There is a third type - image guided transrectal - which seems to be replacing transperineal in some hospitals because it doesn't require theatre time.
The old style trans-rectal biopsy is becoming less popular because it is, in effect, like sticking a pin into a fruit cake and hoping to spear a cherry - not very scientific. The newer trans-rectal biopsy uses the images from mpMRI scan to pinpoint where the suspicious areas are and then take samples (cores) from those areas, so it is much more reliable. Transperineal can sample the back of the prostate, where transrectal cannot reach. Both transperineal and image guided transrectal have their benefits and negatives. Blood in the urine and ejaculate is as likely with either, but not all men experience it. In terms of pain / discomfort, it depends whether the transperineal biopsy is under general or local anaesthetic - hospitals vary on which they offer.
Many men describe transrectal as similar to going to the dentist - the injection is the worst part - or that the core sampling feels similar to being pinged with an elastic band. On the other hand, a smaller group of men describe the biopsy as horrific. I suspect that the level of anxiety a man is experiencing coupled with his personal feelings about anything being put up his backside can sometimes affect how awful he remembers the biopsy to have been later. My husband had a transrectal biopsy on his way to work; he hadn't asked any questions beforehand, was quite ignorant of what would happen so he didn't anticipate any problems and, as it happens, didn't have any problems apart from them finding cancer.
Edited by member 19 May 2022 at 20:21
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"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Local anaesthetic transperineil is the way most NHS trusts are going. Less risk of infection than transrectal. Does not require theatre time. I doubt you will be offered a choice.
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Interesting point you make about theatre time, Lyn. My TP was done in a side room in outpatients dept. I suppose one benefit of that was I had no anxiety associated with entering an operating theatre.
User
I had a TRUS biopsy and it was absolutely horrendous for the reasons that follow. It seems, after being on this site a good few years that most as above report simply uncomfortable.
When my Uro advised I have a biopsy preceded by an MRI scan I explained immediately that I had had piles for many years and more recently anal fissures. I had also had surgery for the piles which had failed but left me tight so to speak. He had just witnessed my reaction to his DRE five minutes earlier. However his response was "well most men tolerate it" I was as green as grass as the saying goes and had no idea that there might be other options. The appointment was made and GP advised see a colorectal consultant about the piles and fissure first. He prescribed some creams and a colonoscopy. Fortunately the creams cleared the fissure up just in time for the TRUS.
My anxiety level in the 6 weeks or so leading up to the event was through the roof. On the day, I took strong tranquillisers from GP which had no effect what so ever.
Well my turn came and getting the probe in took considerable effort and both the radiologist and I nearly gave in. I remember him telling the nurses that he suspected a prolapse of some sort, just before he succeeded. It was nothing short of agony.
Due to the issues mentioned above the probe simply didn't really fit but was eventually forced in. The actual click of each sample was nothing compared to the pain of this foreign object being inserted where it really didn't belong and staying there far longer than I was happy about. After the event I was a quivering mess.
Before I left the nurse told me and my waiting Wife that if I ever i needed another in the future that she promised "it would be done some other way, no one should go through that". To late it turned out to be positive anyway and I had RARP.
I wish I'd knowen then what I know now from this site that there were options.
Sorry if this scares anyone but I'd hate for someone else to choose a TRUS if they have similar problems as I had now that the options are more accessible.
Good luck with both the procedure and the result
Cheers
Bill
User
I have had the 3 types. TRUS as described like being flicked with rubber band and hearing click each time core taken. I drove to it and home almost immediately after. My first Transperineal was under GA and I walked around London shortly afterwards but stayed in a hotel as you are told not to drive for 24 hours after GA. The second Transperineal was done under deep sedation so I was a little drowsy. There was no significant pain and shortly after I was driven some 200 miles home. The next day with the Transperineal rmore samples were taken which resulted in a little more bruising the next day or two.
There is a higher risk of infection with TRUS as cores are extracted through the Rectum with risk of carrying fecal material into the Prostate with the needles. For this reason alone I would favour the Transperineal one and indeed I read that my treating hospital had not used TRUS for years.
There was only the slightest tinge of blood in my urine from all three and nothing after two or three days, although some may find this goes on for a week or two, partly depending on number of cores taken and how easily they heal.
Barry |
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However his response was "well most men tolerate it"
That is a shocking attitude.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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Thank you all for your immediate replies. I have now discovered that my hospital only does Transperineal so that is a relief. It's not clear yet whether this is under local or general (hoping for latter)! I'm very new to this and I'm sure that I will have more questions later. Thanks again.
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Good luck with your biopsy, hope all goes well.
Have they already diagnosed you with prostate cancer? I don’t know for sure but my understanding is that after an MRI they give you a PIrads score of 1-5, with 5 being very likely you have cancer but referral for biopsy to confirm. My husband wasn’t diagnosed until after the biopsy was performed and then he got his staging and Gleason score.
Best wishes
Elaine
User
Thanks Elaine. The consultant said that they found 'abnormal cells' following the MRI. I asked if that meant cancer and he said yes.
I didn't have a score of any description but he was in a hurry! He said we could watch and wait or have the biopsy to confirm. After discussions with the wife we decided that we would rather know for sure rather than just wondering!
Waiting for the biopsy date now but it's useful to know what to ask for regarding staging and Gleason score. When it's your first encounter with PC you feel a bit naïve so receiving posts like yours is really helpful.
User
An MRI cannot diagnose cancer; all it can do is flag up areas that look suspiciously like cancer. The only way to know whether or not it's cancer is to look at cells under a microscope. So you actually haven't been diagnosed with cancer! If the biopsy finds cancer cells (which it probably will, of course), the final stage of the diagnostic process will be a bone scan to find out whether or not it's spread outside the prostate. Only then will you have your diagnosis and be offered treatment options.
Best wishes,
Chris
User
Yes we all know exactly how you feel at this point, it’s just so daunting not always knowing what to expect. Things do get easier when you know what you’re dealing with though and have a plan in place.
My husband was sent for biopsy after his MRI and then also had a bone scan and CT scan. They confirmed cancer in his bone and lymph node from the other scans. We got a second opinion though and further PSMA pet scan which didn’t agree with original diagnosis and decided whatever was seen on the bone was benign. He had surgery in December, he’s doing great and life is pretty much back to normal. (I never believed that could ever be the case)
His Gleason score was 4+3=7 which just meant most of the samples taken were quite menacing but some were not so bad. After his surgery it was upgraded to 4+5=9 which was of a bit more concern but fingers crossed if all the cancer was taken it shouldn’t be a problem. His tumour staging was T3a but this was then downgraded to T2 post op (it changes because they get to look at the whole prostate at this point)
So many on here who are far more knowledgeable than me and who will be able to help and advise along the way. This forum has helped a great deal.
All the very best and keep us posted x