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What causes some men to have pain when they have a biopsy?

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Posted 2/11/2009 3:16 AM (GMT 0)

 

  There have been many posts concerning men who have biopsies that are painful and many men who state that their biopsy was just uncomfortable.  Please read what a well known urologist had to say on the subject.  Wiggyann

 

Question

 

  What is the reason some men have pain when they have a prostate biopsy done and for others it is just uncomfortable? Would state of the art equipment make the difference? 

 
 
Answer  

  There is no significant "state of the art" equipment that makes the biopsy easier; at the basic level, there is still a needle.  Use of a local anesthetic into the prostate can be helpful.  It's unclear why some men have significant pain and others don't.
 
  Stephen W. Leslie, MD FACS  (urologist)

Posted 2/11/2009 3:24 AM (GMT 0)
It sounds like it would be an obvious answer, unless I am missing something. It is not natural for most men to have something long and hard inserted up their anus. I had 3 biopsies, and it never got better on that part. THen you are trying hard not to want to expel the foreign object. Then you know that the dr is going to start moving the probe around, positioning it while watching the screen. Then of course, you know what is coming next, the needles. I did 2 without pain med, and 1 with. The one with hurt the most to me, as the needles to put in the pain med hurt worse than the biopsy needles. Then the noise, the noise of each needle hit made me more unglued than any real or imagined pain. I think the entire procedure, both on your mind and up your bum, would make any man hurt, feel uncomfortable at best, and perhaps humiliated at the same time.

David in SC
Posted 2/11/2009 3:37 AM (GMT 0)
Hi Wiggy,
This does seem obvious that a doctor tries to limit the number of cores taken to keep a patient comfortable otherwise all doctors would do 16 core biopsies. But the price for doing so is increased false negatives. This is my own theory, but personal conversations with doctors I have befriended have told me of patients running down the hall butt naked and screaming after the first core was taken. This was not the case for me and not for most either, but I just know too many guys who had a bad experience with the biopsy to know it is why they try to limit the cores taken. If a person is squimish about a biopsy then ask, can it be done more thoroughly under general anesthesia, and no doubt the answer is yes. Luckily there are alternative technologies and one that we have been talking about here is PCA3 gene detection combined with T2-erg and imaging. A little more comfortable peeing in a cup and no needles. This is not generally accepted here in the states yet, but it will be soon. And while it can detect cancer and it aggressiveness, it remains unclear if it will lead to less needle biopsies. We can hope.

But as for me, I am passed that point anyway...

Nice post...

Tony
Posted 2/11/2009 8:08 AM (GMT 0)
Dave and Tony,

You are right, it was an obvious answer.

This explains it in more detail,

Richard Ashley, M.D., Mayo Clinic urology resident and lead study investigator said researchers discovered that taking tissue samples in certain locations tested in a prostate biopsy were more likely to cause pain. Specifically, biopsy of the part of the prostate closest to the urethra, the prostate apex, was more painful than biopsy of the part closest to the bladder, the prostate base.

"We found we cannot predict who will have higher levels of pain at the time of a prostate biopsy simply based on the patient's history and features," says Dr. Ashley. "We discovered the location of biopsy was the most predictive of higher pain scores -- not age, body mass index, family history or presence of cancer.

Wiggyann
Posted 2/11/2009 9:02 AM (GMT 0)

Multi Choice:

Biopsies pretty much redefine: "Bend over and take it like a man!" yeah

Biopsies pretty much redefine: "Pain in the butt!"

I think after the local pain med wore off was much worse then the procdure itself. I remember going to bed paranoid as heck that I wouldn't get any sleep. Ended up sleeping ok and woke up relived that most of the pain was gone.

