General Anesthesia for Biopsy - Prostate Cancer N...

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General Anesthesia for Biopsy

Chrisopopolis profile image

I have hesitantly decided to follow my Urologist’s recommendation and get a prostate biopsy (more on my situation in this thread )

…and my doctor has agreed to perform the biopsy transperineally at my request but has said that he recommends general anesthesia for the procedure.

I am reluctant to use general anesthesia due to fears of loss of memory and cognitive function. I recently had my appendix removed under general anesthesia and I would prefer other options this time. I did not have an issue with the local anesthesia used for my first TRUS biopsy, although the injection of the anesthetic was painful.

I have read in this forum about nerve blocks and other options being used and would be interested in any feedback.

Thank you!

22 Replies

I had a periprostatic nerve block and didn't feel a thing. Other nerve blocks may include pudendal nerve block and pelvic plexus nerve block. The urologist has to have experience in finding the right point for the lidocaine. Also, he has to very slowly make his way to that point, injecting along the way.

I chose general anesthesia (propofol) when mine was done last Friday.

No food or water after midnight the night before the procedure and that was not all that easy.

I am glad I avoided the potential for an unpleasant procedure. I will say that I woke up quite cognitive. No drowsy side effects at all.

I've done it twice transperineally under local anesthesia. The painful part as you mentioned was the injection of lidocaine (5-10 seconds) and movement of the extraction needle inside your perineum (1-2 secs each time), not the extraction of samples itself. The doctor complained jokingly why I was pulling away from him constantly. I told him what'd he expect, this thing is painful. Overall, if you want to avoid general anesthesia, it is tolerable and your chances of infection are very low compared to the other kind.

climb4blue wrote --- " I chose general anesthesia (propofol) when mine was done last Friday.... "

I have had Propofol MANY TIMES and for me it is GREAT!!! Going UNDER for my 2 Saturation Transperineal 3D Prostate MAPPING Biopsies was without issues and required due to the longevity for the 3D MAPPING requirements.

I had one biopsy done under general and two others with local; I no longer have a prostate but if I had it to do over again I'd do the general--one of the other times was bad, and one was wretched. I've had a little memory loss with general anesthesia (for other surgeries) but it's always been for things happening soon after I've come out of the anesthesia. So I've learned that if they're going to tell me things (results, instructions, whatever) after coming out of general someone else needs to be there to hear those things and write them down. And of course no one should be asked to make any significant decisions right after coming out of general anesthesia.

I had my biopsy performed under general anaesthetic recently and had no cognitive side effects as all.My understanding is that the precision of the biopsy is important so anything that optimises the chance of accurate mapping of the prostate would seem to be a good thing but clearly everyone has a personal view of a level of discomfort and reactive movement versus the potential side effects of a general anaesthetic - personally I am glad I took the general anaesthetic option.

General anesthesia for a transperineal biopsy seems totally unnecessary to me, as I didn’t find any part of it painful at all.

Psychologically it can be a little creepy for some I suppose. Certainly I wouldn’t be worried about cognitive effects from the anesthesia. Propofol is great stuff, recovery is fast and complete compared to previous drugs.

I've always had a pretty high tolerance for pain, and this biopsy was the worse thing I've been through! Maybe the urologist just sucked, but I wouldn't do it again awake.

London441 profile image
London441 in reply to jkm100

The urologist probably did suck. As with dentists, injecting lidocaine should not be done by those who inept at it. Again, not painful for me but if I had to do it over again maybe I would take general.

This because i do imagine it would be pretty unpleasant in the hands of a lesser doc.

Hello. Here's my experience. I am a 67 year-old man who was diagnosed in 2017. I live in Chicago and lucky to have many excellent healthcare options here.I have had more biopsies than I can count or remember, before the diagnosis and then yearly ever since. It took a saturation biopsy to finally find the cancer cells. I have been doing active surveillance since the diagnosis. Except for the fusion and saturation versions (been there, done that) they were always done in the office with me leaning over the table. It is uncomfortable and yes the injection to start is the most painful part--the rest is just uncomfortable but I avoided all of the ceremony of an anesthetic.

For whatever reason my urologist no longer does the procedure in the hospital. I've done a general for the last two with no issues. It's the same prep and it's done not far from home at a major hospital here. No pain during, some discomfort after that is able to be handled with Tylenol (or stronger drugs that I have stashed away). No memory issues.

Now if someone has a remedy for red sperm for 6 weeks following the procedure, I'm all ears. Other than potential life-changing results (can't forget that), it's the worst part!

climb4blue profile image
climb4blue in reply to JamesHChi

Me too James. I was warned of blood in my ejaculation before the procedure, but what I am actually experiencing is all blood ejaculation. It is quite disturbing to me. Also, I was advised this would only be for the first few times after the prostate biopsy, however, based on my experience so far, this all blood ejaculation may be here for awhile - YIKES!

JamesHChi profile image
JamesHChi in reply to climb4blue

Hi there Mr. Climb. I don't know how long it's been since your procedure but from my (too) many experiences, it usually takes 5-6 to clear the waters. You just need to keep testing and then day poof! It's gone.

climb4blue profile image
climb4blue in reply to JamesHChi

Thank you very much for helping me understand how many times it is going to take get return to the all clear condition.

JamesHChi profile image
JamesHChi in reply to climb4blue

Hi there...You might have misread my email because I definitely wasn't clear. That's 5-6 WEEKS, not ejaculations. I guess it takes that long to heal--at least for me. And unfortunately it didn't matter how many times I climaxed. It's just that much time. Sorry to be the bearer of bad news. LMK if you find a magic solution for a quicker "all clear."

I had a similar and maybe a bit longer experience (2 months?) with blood in ejaculate, but not ALL blood. That sounds more severe than my case.When it comes to biopsies, I can’t help picturing the guy in the Warner Bros cartoon who gets shot with a machine gun and says” Ha… you missed me!”, and then drinks a big glass of water which promptly pours out all of the holes. 🤣

I keep imagining my prostate with a bunch of holes in it. 🥵

Rather than a general, how about twilight anesthesia, also known as heavy sedation? It's what you receive during a colonoscopy. You wake up after the procedure a little groggy but with no lasting side effects. I had my transperineal biopsy with no anesthesia other than a local that did little good and would under no circumstances go that route again. The pain made it impossible for me to lay still, which also brought admonitions from the thoughtless urologist who performed the procedure. Talk to your urologist and, if possible, the anesthesiologist about the best and safest means of pain control. If the urologist says, as mine did, that most men find the procedure uncomfortable but not painful, look elsewhere.

My surgeon did mine with the anesthetic propofol which is not a general anesthetic. I had no side effects and woke up like I had taken a nap. The worst part was getting the IV.

I didn't have any anesthesia or local block for a 9-sample biopsy of prostate and SV. It was uncomfortable, but not painful. You may consider trying one or two samples before deciding if your Uro would work with you.

Husband had Propofol. We went to Costco as soon as he woke up.

Please research the Artemis robotic biopsy…I only had a local and it was a piece of cake. I’ve referred two others and they agreed that it was easy. I only know of my local urologist using it but perhaps there is one in your area.

I have had a trans recital awake and a trans perineal with general (propofol).I rather be asleep anytime. I was offered the option of being awake or asleep. I rather be asleep. The only complaint, I had was my throat hurt as they used a breathing tube for me.

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