First Biopsy Experience

[janebob99]

I'd like to share my first biopsy experience. This was a transrectal approach and he took 14 cores: 4 cores from a known 1.3 cm long tumor in the peripherial zone that he could clearly see on ultrasound (which matched the location on MRI). He did it "cognitively" because he could easily see the tumor (he did have an UroNav MRI/US fusion machine on standby that he could have used, but he didn't need to). He said he's done "thousands" of biopsies, so I felt comfortable with his technique. For prophalyxis, he gave me two 500 mg Cipro pills to take the morning of, and the evening after. I asked for a second antibiotic to improve my chances of not getting an infection and he gave me a shot of Rocefin (ceftrioxone), which is a powerful antibiotic that e-coli is sensitive to (along with Cipro). Stay away from using fluoroquinolone antibiotics, because e-coli is very resistant to that class of antibiotics! The most painful part of the procedure was the digital rectal exam (DRE) that he did before, because the prostate tumor was quite painful to palpate. Next, he numbed me up with high doses of lidocaine, which worked very well. The individual needle pokes felt like how a rubber band snap on your wrist feels. A quick sting. I wore ear plugs so that I couldn't hear the "click" sound of the needle gun. One of the pokes felt worse than the other, and he stopped and injected more lidocaine, which I greatly appreciated. I had a sore prostate that evening and took some Tylenol. No pain the next morning. He warned me that there will be blood in my ejaculate for a week or two. Hope this is helpful.

[pd63]

The sooner transrectal are consigned to history the better, I've had 2 tp biopsies, are transrectal still in the majority.The projected path for antibiotic resistant infection is a bit scary !

[janebob99 in reply to pd63]

I agree. That's why I asked for, and got, the Rochepin, which e-coli is still sensitive to.

[pd63 in reply to janebob99]

Don't know Rochepin, good there were no problems.

[janebob99]

Rocephin is the correct spelling (my bad...). Its chemical name is Ceftrioxone. It's given as an IM injection, one time. Wasn't painful.

[Tall_Allen]

"Stay away from using fluoroquinolone antibiotics, because e-coli is very resistant to that class of antibiotics!" yet "For prophylaxis, he gave me two 500 mg Cipro pills..." Cipro is a fluoroquinolone, so it makes no sense that he gave you Cipro. The Rocephin he gave you will eventually cause multi-drug resistant bacteria. This is why many are no longer doing transrectal. But it is hard to find urologists who are experienced at transperineal.

It took 4 weeks for my semen to be bloodless.

[janebob99]

Thanks Tall_Allen. You are absolutely correct. My wife, who's a RN, tells me that Cipro works fine if I don't have resistant e-coli. I was planning on getting a rectal swab culture first, but when the doctor said I could get a biopsy on Friday, I jumped at the opportunity. I had made a list of 33 antibiotics that tend to be e-coli resistant and Cipro was on that list, but I forgot to mention it at the consult. If/when I need a biopsy in the future, I will definitely get the culture & sensitivity test before hand (I will have time to do that). I understand that any antibiotic can create drug resistant bacteria, it's an ongoing problem. There are about 12 antibiotics that e-coli will generally be sensitive to, Rocephin is one. Keflex is another common one; same family of antibiotics. I don't have a history of frequent antibiotic use, so the odds are in my favor that the Cipro and Rocephin will work for me. Hopefully, a single dose of Rocephin won't cause resistance.

You are right, it's hard to find transperineal Bx in New Mexico.

[treedown]

I was given Cipro as well. I asked how long I needed to wait until I could get back on my bike. He said a few days, and I was back riding in 3. Never had any problems that I was aware of.

[janebob99 in reply to treedown]

Thanks. I had some soreness that evening, but by the next morning I was pain free. No blood in stool or urine. I expect to see some blood in ejaculate.

[Mike58]

Australia no longer does Transrectal biopsy's, they all do Transperenial. So much safer and far less painful. Mind you they do generally put you under when they do it.

