen that occurs after biopsy, to prepare yourself. My doctor and nurses underplayed this bit. Totally normal and harmless but a bit of a shock if you’re not expecting it!

 
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