Posted 2/11/2009 1:44 PM (GMT 0)
wiggyann,

your second post rang more of a bell with me. For starters, a doctor doesn't know your particular threshold for pain. Every human being is different there. On the biopsies needles, the standard pain level per man might range from a 1 to a 10, and yes, fear can intensify one's position on the pain scale. Second point, and I remember this from my 3 biopsies. Some cores taken didn't hurt a bit, just the every annoying snapping noise, and others, would make me grab the hand rail against the wall and go white with pain, so it had to have something about where they were hitting. There is only so much they can tell or predict while moving and positioning the probe while looking on a small screen. Third and final, there are simply drs out there with bad bedside manners and rough hands. A previous surgeon of mine, not PC related, also happened to be the county coreneor here, and I swear when he handled me, it was the same degree of roughness as he would a corpse or body from a crime scene. He would actually hurt me during an exam. Glad he's retired now. lol.

David
Posted 2/11/2009 1:49 PM (GMT 0)
Gosh Steve...a bit up early are we... All I can say is, I am thankful I only had to have one biopsy...because if it had came back negative, I doubt I would have gone through another one again. I was given the medication and there were two cores taken that felt like I had a spike shot up the end of the penis to all the way inside me. It was terrible and that pain lasted until well after the surgery. So I am one of the ones that hope that they can detect this disease without having to go through that procedure sometime soon in the future.
Posted 2/11/2009 2:53 PM (GMT 0)
It is actually not such an easy answer. Like surgery some of it is the skill of the urologist. My urologist told me that he had recently been to a seminar on performing the biopsy and learned that there is a certain method that will decrease pain in a certain area. I don't remember all the details but I'm glad he did.
Posted 2/11/2009 3:15 PM (GMT 0)
Well, in my case, I went in neutral on the subject of pain, not knowing if I would have it or not. The probe itself and the manuevering wasn't a problem, once he fought against the initial resistance to insertion, no pain or any real discomfort when repositioining. The 16 sample biospy began fine, numbing shot to deaden the pain, wait 5 minutes then begin. During the 5 minutes he did some survey untrasound work, and determine my gland was 'huge'. 110gms at removal, maybe that is why my experience was so painful. The first few wasn't an issue, but at around 7 it began to be noticable, at 12 it was really intense and painful. I began sweating and became dizzy and nauseaous, each after that was worse and at 16 I was on the verge of throwing up and passing out all at the same time. I was very dizzy and had to lie there for about 10 minutes. My blood pressure shot straight up, but went back down during the cooldown period. I normally am immune to the white coat syndrome, and accept medical procedures well, with no preconceived worry about it, but this one was a doozy of a difference. I went home and started aching bad and feeling really awful , after a couple hours I took a long nap and woke up all better and over the procedure, except for the normal blood in urine and semen. I know most men have much better experiences with it, and I am hesitant usually to discuss my episode so as to not make the worry any more for those who are getting ready for one, but since everyone was sharing their scars... wink
Posted 2/11/2009 3:41 PM (GMT 0)
Well, James. I think all stories and variations are useful here. Even then unpleasant ones. Of course the positive stories are more soothing, but the negative ones at least tell that things don't always go as expected, and might make for additional questions to ask your doctor before a particular procedure or test.

David
Posted 2/11/2009 4:32 PM (GMT 0)

Hi All:

My 16 core biopsy was easy and no big deal...my doc uses IV sedation so I took a little nap and it was over.  He tells me he does this for two reasons:  (a) patient comfort and (b) so he can take his time and get the 16 samples the right way without squirming patients.

I woke up, popped a Vicodin before going to sleep that night, and the next day all was well except a small amount of discomfort.  I had the usual blood in urine for a day and in ejaculate for weeks, but no pain.

So, I compare my experience to some bad ones and advise anyone considering the biopsy to get the sedation...

Tudpock

Posted 2/11/2009 5:10 PM (GMT 0)

Hi:

Not all doctors use adequate pain medication with biopsies.  My first one did not and I ended up walking out on him.

My second doctor which performed the biopsy did.  On a pain scale of 1-10, I would rate the pain at most a 3.  It was mostly discomfort from having an object shoved up my butt.

So make sure first of all that adequate pain medications are available.

