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Template biopsy option

User
Posted 02 Mar 2025 at 17:36

Hi, my husband was diagnosed just before Christmas. He is 71 and his PSA is 8, and his Gleason score is 3/3. The diagnosis was following an MRI which showed A small area of concern. He is currently on active surveillance, and has also been offered a template biopsy , which would need to be done under general anesthetic. Is this a good way forward? At the moment he is leaning towards this, but is slightly nervous of the general anesthetic. We live in Nottingham and he is confident that with or without the additional biopsy he will be followed up regularly. Would be grateful for your thoughts. 

User
Posted 02 Mar 2025 at 18:22

Hi, 


I had a transrectal biopsy and found it perfectly OK to go through. I understand that some men can't take the feeling of the probe but for me it was much better than the transperineal version and especially not having to undergo a general anaesthetic.  


Biopsy is the good standard way to assess prostate health so I would advise your husband to definitely have a biopsy and if transrectal is available for him to opt for that. 


Hope that helps.


Mick 

User
Posted 02 Mar 2025 at 21:06

Hi


Can I just ask why the biopsy needs to be done under general anaesthetic? My husband had a transperineal biopsy under local anaesthetic without any significant issues. All done in a morning and we went to London and back on the train. There are many men on this forum who have had biopsies under local anaesthetic which really makes it quite a swift procedure.

User
Posted 02 Mar 2025 at 21:08

I've had two transperineal template biopsies, the first under a general, the second 18 months later under a local.  My personal view is that a general is preferable as the second one hurt!  Under a general you know nothing about it of course.  The process was simple enough and went smoothly.  I went in early morning and went home in the afternoon.  I had some soreness between the legs after but nothing too bad.  Also found peeing painful for a while after because you have to have a catheter in the urethra during the biopsy itself.  My advice to anyone going through that would be to drink plenty of water.  The more you pee the quicker the pain goes.

User
Posted 02 Mar 2025 at 21:10

Originally Posted by: Online Community Member


Hi


Can I just ask why the biopsy needs to be done under general anaesthetic? My husband had a transperineal biopsy under local anaesthetic without any significant issues. All done in a morning and we went to London and back on the train. There are many men on this forum who have had biopsies under local anaesthetic which really makes it quite a swift procedure.



Just depends on the Trust's policy.  My first in Jan 2018 was at King's College Hosp, Camberwell and was done under a general.  My second in November 2019 was at Queen Elizabeth Hospital, Woolwich and was done under a local. Both were transperineal template.


EDIT: Just to add that of course having it done under a local is much quicker.  With a general you have to factor in the recovery time at the hospital.

Edited by member 02 Mar 2025 at 21:13  | Reason: Not specified

User
Posted 03 Mar 2025 at 06:44

Oh I see. My husband had targeted and template biopsy. I think it was 24 samples under local but that was done privately in London. He said it was really not too bad. He felt  little pain at some point and they just topped up local anaesthetic. Some men say it is a painful procedure and others say not so I suppose it depends on the individual. A targeted biopsy would allow for much more of the prostate to be sampled but in my husband’s case three small tumours were still missed. He does have a large prostate so perhaps that made missing things more likely.

User
Posted 03 Mar 2025 at 08:29

I had a template biopsy on 2 occasions, I can tell I did not feel a thing when I came round. The thing only was blood on my pee and semen. I also thought template biopsy was more accurate and would target the area of concern. 

Edited by member 03 Mar 2025 at 08:30  | Reason: Not specified

User
Posted 03 Mar 2025 at 10:56

I'm not medically qualified. There are risks with GA, but if he is reasonably fit they may not be very high. Also bare in mind a template biopsy is not deep surgery so they will probably use the minimal amount of GA to get the job done and for a minimal amount of time. 


His diagnosis at the moment is very favourable. The template biopsy will give them a more complete picture of his prostate, just in case something more serious is hiding.


If I were in his situation and assuming no other medical conditions that would increase the risk. I would have the biopsy.

Dave

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User
Posted 02 Mar 2025 at 18:22

Hi, 


I had a transrectal biopsy and found it perfectly OK to go through. I understand that some men can't take the feeling of the probe but for me it was much better than the transperineal version and especially not having to undergo a general anaesthetic.  


Biopsy is the good standard way to assess prostate health so I would advise your husband to definitely have a biopsy and if transrectal is available for him to opt for that. 


Hope that helps.


