Different Types of Prostate Biopsies

JasonB176
JasonB176 Member Posts: 21 Member
edited February 16 in Prostate Cancer #1

I know of the perineal versus the rectal ones but I'm confused about the length and involvement of the procedure. As I mentioned in the other thread, I'm due to have a transperineal one this coming Monday. I will be on full anesthesia and it could be several days before I'm recovered. I don't know if all require an enema but mine will and I can't eat following midnight. Yet I've read of other prostate biopsies that appear to be much more basic. A friend of mine said he went for about eight of them, drove himself every time, and said the pain was gone in about two hours.

Could it be that mine is more involved because I had the MRI with a PRADS score of 5 that identified some very specific areas that are highly suspicious? Will this be more than just the random 12 sample type?

I certainly want a thorough biopsy and am glad to endure the more complicated terms of it but it's still puzzling to me. Any insight into this would be appreciated. Thank you.

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Comments

  • swl1956
    swl1956 Member Posts: 42 Member

    I had a transrectal MRI fusion biopsy in November at my local hospital. Was anesthetized for it, so no pain. Felt pretty good waking up. Once awake pissed some blood and for a couple of days after. One issue I did have was with the Ciprofloxacin antibiotic I was required to take for a day before and a couple days after. Geez! It messed up my gut. Diarrhea for a couple of weeks. Other than that was a piece of cake. Took my dog for a 3 mile walk the next day. I've learned since that the perineal biopsies are safer. Less likely to cause infections. Some Docs do these transrectals in office while you're wide awake. Just my opinion, but I'd stay clear of that process. I believe the image guided biopsies are more precise. I'm sure it would be less expensive and logistically simpler to have done in urologist's office, but again, considering safety and accuracy seems the outpatient hospital is the way to go. I'm likely going for another one soon at Fox Chase Cancer Center. They do them transperineal. I don't think the heavy duty antibiotics are needed with those.

    I'd stick with your current plan.

  • JasonB176
    JasonB176 Member Posts: 21 Member

    There was no mention of antibiotics for my transperineal one so it seems likely they are safer in that way even if they appear to be more involved requiring anesthesia. If I need these every six months, it might be something that I'll at least want to discuss but I'll cross that bridge later. Thanks for sharing your experience.

  • Rob.Ski
    Rob.Ski Member Posts: 136 Member

    I've had both rectal & transperineal. Was awake for both, not a big deal. Some discomfort when taking the samples. Drove myself home after both.

  • BeardofStars
    BeardofStars Member Posts: 7 Member

    I had the rectal biopsy. No food after midnight, Ciprofloxacin starting 2 days before and continuing for 2 days after. It messed with my gut a bit. Enema a couple of hours before appointment. Drove myself there and back again. The whole procedure took about 5 minutes. A little bit of discomfort when it was done and some blood to clean up, but no other real issues.

  • On_A_Journey
    On_A_Journey Member Posts: 87 Member

    I've had both. Two rectal, one transperineal. I can't remember if antibiotics were required or not.

    Fasting from midnight, and in the case of the rectal ones, a suppository up the clacker on the morning of the procedure. Let me tell you, they're damn effective!

    Asleep for all three, no pain afterwards, got a few days off work each time because I could. No big deal. Post-op, after the recommended abstinence period, the hardest thing to get my head around was the grotesque sight of blood colored ejaculate for the first couple of times.

  • Clevelandguy
    Clevelandguy Member Posts: 941 Member
    edited January 29 #7

    Hi,

    I had a rectal biopsy in the Urologist office with antibiotics a day or two in advance and after. No infections, no general anesthesia, no pain afterwards, just a little pinch when he took the samples. Seamen was discolored for a bit. Pretty easy peasy in my book.

    Dave 3+4

  • JasonB176
    JasonB176 Member Posts: 21 Member

    Well, I had the transperineal biopsy yesterday. Before the procedure I was able to ask my urologist about why this one was under total anesthesia rather than the short type where patients can drive themselves home. He said that his practice has been doing this for the last 18 months. One of the reasons he gave is that even slight movement by the patient can cause an error getting the right sample area.

    I had fairly high pain right afterwards but they gave me one oxycodone that helped and by the time it wore off, I was fine. I have almost no pain this morning.

    We also discussed more about my RADS 5 score and how that could be connected to a wide range of diagnoses.

    It's unclear to me if I'll be getting any results sent to my portal or whether I'll have to wait until my February 16th appointment with my urologist to get the results and learn his recommendation.

    He said that with the transperineal no antibiotics are prescribed.

  • swl1956
    swl1956 Member Posts: 42 Member

    My results were posted on mychart portal two days after biopsy.

  • JasonB176
    JasonB176 Member Posts: 21 Member

    Did the results provide a Gleason score or does that come only later once the urologist looks at it?

  • Old Salt
    Old Salt Member Posts: 1,258 Member

    Yes, the report should include the Gleason score of each suspected locus. We can help with the interpretation, if necessary.

    More in general, if there's any doubt about anything, we recommend getting a second opinion.

  • swl1956
    swl1956 Member Posts: 42 Member

    As Old Salt says, Yes it comes with Gleason scores and other information. Difficult to comprehend at first. I believe second opinions are a must.