[MarkS]

I had a TP biopsy a few months ago. This was on the NHS in the UK and most biopsies are TP now. I have to say it was easier than I expected. I would put the pain at 3 briefly when injections or the biopsy samples were being taken and was easy to handle - more discomfort than anything. About 25 samples were taken. I felt little discomfort afterwards and stopped the paracetamol after a day. As it was TP I did not need any antibiotics which was great.

Then I had to wait 5 weeks for the results (Gleason 9) which was not great.

[janebob99 in reply to MarkS]

Thank you for your experience. Sorry about your Gleason 9. That's what I'm expecting, based on the size of my tumor on MRI (PIRADS 5).

[Nordman]

My recent biopsy experience.

In Scotland they are generally still performing trans rectal biopsies, so I was down for that. However, I had done my research on the negatives of this method and discovered one consultant at my regional hospital was doing the TP biopsy method one day a week. I requested the TPB and was allocated to his list. The fact that I had been hospitalised in the past with urinary sepsis added weight to my request.

I received instructions that I should arrive for the procedure with a full bladder, for what I assumed was a flow test prior to the TPB. I duly complied. When I arrived in plenty of time it all seemed a bit uncoordinated. A nurse arrived to escort me to the theatre. When I mentioned the full bladder (and it was full) she said "you shouldn't have done that"! I produced my instruction letter, and she said well we are not doing that today! I was now on the clock to get to the theatre, but I desperately needed to empty my bladder. Of course try and do that in time with a really full bladder. I subsequently went to the theatre with an incompletely emptied bladder. When I came out of the toilet they then decided to take my BP. It was high, and no wonder!

I anticipated I would be offered Cipro and having read all the significant negatives, I declined it. I put the case for no antibiotic but the consoltant said I would have to have an alternative. They could not get the alternative from the pharmacy, so I was given Trimethroprim.

I found the local anaesthetic injections so painful they elicited a nerve response from my body. I had a really strong arrhythmia, which subsequently abated. I had 15 biopsies taken via the 'cognitive' method. The MRI had shown a 1.4cm left sided tumour., with some vague ech on the right.

Again having done my research and noting the significant negatives I had refused Gadolinium for the MRI. Instead I substituted fasting and bowel cleansing myself. I advise everyone to research Gadolinium contrast and most particularly if there are any CKD or renal issues.

Post the TP biopsy it was largely uneventful for the first 4-5 days. However, I then developed gastric issues ie constant burping and upper left quadrant abdominal pain which went around to my spine. I was concerned I had developed a UTI or kidney infection due to the TP biopsy. Urine and blood tests were largely normal. I was then tested for H.pylori. These tests were all requested by me.

The gastric problems and pain increased over the next days. I also began to feel pain along the top of my hip and got more worried! I subsequently developed a rash on my left side and then I deduced what the problem was. I had shingles. This was subsequently confirmed by the doctor.

IMO and reiterated by the doctor the TP biopsy was possibly a nerve shock to my system. In addition I have been waiting 5 weeks for my biopsy results, and they are saying it could be 6-7 weeks, which does add an element of stress. Apparently the consultant who did the biopsy is the only one that can give me the results and he has been busy. in theatre. Apparently these stress factors can trigger shingles, as they can affect your immune system.

So 'the best laid plans' don't always turn out the way you want. Things may have turned out differently if I had simply gone along with the trans rectal biopsy, which are performed by nurse specialists. Then again, I may have experienced different issues!

[janebob99]

Wow, that's a rough experience. Thank you for sharing it with me. My wife had shingles...it's awful. I have a 1.3 cm tumor by MRI, and am hoping to get a PSMS-PET scan next. I thought TPB's were done under general anesthesia or conscious sedation. Sounds like you didn't have either of those.

[cpl901]

same experience, same procedure, exept that i had a small prostate and nearly invisible tumor on mri. Didnt wear earplugs and could count the cores and even feel right or left. Biggest pain was a couple of houres after and the first night but with paracetamol it was ok

[rlafford]

I had my first biopsy transrectally a year ago and this year they changed to transperineal. I have to say that neither was particularly painful - just uncomfortable with a few "pinches" here and there. I felt less pressure with the tp approach.

[janebob99 in reply to rlafford]

Thank you. That's helpful.