Mick 

User
Posted 02 Mar 2025 at 21:06

Hi


Can I just ask why the biopsy needs to be done under general anaesthetic? My husband had a transperineal biopsy under local anaesthetic without any significant issues. All done in a morning and we went to London and back on the train. There are many men on this forum who have had biopsies under local anaesthetic which really makes it quite a swift procedure.

User
Posted 02 Mar 2025 at 21:08

I've had two transperineal template biopsies, the first under a general, the second 18 months later under a local.  My personal view is that a general is preferable as the second one hurt!  Under a general you know nothing about it of course.  The process was simple enough and went smoothly.  I went in early morning and went home in the afternoon.  I had some soreness between the legs after but nothing too bad.  Also found peeing painful for a while after because you have to have a catheter in the urethra during the biopsy itself.  My advice to anyone going through that would be to drink plenty of water.  The more you pee the quicker the pain goes.

User
Posted 02 Mar 2025 at 21:10

Originally Posted by: Online Community Member


Hi


Can I just ask why the biopsy needs to be done under general anaesthetic? My husband had a transperineal biopsy under local anaesthetic without any significant issues. All done in a morning and we went to London and back on the train. There are many men on this forum who have had biopsies under local anaesthetic which really makes it quite a swift procedure.



Just depends on the Trust's policy.  My first in Jan 2018 was at King's College Hosp, Camberwell and was done under a general.  My second in November 2019 was at Queen Elizabeth Hospital, Woolwich and was done under a local. Both were transperineal template.


EDIT: Just to add that of course having it done under a local is much quicker.  With a general you have to factor in the recovery time at the hospital.

Edited by member 02 Mar 2025 at 21:13  | Reason: Not specified

User
Posted 02 Mar 2025 at 22:43

He has already had a transperineal biopsy, on the area of concern, hence the Gleason 3/3 and active surveillance. This is an optional template biopsy, again transperineal, but over the whole of the prostate and taking a lot more samples. This is why , at Nottingham , they do this under general anesthetic. There isn’t the option for a local anesthetic for this biopsy. He has just had the pre op,and we are now waiting for a date. 
thanks 

User
Posted 03 Mar 2025 at 06:44

Oh I see. My husband had targeted and template biopsy. I think it was 24 samples under local but that was done privately in London. He said it was really not too bad. He felt  little pain at some point and they just topped up local anaesthetic. Some men say it is a painful procedure and others say not so I suppose it depends on the individual. A targeted biopsy would allow for much more of the prostate to be sampled but in my husband’s case three small tumours were still missed. He does have a large prostate so perhaps that made missing things more likely.

User
Posted 03 Mar 2025 at 08:29

I had a template biopsy on 2 occasions, I can tell I did not feel a thing when I came round. The thing only was blood on my pee and semen. I also thought template biopsy was more accurate and would target the area of concern. 

Edited by member 03 Mar 2025 at 08:30  | Reason: Not specified

User
Posted 03 Mar 2025 at 10:56

I'm not medically qualified. There are risks with GA, but if he is reasonably fit they may not be very high. Also bare in mind a template biopsy is not deep surgery so they will probably use the minimal amount of GA to get the job done and for a minimal amount of time. 


His diagnosis at the moment is very favourable. The template biopsy will give them a more complete picture of his prostate, just in case something more serious is hiding.


If I were in his situation and assuming no other medical conditions that would increase the risk. I would have the biopsy.

Dave

User
Posted 03 Mar 2025 at 19:47
As regards a GA for Transpeineal Biopsy, before doing this it is usual for the patient to undergo various preop tests to ensure he is up to it. I remember I had to provide a urine sample they could grow as a culture, rather than do a dip test to ensure there was no infection. The anaesthetist was not immediaately happy with ECG and I had to have another and wear a device connected to points on my chest for 48 hours and because my blood oxygen levels were deememed too low, I had to do this test again having taken some big breaths. Eventually all was considered OK. My case is probably somewhat rare but it shows how much care is taken when a GA is given. In any case a Template Biopsy is not a long or major operation.

The worst part is the catheter which has to be worn for a week or so.after the OP I found that I needed to ease myself down when sitting and leaning back. You don't want to get your weight forward so you crush the part the needles have gone through!

A pretreatment PSA of 8 is not very high for a man of your husband's age and some consultants don't even consider 3+3 to be Cancer. however, by carefully targeting the suspicious area, any higher grade Gleason that is there should be found.

I was about your husband's age when first diagnosed but thanks to treatment am still here at 88 and am in remission. So both of you don't let this disease get you down!
Barry
User
Posted 03 Mar 2025 at 20:09

Thanks Barry. That’s really helpful. 

 
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