  • JasonB176
    JasonB176 Member Posts: 21 Member

    Today is day 2 since the biopsy and the anxiety of waiting for the results is very high. There's a part of me that wishes the results would only go to my urologist and that he'd inform me when I see him on 2/16/24. I wonder if any guys purposely don't look at their portals and just wait. Knowing myself, there's no way that I won't check the results when I get the message that they're there. It will be hard to wait until 2/16 especially if it's bad news. It's good to have the forum here for help in the meantime.

  • BeardofStars
    BeardofStars Member Posts: 7 Member

    Hang in there. Everyone is going to have their own way of dealing with this. But I purposely did not look in the patient portal for the results prior to my appointment. I felt better not knowing, having Schrodingers Prostate, than knowing and not having a plan.

  • JasonB176
    JasonB176 Member Posts: 21 Member

    Today is day 9 and still nothing on the portal for results. I'm wondering if it's possible that in this case my urologist blocked the results from being available on portal first. I'm due to see him on 2/16/24. At this point, I would prefer to just have the results. My MRI results were available the same day. The Gleason scores seem pretty straightforward and at least I'd have a pretty good idea of where I stand. With the PRAD 5 score on the MRI, I'm thinking the best case scenario would be a 3 + 3 and contained but I'm steeling myself for something far worse.

  • swl1956
    swl1956 Member Posts: 42 Member

    I feel for ya Jason! Lots of waiting in this PCa arena. My diagnosis was in November and still no treatment. Likely won't be for another month or two. Having a PRAD 4 and 4+3 Gleason. GG3 Intermediate unfavorable, I've been a nervous wreck. I am however beginning to accept what all the professionals are telling me. "You have plenty of time". I now have another "Mapping Biopsy" scheduled at Fox Chase Feb. 27th. This will indicate whether I'm a good candidate for focal therapy or not, and if so they'll have the precise coordinates on how to apply the treatment. If not, I'll likely go for radiation treatments. Keep us posted on your results when you get them.

    Hang in there!

  • swl1956
    swl1956 Member Posts: 42 Member
  • JasonB176
    JasonB176 Member Posts: 21 Member

    Thanks guys for the encouragement and the helpful youtube video. That video really shows the importance of not panicking and taking time to get the treatment plan right. I think I'll be okay with that part of it. I just need to know my biopsy results so I can start focusing on my particular case. It's never taken 10 days for me to get a result before but it would make sense that it would take longer to fully analyze the samples from my targeted biopsy.

  • JasonB176
    JasonB176 Member Posts: 21 Member

    So I called my urologist's office and asked about not getting the results now after 2 full weeks. I was told that my doctor has not released them. I don't understand why he wouldn't have told me this before the procedure and at least ask if I wanted to see the results before I see him. The nurse will be contacting him and asking that they be released. That lack of communication has had me waiting breathlessly for every email that comes in. I should have been given the choice AND it should have been clearly communicated to me!

  • centralPA
    centralPA Member Posts: 207 Member
    edited February 12 #20

    Yeah, I'd go full "WTF I want to see them on my portal right f***ing now". I get that some people need to hear it from the doc, but some others are ready for the hard truths immediately.

  • JasonB176
    JasonB176 Member Posts: 21 Member

    I finally just got the results. They're pretty bad. I'm thinking I may not even be a candidate for surgery.

    The results:

    A. Prostate, Right Medial Apex:

    ADENOCARCINOMA OF PROSTATE, GLEASON SCORE 3 + 3 = 6/10 (GRADE GROUP 1), INVOLVING ABOUT <5% (1/1 CORES) OF THE BIOPSY, MEASURING ABOUT 1 MM IN LENGTH.

     

     

    B. Prostate, Right Medial Base:

    ADENOCARCINOMA OF PROSTATE, GLEASON SCORE 3 + 4 = 7/10 (GRADE GROUP 2), INVOLVING ABOUT 30% (1/2 CORES) OF THE BIOPSY, MEASURING ABOUT 9 MM IN LENGTH. PERCENTAGE OF PATTERN 4 = 5%.

    PERINEURAL INVASION PRESENT.

     

     

    C. Prostate, Right Lateral Apex:

    ADENOCARCINOMA OF PROSTATE, GLEASON SCORE 3 + 3 = 6/10 (GRADE GROUP 1), INVOLVING ABOUT 5% (1/1 CORES) OF THE BIOPSY, MEASURING ABOUT 2 MM IN LENGTH.

     

     

    D. Prostate, Right Lateral Base:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    E. Prostate, Right Lateral:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    F. Prostate, Right Anterior:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    G. Prostate, Left Medial Apex:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    H. Prostate, Left medial Base:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    I. Prostate, Left Lateral Apex:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    J. Prostate, Left Lateral Base:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    K. Prostate, Left Lateral:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    L. Prostate, Left Anterior:

    BENIGN PROSTATE TISSUE.

    NO CARCINOMA SEEN.

     

     

    M. Prostate, target #1:

    ADENOCARCINOMA OF PROSTATE, GLEASON SCORE 3 + 3 = 6/10 (GRADE GROUP 1), INVOLVING ABOUT 5% (2/4 CORES) OF THE BIOPSY, MEASURING ABOUT 4 MM IN LENGTH.

    PERINEURAL INVASION PRESENT.