Risks & Alternatives | Random Needle Prostate Biopsies

[@HuckToohey]

This channel is priceless. Thank you P.C.R.I. My PSA went form 1.8 in 2018 to 5.4 in 2024. I had absolutely no symptoms. My M.R.I. was scheduled and two different "dark spots" were discovered, so a biopsy was ordered. When the day came, needless to say I was nervous and my anxiety was peaking. My pre-biopsy consultation with the urologist revealed he was absolutely on board with a "targeted biopsy" of 6 cores from 2 spots, not the 12 samples. He said it was very reasonable to do the targeted and the urology community was moving away from unnecessary samples from unaffected prostate tissue. I took the antibiotics as directed. And received shot of antibiotics before the biopsy. They prescribed one valium 30 minutes before the biopsy. And I took it upon myself to dip into my prescribed pain meds for my back. The procedure was uncomfortable. The only pain (stinging) was 2 or 3 seconds with the initial lidocaine injection, then again in the second lidocaine injection. The 6 core samples were collected in 10 minutes. Then it was over. 7 to 10 days for results. I incurred no infection, nor blood in my urine or stool. I'm single so the semen sample may take awhile. LOL. These are my results. Your results may vary.

[@BW12149]

I’m scheduled for prostate biopsy in October. My urologist is very experienced and capable. Already had a prostate MRI, which showed the possibility in two areas of prostate cancer. I’m 74, PSA of 5.5 and he doesn’t seem concerned of it being serious since nothing else was seen on the MRI scan.

[@TheJon2442]

After my biopsy I had an infection, which despite my returning to the doctor who did the biopsy failed to treat and I received antibiotics very late. When I had my prostate removed the surgeon said that it was a very complicated operation, he has been doing prostate removal for over twenty years. A week later I was admitted as an emergency case, for life saving surgery due to a hole in my colon! Ended up with a stoma etc with lots of complications. Before the biopsy I was very fit, now not so, I have the stoma removed next week hopefully. Do your research before you let some mess around down there. Good channel and great content!

[@scottjackson163]

Truly a horror story. The whole system is barbaric.

[@nickstrapko7549]

How did you feel down there the first week after.

[@TheJon2442]

@@nickstrapko7549 in shock.... do no harm comes to mind.... I am recovering and will never be normal again.... every day is a gift.

[@Gary65437]

My 83 yr old father ended up in a small town hospital getting a prostate biopsy, and getting a C-diff infection. Sent home with a catheter on his leg and a diaper to control the diarrhea infection.A couple wks later at hospice where he soon died. At least he made it to 84 before the cancer and medical treatments finished him off.

[@schmingusss]

@@Gary65437 He probably would have been better off just being put straight on hormone therapy.

[@bglrj]

This is such a good-hearted public service.

[@donforonda7115]

I had a pelvic MRI to include the Prostate and the results where areas are vague so I had a transrectal Ultrasound guided prostate biopsy with 14 core needle sites under local anesthesia with an antibiotic injection pre procedure and oral antibiotics for 5 days to prevent infection. It was a Gleason 6 and the tumor is so small and encapsulated, slow growing and no aggressive treatment for now but I will be on “Active Surveillance” meaning PSA every 4-6 months and DRE ( digital rectal exams). I have a urologist here in Houston and a urologist in Ecuador S America and they both on agreement on my treatment. A Polaris test from the biopsy will be done to clarify cancer risk. “Prolaris is a genetic test developed by Myriad that directly measures tumor cell growth. The Prolaris test paired with both PSA and Gleason provides the level of aggressiveness of a patient's individual prostate cancer.”

