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Prostate Cancer Network
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Prostate biopsy with local or general anaesthetic?

Hi, this is my first post. I will soon have a prostate biopsy and can elect to have a local or general anaesthetic. Since I am paying privately myself, I would prefer a local anaesthetic but have heard some horrendous accounts of the pain and discomfort it can involve.

Can anyone advise me based on their experiences? Is a general anaesthetic really necessary? Also can one have sedation instead of general anaesthetic for this procedure?

Thanks in advance.

yup

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Why accept the 3% risk of death from general anesthesia. Any capable and experienced urologist should be able to locally anesthetize the area for a painless biopsy. Mine certainly was. My surgeon liked to count 1-2-3 before triggering the biopsy device. After the first one I asked him not to do the countdown because I was reflexively tightening my anal muscles in anticipation. No use in tightening anal muscles when there is a probe already in there! I never felt anything beyound the brief, 10 second burn of the anesthetic. The rectal wall does not have pain fibres. Of course if the patient clinches the anal muscles insertion will hurt. A good surgeon will wait until the patient relaxes the muscle; a crude impatient one will not.

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I've had 2 biopsies, no anesthesia either time. It's uncomfortable but certainly doable. In fact, I had a conversation with the urologist during the 8 minute procedure to release some nervous energy.

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Pain with a biopsy is different for everyone, I had some really bad pain with mine. If you are relatively young and healthy go for general anaesthetic.

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I've had 2 biopsies by same doctor, assistant, room, etc. On a scale of 100 my first was barely tolerable 90+, the 2nd was easily tolerated, say 50. It is a short procedure, just minutes. My cost, each, including pathology, was $3,000+ with HMO Kaiser Permanente, Seattle. Spendy but ABSOLUTELY necessary.

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I had some pain, not intolerable. YMMV--I think some urologists are better than others with local anesthesia (as usual--I'm a dentist--patience counts, and don't spare the sauce). General is more to manage anxiety than pain. If you're relatively healthy, general (or sedation) is pretty safe, and 3% mortality (!) is very pessimistic. But competence counts, and I don't know that general is always available. If you feel you need it, go for it.

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Level of pain will depend on the uro’s experience and the individual patient. That being said, my urologist, who is a friend of mine suggested anesthesia. Propofol is what is used. The same anesthesia used during a colonoscopy. 10 minutes under and then reversed. I had no pain at all and left facility 20 minutes or so afterwards. You will need someone to drive you home.

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No anesthesia and it was fine although not fun. I was 42.

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I had my biopsy last August. All 12 samples were positive.

The procedure was okay. Worst part was the injection of the local anesthetic. It felt like a bee sting but after it numbed the prostate, I didn’t feel any of the 12 samples taken.

I didn’t need it but you can ask for a prescription for Xanax to take an hour before the procedure.

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Obviously this is opinion but my in clinic biopsy missed and was given the all clear no cancer. Couple years later my biopsy in the hospital showed Gleason 8 4-4 tumor out of the prostate. I’d say the first guy missed. I remember his nurse saying the pieces were small. I now understand that 30% of the time they miss but the second Dr wouldn’t do it in his clinic said he always got a better test. He was right. My vote hospital and Anesthesia.

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Thanks for all your help so far, guys. My pain threshold is about normal as is my anxiety level so Xanax is not needed and the vote so far seems to favour a local anaesthetic, particularly as the cost of general is significant where I am located.

Would like further comments if possible, though.

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There as been a medical research on pain reduction in transrectal biopsy by taking Dilodil 2 hours before. I showed it to my doctor and he prescribed me 1 pill. It helped a lot - maybe the placebo effect but the procedure went on smootly. I had 2 biopsy in 6 months interval. Each time with Dilodil.

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I had local and it was fine. I took a basic dose of adavan (lorazapam) which took the edge off my being nervous. None of it was fun, but I would say it was a tiny bit less painful than getting a shot or an IV. And it was fast. And since I was awake I was able to have a meaningful conversation with the doctor.

I had an MRI guided biopsy...which if you did have an MRI, is really the only way to go. General random biopsies run the risk of missing something. So my doctor had the image from my MRI and was able to explain what the MRI might be indicating, so I found this a beneficial source of information.

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I had the TRUS biopsy and found it more annoying that painful with local anesthesia. It felt to me as though my prostate was getting stapled. I was not offered general anesthesia but would not have taken it given the risk.

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Kurt65 hit the nail on the head when he described it as bring stapled. If you've ever used a t-50 stapler, the sound and sensation are almost identical. By the way, the biopsy is the doctor playing darts on your prostate. Could hit, could miss, could brush something, or miss altogether. Really pretty primitive but provides some good information as to the condition of your prostate. I had no anesthesia and each shot hurt like hell. Each shot takes a thread like core to be examined. So take the tranquilizer and at the least the local. It only last for a few minutes and it is just the shot that hurts,me then it's over. You can do anything for a few minutes! Also, brace yourself for the blood in semen. That's a trip. Good luck to you!

