Hello,
My Urologist normally does transrectal but he has done a few transperineal (TP). I told him I may want to go to a University center where they do hundreds of TP biopsies. He replied that any Urologist can do a TP, "it's not rocket science".
Be interested to hear if any Urologists on the forum agree. Thanks.
Numbing the right nerves takes some experience, but if you are totally out, it shouldn't make a difference.
I believe current best practice is to just do transperenial.
What are you doing so many of them? Seems to me you should be avoiding them unless you have good reason... at least after your first one.
I had a biopsy in 2017 prior to FLA. My latest MRI shows a PIRADS 3 lesion for the first time post-FLA. I'd like to biopsy it. However, the Radiologist at MSK says he sees the same lesion on my 2017 MRI and it hasn't changed, so that makes it seem less urgent.
Cutting and bleeding around a tumor is sometimes a necessity.
It isn't for you now.
From here on out I think you should rely on scans and of course PSA testing.
When I visited MSK last week Dr. Ehdaie lectured me about the need to get biopsies every year. He said the results of his focal MRI-guided ultrasound trial showed a high recurrence rate. I think he said 30%. He doesn't put a high level of trust in MRIs.
In the past 3 weeks, I've consulted with 3 different experts and received 3 different opinions and recommendations regarding my need to get a biopsy.
1. Biopsies are the traditional gold standard for cutting flesh in an operating room. They will continue to be so until most of the current docs retire or die off.
2. About a few years ago the research finally showed that scans are as good as biopsies.
3. Mixing blood and tumors as what happens in a biopsy is always dangerous. You don't want to do it unless necessary.
4. The peritoneal biopsies are because of increased infection risks because of bacterial adaptation to antibiotics (mostly from farming practices).
5. Do the biopsies make life simpler and easier for the doc. Sure. Are they worth the risk to you? Probably not.
6. You aren't asking your doc enough "why" questions.
If you do, you will find you don't need all these biopsies. Scans and PSA are all you need. Even with neuroendocrine prostate cancer.
7. Get more second opinions. Remember the Docs look after their interests before yours. If you aren't looking after your own interests, no one is.
"He doesn't put a high level of trust in MRIs."
"Why" What do the most current peer reviewed studies show. What is the most current data. What are the comparative numbers for false positives and false negatives?
Do you have a written consent form explaining the risks of these biopsies? Can I see it?
Or is it you want biopsies for your research needs?
Be careful and research how many TPs your Urologist has previously performed. My husband travelled 300 miles to have a private TP (was not available upon NHS at the time), and unfortunately suffered rectal bleeding post-procedure AND septicaemia twice! It was only later that we discovered he had never performed a TP previously.
So, to answer your query (and the assertion of your Urologist) - NO, Urologists have to undergo specific training before they may possibly be capable of performing TP competently.
Definitely have PSAs and MRI scan first though, before any biopsy. Good luck and best wishes.
I have a Hip implant so was very concerned about infection...it took some time to find a qualified center that was doing transperineal and this was only 6 months ago...finally had Dr. James Eastham do it at Sloan Kettering NY (he has done 100's of TP)...no problems whatsoever
ncbi.nlm.nih.gov/pmc/articl...
Main Points
Transperineal prostate biopsy achieves comparable cancer detection rates with transrectal prostate biopsy in biopsy-naive patients but is superior in cases of prior transrectal biopsies and active surveillance.
Transperineal biopsy offers a superior access to the anterior and apical prostate regions.
Infectious complications are nullified with the transperineal method.
Transperineal biopsy can also be performed with local anesthesia, is feasible in an outpatient setting, has a moderate learning curve and a good reproducibility.
Multiparametric MRI augments the function of transperineal prostate biopsy and focal therapy can be easily applied transperineally.
While any urologist should be able to do a TP biopsy, since they are surgeons after all, if it was me, I would want someone who has done quite a few of them
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