[@barrie888]

I am doctor, different field .Great channel with pertinent common sense information ,Thankyou

[@chasa4347]

I have a family history of prostate cancer. My PSA was steady for years hovering around 2 - 2.5 Recently, it increased to 3.9, with my history we did a 3T MRI, and found a PIRads 3 lesion in the median lobe of the prostate. Met with the urologist to discuss options, rewards and risks. His thoughts after reviewing the MRI scans were that it wasn't cancerous, but pressing against the bladder was causing urinary issues. My first option was a perineal biopsy, both systemic and targeted. Option 2 would be Holep removal of central and transitional zone prostate tissue. He offered that we could remove just the median lobe currently causing issues, that may or may not resolve the urinary issues. Or we could remove that lobe, along with the left and right lobes. In either case, the tissue removed would be sent to the pathologist. The third option would be watchful waiting with periodic monitoring of PSA. (Not active surveillance as he doesn't suspect even Gleason 6 tumor at this time. We also discussed the risks of doing each option and agreed to meet again in 3 months with a follow up PSA and determine a plan forward. I'm leaning towards option 2 to deal with my BPH issues, not sure whether to just address the median lobe, which might mean additional surgery in the future, or do the "one and done" Holep, which might have a little higher chance of intermittent incontinence.

[@trevcam6892]

When I initially had my prostate cancer detected by high PSA and a digital examination by my GP they did a transrectal biopsy at the hospital as well as an X-Ray. That was in 2014. I think that I had a further biopsy a year later. I can't remember what the Gleason score was but it apparently was not too bad although there were some cancer cells present. The hospital stopped doing biopsies when the consultant left abruptly. Never found out why he left almost overnight. I certainly didn't like the biopsy, but who would? Since then my PSA has not changed much above 4 so I see a consultant once a year who will do a digital examination. He's not worried so neither am I. I am 81 and have ED, but that happened slowly and not straight after the biopsies. It's not something I stress about any more. My wife is too sick anyway. (I would add that our long relationship has always been based on love, friendship and doing pretty much everything together with sex as a delicious bonus.) I have changed my diet and don't eat much red meat. I drink a 250ml glass of tomato juice every day and eat lots of veggies. I get plenty of exercise caring for my wife, pushing her wheelchair in local country parks and doing totally unnecessary DIY projects. I also had a TURP without any serious side effects and now have no problem. I don't think that I could ever have an MRI on the lower body because I have a stainless steel femur. Your videos are very informative. Thank you. I would also say that I have to take care of my own health because if I'm not around to care for my wife she would finish up in a nursing home. She's 10 years younger. It's a nightmarish thought that haunts the both of us.

[@tonyberry850]

I refused a biopsy 22 years ago maaged with a tablet evercsince now near 86 i rest my case!!

[@donapodaca3729]

@@tonyberry850 what is "maaged with a tablet" mean?

[@ralphal.8398]

I had a mri guided biopsy but I got a sepsis infection the next day. Was in the hospital 6 days

[@scottjackson163]

Did they do the rectal culture, enama, and antibiotic?

[@onexsculler]

Such very valuable and much appreciated information! Thank you to PCRI!

[@jasonl9847]

I would like to hear about the research on pre and the post biopsy spa levels and the risk of spreading cells through the hole left by the needle.

[@kazimgumus7232]

Thank you for these explanations!

[@corgiowner436]

Good luck getting insurance to pay for a PSMA PET scan unless you have recurrent prostate cancer. I had a PIRADS 5 lesion on MRI with a low -5.8-PSA. The PIRADS was a 3+4=7 but one core out of 15 was a 4+3 which puts me in a different risk category. Less than 50% of cores were positive. The other biopsies were random. Doing ADT for 4 months/rectal gel spacer/EBRT for 5 weeks.

[@dennissecor8092]

And they are extremely, painful, you're not mentioning, that!!!!!!!!

[@JustaReadingguy]

I second that comment. And my doc says "nothing yet, but let's keep looking every three months. " I ask for imaging and guided biopsy. Doc said, no we will eventually find something. But the extreme pain doc. Where can I find a bit more modern approach?

[@corgiowner436]

I was offered propofol for the rectal biopsies. I did local and didn’t think it was bad but I’ve got a pretty high pain tolerance. Much more worried about the transperineal rectal gel spacer.