Posted 2/11/2009 10:01 PM (GMT 0)
I had 3 biopsies over 3 years, 8, 12, and then 16 cores, all performed by the same doctor.

The first two biopsies were slightly uncomfortable whenever a core was taken, but nothing to complain about. The pain was a 1 or 2 out of 10. I conversed with the doctor through the whole procedure and got up, got dressed, and caught a train to work immediately after both biopsies.

The last biopsy was completely different. The first core was easily a 7 on the pain scale and every core afterwards kept getting worse, quickly hitting 10. I was in shock by the 4th or 5th sample. I was too out of it to move for an hour afterwards (from shock, not medication) and finally was able to get pull it together enough to be wheeled to the car. I went home, took vicodin and slept for 2 days afterwards. I was extremely uncomfortable for several days afterwards.

I can't explain the difference in pain and neither can my doctors, but I do know that my prostate had doubled its size since the previous biopsy.

Meanwhile, a close friend just informed me that he was the opposite. His first biopsy was horrendously painful, but his second and third were very easy.

It seems that there is no rhyme or reason to how the prostate will react.

Shawn
Posted 2/12/2009 5:20 AM (GMT 0)
I'll chime in on this wonderful conversation too. My first prostate biopsy I had really no idea what it was about or what was going on. I went in there and though the urologist did give me 2 shots of novacaine, or some other "caine" it hurt like bloody hell. Because it came back "suspicous for cancer but not diagnostic" I had to repeat the experience 3 months later. The second time I had my wife drive me to urologist's office and I took one of my sleeping pills, ativan, about an hour before this biopsy. BIG DIFFERENCE. Very little pain this time. Sort of tiwilight sleep. And since the second biopsy was postive for cancer and I had robotic prostatecomy on 09/11/08 at least I'll never have to have another prostate biopsy again! :-)
Posted 2/12/2009 1:32 PM (GMT 0)

Simple answer - having a doctor who doesn't administer anesthesia is what produces pain.  I've had four biopsies and was injected with a mild anesthesia which permitted the procedure and allowed me to regain consciousness quickly with no after effects. 

Chuck

Posted 2/12/2009 2:46 PM (GMT 0)
I've had 13 biopsies over the last 10 years so hear's a few tips:
Take a vicodine before the biopsy, It won't promote bleeding. A vicodine about 2 hour later also helps with the pain. I've had biopsies with and without lycodyne shots. A 16 core without lycodine was really bad. I had a couple of 12 cores with lycodine no problem. The 25 core with lycodine and vicodine still hurt like hell. What confuses me is some docs make you fast for at least 12 hours and take an enema before hand. The last 6 core targeted biopsy by a dr who has done over 14,000 biopsies didn't require either fasting or an enema and used no lydocane. It was the best biopsy I had. Go figure.
JohnT
Posted 2/12/2009 5:21 PM (GMT 0)
Oh my, John,
You have almost had a prostatectomy one needle at a time. 13 biopsies? I think after about 5 I woulda said just take it out.

Yikes...

Tony
Posted 2/12/2009 6:27 PM (GMT 0)
For the record, I’ll contribute my experience. If I remember correctly, I did a sort of mini-fast the day before, took an antibiotic the evening before, and did an enema that morning. The lycodyne shot stung a bit. However, the 12 samples weren’t that bad. I’d give them a 1 or 2, well maybe a 2+, on a scale of 10 pain-wise. Of course I was glad when it was over, but I’ve had worse experiences in the dentist’s chair. Sounds like I was pretty lucky.

I went back to work for the afternoon and left for a five day trip to hunt pheasant in Kansas the next day. I was surprised I was given only one antibiotic, but there were no problems. The problems occurred when I had a message waiting for me to call the Doc upon my return!

Best to all
Posted 2/12/2009 6:54 PM (GMT 0)
Again - I've had four biopsies, each 12-15 sticks. No pain or discomfort. Anesthesia was administered by an anesthesiologist on each occasions. I have a very humane and caring urologist. I am a Marine but no fan of pain. We get enough of it anyway. Avoid it when you can.

