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Second biopsy, Apixaban concerns

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User
Posted 17 Dec 2025 at 22:10

I am 73 and since 2021 have been on active monitoring for grade group 1 (Gleason 3+3) cancer, (lowest as far as I know). This was diagnosed by a transperineal biopsy. Unfortunately, in July this year my PSA score was 9, twice the level in 2021. This prompted an MRI for possible growth/spread. The results took 57 days to come through and the urologist said MRI: “shows changes, which suggest a more significant cancer than your known grade group 1 (Gleason 3+3) cancer.”

As a result, I am having a transperineal biopsy tomorrow (Thursday, December 18). I am apprehensive about this because six days after my first biopsy I had such large blood clots in my bladder I couldn’t pee, which put me in A&E at Coventry University Hospital (UHCW) for five painful days on a huge catheter.

This time around I am going to take things VERY easy after the biopsy and stay alert for signs of excess bleeding. A complicating factor in my case then, and now, is that my cardiologist has me on Apixaban for anticoagulation due to my atrial fibrillation. 

Tomorrow I will have been off the Apixaban for full three days then restart in two, which seems to be the advice, although there are no concrete clinical guidelines for this, which is pretty crazy given how many people are on Apixaban and drugs like it. Nobody seems to know if the blood got into my bladder because I was on blood thinners. They certainly didn’t stop the coagulation of blood that did get into my bladder.

I am definitely going to be discussing this with the biopsy team tomorrow. I will let folks know hat they say, and how I get on. Back in 2021 it took 82 days to get the biopsy results and I so I will also be making sure everyone know I will be calling early and often for my latest results.

Has anyone else had similar experiences?

Stephen

Edited by member 23 Dec 2025 at 08:29  | Reason: Not specified

User
Posted 18 Dec 2025 at 10:52

Stephen, only just seen this. I have not had the same experience but a couple of things came to mind ,make sure you drink plenty, although the thought of going into retention may make you feel like drinking less. You could ask about self catheterisation, just in case. It is quite easy but the urology team may consider it inappropriate or over the top. 

Thanks Chris 

User
Posted 18 Dec 2025 at 18:20
Thanks, Chris, much appreciated.

Biopsy went well. Plenty of delightful staff on hand. Coffee and cake afterwards. Learned way more from the senior nurse practitioner who performed the biopsy than from Mr. J. the urologist. She showed me the changes in my MRI from 2021 to 2025. The urologist didn’t do that even though I had asked. She pointed out how a small dark area on the first MRI was now slightly larger and explained why she was going to do a combination of targeted and template cores. Five targeted cores from the dark area of concern on the prostate, then 23 more based on the six segments of the template. The procedure was ultrasound guided.

Had some good and jovial conversations with the team during the procedure and I’m now attempting to take it easy at home, and as you so rightly suggest, taking a lot of liquids. I told them it took 82 days to get the results of that first biopsy in 2021 and they promised to try and do better this time (to be fair the processing of results is an entirely different group of people then the folks who obtain the cores). Will not restart my Apixaban until all signs of bleeding have ceased. Fingers crossed.

User
Posted 23 Dec 2025 at 16:36
Post biopsy progress update and deep purple balls warning.

First urinations without blood happened on day 4 of the recovery. But a bit of blood came back later in the day and most streams on day 5 began with a dash of red. Nothing to worry about so far.

What was a bit alarming on day 4 was the deep purple coloring all over my scrotum. A quick check with Google and ChatGPT assured me this is benign and not unusual. Fair enough, but I swear nobody warned me about this.

Sure, "there will be some bruising" was said and is in the papers I was sent home with. But I have no recall of words to the effect that "your balls may turn blue" or your scrotum could look a weird for a week or so. To be clear, I'm not vain about my balls, but this form of bruising is pretty alarming if you're not expecting it. I'm a reasonably intelligent bloke but when I caught sight of this for the first time my initial reaction was not "Oh, that's just blood from the biopsy punctures spreading under the skin of my scrotum, nothing to worry about."

Hopefully putting this note here will make it easy for any similarly unwarned experiencer of purple scrotum syndrome to find reassurance.

Stephen

 
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