Partner is going to have prostate biopsy after "suspicious" areas were detected via MRI. Uro wants follow up biopsy. I assume he will use the results of the MRI as a way of targeting the suspicious areas so that the results are a better indicator of the presence of cancer, correct? (as opposed to the older "shot gun" approach which may have missed the target, as it were. As I understand it, there are two approaches: the needle passes through the rectum or through the perineum. What are the pros and cons of the two procedures? And, are we talking about a difference without a distinction?
Many thanks,
EdinBaltimore
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EdinBmore
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"According to single-arm studies, the rate of infection after transrectal biopsies is 5–7% and rate of sepsis is 0·3–9·4%, while after transperineal prostate biopsy, the rate of infection is 0·0–1·1% and rate of sepsis is 0·0–1·5%. "
Two reasons to consider the transrectal procedure: efficiency and modesty.
1. With an MRI fusion transrectal procedure, only your doctor and one assistant needs to be present in the room. Since only a moderate amount of general is required and there is less calibration that needs to be done to aim the equipment, your procedure will last less than half an hour.
2. With an MRI fusion transrectal procedure, you lay in a fetal position with your genitals covered by your legs.
Men react differently when it comes to modesty, to exposure of their bodies to others. Some men take offense to having anyone on a medical team messing with their rectum, whereas other men don't want their genitals on display for all to see. A lot of the decision - I believe - comes down to which procedure is more amenable to the patient.
In contrast, a perineal MRI requires the patient to lay on a table, genitals and rectum completely exposed, his feet placed in stirrups and lifted high in the air, off the table. The patient's body is literally positioned on the exam plate by calibrating exactly where his testicles fall (behind the scenes, this is jokingly known as the "ball drop"). Depending on the practitioner's experience and ability, the local anesthesia that is administered in the area of the perinium can be quite painful (although I have read, this has improved) and the entire procedure requires several parties to be present, not simply your doctor.
My MRI fusion biopsy was performed by the head of Harvard Urology. He gave me a choice and he presented citations of each procedure (knowing I am the inquisitive sort). A closer reading of the literature showed that if you controlled for men who were immuno-compromised and for men who had difficulty clearing/cleaning their colon and rectum before the procedure (much like prepping for a colonoscopy), then infection rates were almost identical to the perineal method.
Modesty is important to me. I knew that being in a room with seven or eight medical professionals working on me or observering would be an alienating and humiliating experience. So I chose the transrectal method. It was over in ten minutes and there was no fuss or mess.
I don't think there's a wrong decision here and I do believe men should factor in potential emotional impact/trauma when weighing any treatment or procedure they might have to endure during their cancer journey.
I had a transrectal biopsy performed by the head of the urology department at the institution I was using. I wasn’t offered any other option. And overall it was surprisingly painless. I expected the local anesthetic to burn but even that was not painful at all. He nerve blocked the pudenal nerve in two places which pretty much anesthetizes the entire prostate so the biopsies themselves were painless. They usually biopsy from both halves of the gland taking many samples to get representative cores from the entire gland even if there is a focal lesion. JetBoy is correct that I was positioned on my side in a hospital gown covered in a blanket in the fetal position with the backside exposed. You do need to prep for it and my doctor put me on a couple doses of prophylactic antibiotics. The ultrasound probe is inserted into the rectum but that wasn’t a big deal. Believe me, I found the colorectal coil they put in for the MRI I had much more unpleasant than anything that happened during the biopsy. My procedure took about half an hour.
There is prostate cancer in my family so I am watched very closely. In my 50's, when my PSA spiked, my Urologist did a transrectal biopsy....using the hit or miss method. The anesthesia was the nurse holding my hand. Though not excruciating, it was painful. My Urologist patted me on the head and sent me home saying I may have some blood in my urine in the coming days. My friend, who had MANY years of prostate tests, biopsises, MRIs etc warned me to masturbate as soon as I could and OFTEN and to prepare myself for the large amount of blood that I would probably see. HE WAS SO RIGHT!!! For the next few days I jerked off daily and red lava-like semen shot out of my penis into the waiting toilet. I was so upset with my Urologist, who prepared me for nothing but, thankfully, has since retired. In the coming years, I have had 2 MRIs because of PSA spikes. The 1st showed nothing....and my PSA magically went down in my next test. The last one I had, at age 64 showed a tight lesion in my prostate gland. I was handed a CD / DVD to bring to my Urologist who offered me 2 ways to have my biopsy done.... I could go to the hospital (a several month wait) and get it done FREE with what will or might be done with the hit-and-miss method OR, for a cost (at the time) of $800 CDN to have it done in my Urologist's office where he would pop the CD into a machine which would allow him to be able to take ALL samples from the lesion and it's immediate surroundings. I chose this method and got precise and informative results. My friend who had told me about the post biopsy blood, never did this method of biopsy. He was never offered it! Perhaps his Urologist was so old school that he had not learned to use this machinery? After having progressively increasing PSA results year after year, he was sent for biopsies (5 total) which always showed NO cancerous cells. It turns out that the cancer was in the extreme outer walls of his gland and the biopsies were always targeting and taken from the central areas. They finally were able to get cancer cell biopsies when the cancer had grown INTO the gland.
So......PLEASE....opt for the directed biopsies after you've had the MRI. Rectally is fine as long as you have some anesthetic. Good luck!!!
(PS...... because they got early MRI / Biopsy results, my Prostate removal seems to have removed the cancer before it had a chance to leave the gland capsule and spread to other parts of my body.)
OMG. Quite the ordeal. You know, there's just got to be a better way! I, too, found that, while the docs may have been good body mechanics, they awful at some basic comfort skills. And, completely oblivious to the differences between straight and gay men. Anyhoo, thank you for responding and sharing your experiences.
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