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Biopsy under anesthesia

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Prostate Cancer
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Posted 2/3/2023 7:48 AM (GMT 0)
67 yo male in otherwise great health. All biomarkers are fine except for a PSA of 20.

I have had two hip replacements so am familiar with surgery, hospital stays and long, slow recovery and some serious amounts of pain and discomfort. Despite this I could not wrap my head around the biopsy. Call me squeamish.

Am I a coward for not wanting to be awake during this distasteful procedure? Some people say it's no big deal, yet there are some scary stories out there.

I was initially going through the VA, but they did not offer anesthesia. If they did, I would have had it done years ago before the PSA number got so high. Foolish, I know, but that is where I am today.
Posted 2/3/2023 10:09 AM (GMT 0)
Hi Raquetman, I have had three prostate biopsies over a period of about ten years. I was awake for two of them, the last was an MRI guided biopsy that I was under anesthesia for. The ones that I was awake for, while far from the worst thing I've ever been through, were quite uncomfortable to say the least. Most of my friends who have had biopsies were under anesthesia and they did fine. Believe me, you are not cowardly for wanting to be put under for this. They will tell you to get off of all blood thinners before hand. My urologist had me get cleaned out ahead of time as well to avoid infection. If you have a problem or concerns afterward, don't be shy about telling them! It's better to get concerns or problems taken care of while you are there rather than having to turn around and going back. Best of luck to you! My first one ten years ago was an infection. The last one was 2 years ago and they found prostate cancer. PSA was 16 both times.
Posted 2/3/2023 11:59 AM (GMT 0)
Anesthesia is indicated for biopsies involving many cores. Maybe you may have one of them, they are more accurate since many cores are taken and analysed.
Posted 2/3/2023 12:03 PM (GMT 0)
Hello Racquet Man and welcome. With a PSA of 20 you definitely should have a biopsy soon. Prostate cancer is best caught in its' early stages so please don't delay any longer.

Most of the men on this site seem to have had their biopsies done without sedation. Most of the reports cite the procedure as uncomfortable but not particularly painful. Of course there are those who do find it to be painful. My urologist recommended IV anesthesia for the procedure and that's what I did. His philosophy was that he didn't want his patients to suffer any unnecessary pain hence the anesthesia. So for me it was a breeze, other than the unpleasant after effects like bloody ejaculation.

If you want it done with anesthesia then shop for a urologist that will accommodate you. But the important thing at this point is to get it done.

Jim
Posted 2/3/2023 3:26 PM (GMT 0)
When I met with the urology PA after my PSA went to 4.7 and the DRE suggested further investigation, I was offered the biopsy and when I agreed, thinking this would be some time in the future, I was told they’d had a cancellation and 90 minutes later I was on the table. I was not offered anything but the uro said she’d be using some lidocaine. If I had to do it all over again I’d probably tough it out like before but that’s easy to say since I won’t be having it done again.
Posted 2/3/2023 4:01 PM (GMT 0)
I'd agree that it was unpleasant but not horrible. It was less painful than just weird. But if you think you need to be knocked out, there is no reason to be embarrassed to ask for it. You should have no trouble finding a urologist who will accommodate you. Good luck, and let us know what you choose and how it goes.
Posted 2/3/2023 4:23 PM (GMT 0)
My experience is similar to the one described above by fiddlecanoe.
I believe that full anesthesia requires a hospital setting rather than a urologists's clinic. Would be more expensive, I guess.
More importantly though, the way to go these days is transperineal. It's safer!
Posted 2/3/2023 5:01 PM (GMT 0)
I would not agree to a prostate biopsy without some kind of anesthetic. My Uro shot a numbing agent into my prostate. The needle stick stung, but after that everything was good. I can't imagine enduring a dozen "bites" from the biopsy tool without a numb prostate.
Posted 2/3/2023 10:37 PM (GMT 0)
It really doen't amtter what most men do or think. You do what you want. I have no memory of my biopsy. For me (and you) that's the way to go.
Posted 2/3/2023 11:07 PM (GMT 0)
I have had all sorts of procedures with and without being knocked out and lived through all of them. Upper endoscopy without anything was probably the worst. Prostate biopsy was not one of my favorites. If I did it over, transperineal biopsy with anesthesia would by my choice. No need for needless pain and discomfort.
Posted 2/3/2023 11:45 PM (GMT 0)
Thanks everyone for your feedback; especially Mumbo.
Posted 2/4/2023 1:16 AM (GMT 0)
I had nine TRUS biopsies, and for me they were no big deal, but by all means go for anesthesia if you like. IMO, just how much discomfort/pain one experiences depends a mainly on whether or not your uro does a nerve block and, perhaps, how good their technique is for hitting the nerve plexus.

Djin
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