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 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 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

User

Posted 26 May 2022 at 22:20

I am 64 have an enlarged prostrate and have a very shy bladder and just have a transperineal biopsy. I am a anxious person so worried for the 4 weeks. However on the day the staff where great, I had a local and that was more uncomfortable than painful, after that I felt nothing at all, I had 5 cores taken( had a MRI before ) and it was all over in 10 mins. I was out of the hospital 30 mins later. I was informed about blood in the urine but when I got home urinated the rest of the day with no blood and a bit sore down below but it was minor. I thought it was all done so I went to work the next day and started to pass blood in the urine. This is day 2 decided to stay at home, sometime there is blood sometimes not (not a lot of blood drinking seems too help). Hoping that will get better over the next few days. Now I wait for the results. Good luck

User

Posted 20 Apr 2023 at 14:03

After the next few weeks the colour should change from "tomato sauce" to "brown sauce" as the blood cells die, and then it'll gradually clear up. It is entirely normal.

All the best,

Chris

User

Posted 20 Apr 2023 at 15:52

Glad it went well open4321. I think it’s certainly better than getting it done up the jacksie! And much less prone to infection too.

I’m Amazed (I shouldn’t be really) at just how good the nurses are..they kept my mind right of it even though I had a visiting party from another Healthboard watching the whole procedure! You kind of get use to these things like dropping your drawers every day for RT!

User

Posted 10 Jul 2023 at 22:40

I had a tp under local 6 months ago - I have delayed posting as I did not want to put people off. But as a retired medic I think it is reasonable that people should have all the facts. I was probably unlucky but I found the procedure extremely uncomfortable and would not be prepared to go through it again. Although it was carried out very professionally by experts. The local anaesthetic was very painful (8/10) although I was warned and prepared for that. They then waited for 5 minutes for the local to work. What I was not prepared for was that I felt all 9 biopsies (a bit like bee stings) on the one side and by the 9th I felt the prostate was on fire (9/10) and I could not have taken much more. Fortunately the second side was not as bad. Then to cap it all the burning increased and I was in severe discomfort for the next 1.5 hrs. Fortunately my wife was able to come in and drive me home as I could not have driven. I told the nurses I was in pain but no analgesia was offered. Once I got home a large dose of ibuprofen soon calmed things down. But it was all very unpleasant especially as I consider myself a reasonably stoical person who hardly ever takes painkillers. - and the results were negative so that's good.

Given that this is going to be a very common procedure and many people will need more than one. I wrote to the surgical team to tell them about my experience as I felt the level of pain was unacceptable in this day and age. I suggested that they should at least offer people IV sedation/ analgesia with something like shot of midazolam and fentanyl immediately before the procedure. The surgeon did reply to me but made no mention of offering anything IV. I can see this is offered by some centres, perhaps more so in the USA. I don't think I could go through that again without more attention to pain relief.

User

Posted 11 Jul 2023 at 01:41

It appears to me that it is the injections and time waited for these to take effect that may account for the widely differing experiences of men. Many will have had a tooth drilled and filled where the dentist waits a short time before drilling, while others let you wait in the waiting room while they work on somebody else and only then resume working on you - the latter with less painful results.

As previously mentioned, i can't say i found my 2 tp biopsies painful at all. However, I had to abort a Colonoscopy for a different problem as it was very painful, whilst others breezed through it.

Barry

User

Posted 30 Jul 2023 at 21:13

MIke had 22 cores taken under local anaesthetic

User

Posted 30 Jul 2023 at 21:38

I had 14 under local which subsequently broke into 21

User

Posted 30 Jul 2023 at 21:40

My husband had 26 samples under local. He said although he winced at every click, it wasn’t painful through most of it, at one point he started to feel more pain and they administered more anaesthetic and he was fine. Post TPB he was a bit uncomfortable but not really any pain and he was pleasantly surprised.

User

Posted 31 Jul 2023 at 04:33

I had 12 under local and 3 months later 24.

My 1st experience was rather teasing and uncomfortable. So I decided to keep myself busy (talking to the nurse standing next to me) 2nd time round. It did work. I virtually felt nothing during biopsy.

User

Posted 22 Jan 2024 at 18:43

Had a transperineal biopsy on the 18 January under local anaesthetic.

It was done by a nurse in training overseen by a doctor. The original plan was to take 12 samples but this changed to 24 when I arrived for the procedure. My positive outlook suggested that this was to give the nurse additional practice. :) She had a few ‘misfires’ meaning more than 24 ‘shots’.

Next to no pain during the procedure except for a couple of times I felt a very small sting from the needle.

A little bit of blood when I went to the toilet at the hospital and zero since. No pain whatsoever. Not got as far as finding out how much blood is in my semen.

I hope the above helps someone about to go through this.

Edited by member 22 Jan 2024 at 18:45 | Reason: Not specified

User

Posted 24 Jan 2025 at 14:38

I had a transperineal targeted biopsy with 24 cores taken under a local aesthetic.

The biopsies were very tolerable, as others have said it's like a flicking elastic band at worse.

The ultrasound probe in the back passage was uncomfortable but very tolerable.

The initial local aesthetic was the worse bit of the whole procedure, the deeper injections did hurt but its very quick.
I just grittted my teeth, one of the nurse held my hand for that bit and comforted me.

After effects have been minimal, initial first pee a small amount of blood and weakish flow, but no other blood in the urine after that.
Normal flow returned after 12hrs.

My urologist said he can see on the ultrasound if the prostate is badly inflamed after the procedure, if it would cause a restriction of the urethra to restrict peeing, but said its very rare to ever see this.

Mild post procedure soreness in the area where the needles went in, and similar in the back passage from the probe.
I didn't take any painkillers afterwards, these symptoms rapidly declined over a few days.

Its the unknown with these procedures, but I would say to anyone please don't worry the nursing team and consultant will put you at ease.

Edited by member 24 Jan 2025 at 15:38 | Reason: Not specified

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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 !!)

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

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

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