Chuck
Posted 2/12/2009 7:20 PM (GMT 0)

Paralleli said...
For the record, I’ll contribute my experience. If I remember correctly, I did a sort of mini-fast the day before, took an antibiotic the evening before, and did an enema that morning. The lycodyne shot stung a bit. However, the 12 samples weren’t that bad. I’d give them a 1 or 2, well maybe a 2+, on a scale of 10 pain-wise. Of course I was glad when it was over, but I’ve had worse experiences in the dentist’s chair. Sounds like I was pretty lucky.

I went back to work for the afternoon and left for a five day trip to hunt pheasant in Kansas the next day. I was surprised I was given only one antibiotic, but there were no problems. The problems occurred when I had a message waiting for me to call the Doc upon my return!

Best to all


No you weren't lucky I'd guess that's the experience most guys have with a standard biopsy. After mine I played golf the next day with no problems. I have to have another one, I hope the final for a long time in April. While I'm, not looking forward to it, I'm not fearful. I too have had root canals much worse than that.
Posted 2/13/2009 5:15 AM (GMT 0)
Have to disagree with you, realziggy, I think Paralleli was lucky. I've said here before that my biopsy experience was like dental work done on your butt. Much more painful than dental work for me, though the biopsy had the advantage of being over with sooner. To come full circle with this picture, after the biopsy (and subsequent surgery), I learned that I'd clenched my teeth so hard from the pain that I cracked a molar.

And, you don't get that phone call after dental work.

DJ
Posted 2/13/2009 5:32 AM (GMT 0)

DJBearGuy said...
Have to disagree with you, realziggy, I think Paralleli was lucky. I've said here before that my biopsy experience was like dental work done on your butt. Much more painful than dental work for me, though the biopsy had the advantage of being over with sooner. To come full circle with this picture, after the biopsy (and subsequent surgery), I learned that I'd clenched my teeth so hard from the pain that I cracked a molar.

And, you don't get that phone call after dental work.

DJ


And I'll disagree with you by saying my and Paralleli's biospy experience is much more common than yours. I can't see needlessly alarming guys who haven't had one yet to expect the horror show you had. I'm not doubting your word just stating my experience is much more the norm. I go by that conclusion by reading of others biopsies here since Nov 2007. Which is my real original date arriving here, some could attest to. I had that phone call too and later a saturation biopsy of 45 needles where yes you are required to be sedated for but that's due more to the mapping part of it requiring you to be still. That said I'm to have another normal biopsy in April and I'll be looking forward to it to end for sure while lying there. But I'll also expect to be able to play golf the following day if I want to.
Posted 2/13/2009 2:37 PM (GMT 0)
realziggy:

I don't think DJ's post was "needlessly alarming" anyone.  The truth is that, before any biopsy, a person just does not know how painful it will be.  The pain (or lack thereof) depends on a number of factors, e.g. number of samples taken, skill of the doc, pain threshhold of the patient, etc. 

My bottom line is similar to Chuck's (MarineMustangPA)...I advise those getting biopsies to get anesthesia...that takes the worry, uncertainty and pain out of the equation.

Tudpock

Posted 2/13/2009 6:09 PM (GMT 0)
Got that right! Tadpock! Anesthesia removes any doubt and pain. But for those that don't mind it more power to them. And my advice to anyone who hasn't yet had a biopsy of the prostate is to get anesthesia and you'll do just fine.

Chuck
Posted 2/21/2009 5:14 AM (GMT 0)
Sleepytime... Hi Shawn

I was just reading about your biopsy and I wondered if the nurse stayed with you when you were in shock and could not move for about an hour after the biposy and if she was the one who wheeled you out to your car later. Also, did the urologist talk to you about your experience afterwards or did he offer to stop when he noticed you were in such agony during the biopsy. What a horrible experience
for you.

Wiggyann
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