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Consider a 3T MRI by a competent (in doing prostate imaging) radiologist to see if you need a biopsy at all.

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Done it - a 2T and 3T and psma pet/ct over last 3 years with 2 diff radiologists and urologists - all voluntary and paid by me - apparently no spread and no cancer but likely chronic prostatitis and adenosis. Sounds good except MRI misses 10-15% of cancers and my PSA has been rising fast and linearly for a long time now so I want a biopsy to clear up any doubt. I dont really want to discuss my general condition at this stage on thus firum, though, with all due respect, until I get some facts from a biopsy. I dont want conflicting hypotheses, just peoples experiences and I have started with biopsy.

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Understand.

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Local.

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I've had more biopsies than I can even remember till they finally found a few cells and I'm currently on active surveillance for as long as possible--but this isn't about that personal choice. The point is that I've had every kind of biopsy, from simple in the office to a saturation under general. if you are confident in your urologist doing the procedure in the office then that's my preference. The initial needle for the local smarts but the rest is truly just like staples, and a xanax beforehand to calm down doesn't hurt. I've had pain afterwards when I got home and I was instructed to take Tylenol...and it worked. The worst part (other than the news) is bloody semen for 5-6 weeks. Good luck.

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Seriously you are being offered a general anesthesia for a prostate biopsy? I would say "LOL" but that is inappropriate here. The risks of general anesthesia are far greater than those of a local, and the slight discomfort from a biopsy, at least if it's being done by an experienced urologist. Since you are paying, I would assume the cost for general anesthesia would by many times the cost of a local. You have the anesthetist (doctor) to pay and other charges as well. Go for the local. I did, and had just the feeling of a pinprick when the local was administered.

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I am not being exactly 'offered' a general, but can elect for one if I want as I pay for myself. I am debating as to whether I want to pay extra for a general or not based on other people's experiences, many of whom have no choice and sometimes would have preferred a general, as on this forum. Hope that's clear.

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I've just never heard of someone being put under general anesthesia with all its risks for something a relatively benign as a prostate biopsy! It's not open heart here! Not to be flippant, but I see no reason for you to "go under" for this procedure.

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I had local for the first basic biopsy and while uncomfortable, was not painful except the initial sting of the local ana needle. 2nd biopsy was MRI fusion and they didn't give me the choice of local. They switched from local to "general" (a little more propofol than colonoscopy, really) for the fusion biopsies because they felt their patients handled it better since it's more involved. I preferred the propofol, but could handle the local if needed.

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I hardly felt any pain. It was rather more a discomfort...

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We're all different. Mine was fine. I did take half a Lorazapam to relax me and it worked. You might get the sensation of a staple gun going off when they take the samples, but if you are told to expect it then no problem. That was my experience anyway.

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I might be wrong, but when I had my biopsy, I had no anesthetic at all.

I went in after a couple of self-administered painkillers (and perhaps a puff or 2)

It was uncomfortable and unpleasant, but not nearly as bad as I expected.

I was a bit sore, but I got thru it OK. I sat on a comfort cushion in the car on the way home and let the wife drive.

In the following days, I felt fine and had no further issues or complications.

I might suggest a 'local' if that is what they are offering.

A general is way over the top, in my humble opinion.

I wish you well and hopefully, just a bit of discomfort - you should be fine afterwards.

Take a deep breath between 'rounds' - you're probably looking at a dozen pokes.

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No anathesia or local here... nine plugs, felt like pin pricks, no big deal... SV’s were a little more sensitive, but overall about 2-3/10 on a discomfort scale.

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To me, it was pretty much like someone snapping a rubber band against your skin with each core taken. So 12 'snaps' in my case. Over within 10 minutes, I had a local, I was fine.

Look at all the numbers regarding side effects etc.

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I read through most of the responses but only one person mentioned what would be the key for me- he said he had 12 needles. The number of samples would definitely be the determining factor for me. There are some biopsies that are similar to battleship if you remember that game- these biopsies can be over 20 samples- that would definitely be

general anesthesia for me. My only biopsy was in 2001 -6 samples- but she didn't tell me it would be 6- she said "you'll feel a little sting"- a little sting means ONE to me- but she kept giving me stings- there was no anesthesia used so the anxiety for me was not knowing how many more there were going to be. Today most people seem to have 8-16 samples so- if you can handle small pieces of your skin being plicked off that many times go with

local- you won't need a driver that way.

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