[@John-dw6ru]

@@corgiowner436 It depends upon how many prior biopsies have been done. With each biopsy, scar tissue forms. The more scar tissue, the more painful the biopsy.

[@Blue_Dun]

​@@JustaReadingguy Did you find a "more modern approach?" Find your local TULSA facility and have them determine if you're a good candidate. I have an appointment at Stanford coming up. You may have already resolved your condition, but thought I'd throw this option out to you just in case. Here's the TULSA website where you can search the closest facility

[@pauldamore92]

Better off with the transperineal biopsy under anesthesia imo. Sticking a 12 gauge needle into your prostate has to be quite painful

[@45graham45]

After having a PSA test then an MRI, could it be worth geeltting a Percent-Free PSA test done to help decide on whether to have a biopsy? ...or to help decide whether to get an expensive PSMA PET scan?

[@skyking1328]

I don't understand how my total PSA of 10.6 goes down to 6.01 and my free PSA goes down to .756 from 7, and the labs say my chances of cancer increases? Why would free going down raise risks ?

[@wendyrowland7787]

That was very useful.

[@willemvanriet7160]

Is there a risk that repeated biopsies can increase the risk of cancer as cancers can be attracted to scar tissue?

[@diptimnm]

Thank you so much.

[@orangeguy3314]

I just had a random with twenty samples taken. This was done in a VA hospital. It's didn't hurt one bit and was done around 25 minutes. No blood in my urine period.

[@callofduty6661]

I had a transperineal biopsy in Jan 2024 . No pain but minor discomfort for a few days. Blood in urine for 20 hours improving with copious amounts of water.Two weeks later a small amount of blood occurred.

[@orangeguy3314]

@@callofduty6661 just had a holep procedure done yesterday at the VA hospital in Las Vegas. So, far in day one the bag was filled with blood and material from the procedure. Now everything coming out of the tube and into the bag looks clear.

[@callofduty6661]

​@@orangeguy3314 I had a targeted and random biopsy which gives more chance of the biopsy needle to stick the urethra. Fortunately for me no cancer found this time.My PSA was 4 and prostate size 66cc. Pirads was 3.

[@orangeguy3314]

@@callofduty6661 that's always good when you get the call that nothing was found. Also my mri or pirads was a 2. I also happy that I got the holep done a day ago. Now I'm free of taking no drugs for my bph.

[@BradleyBrough]

I have an enlarged prostate. I underwent prostate biopsy with a psa of 15.4 (up from 12.4 a month earlier)(psa was 15.7 from 3 months earlier)(psa was 8.5 six months earlier). I had a psa test again as part of blood panel for testosterone replacement therapy consideration. This psa test occurred 4.5 days after the prostate biopsy and my psa increased to 43.67! Is it possible that the sampling process has caused the excessively larger psa level? I still do not have results from the biopsy that occurred on September 6, 2023.

[@msbmsbus]

There needs to be something better. Prostate biopsies are barbaric and carry too many risks. There needs to be advocacy with insurance companies so men can, hopefully, replaced needle biopsies with imaging. Especially those who need repeat biopsies. Also, just wondering where we are with liquid biopsies? Liquid biopsies would solve the horror of needle biopsies once and for all. Imaging combined with liquid biopsies seems like a much better way to diagnose PC.

[@markusrose9667]

I have to disagree with Dr Scholz here. I’ve just been diagnosed with a Gleason Six on a TRUS after two negative MRIs. All things considered, I’m glad to know the truth. At least now, I’m know that I’m going to be watched closely.

[@DianneElizabeth64]

From everything I am learning, it’s not genetics that is involved in triggering cancer. It’s our diet, our environment, our stress that mutates or unhinges bad genes

[@davidhakes3884]

NEVER Get a Random Biopsy. PERIOD !! There are many other ways to check out a prostate.

[@terrellwilliams5829]

If youre at risk of having a high grade cancer 8 or 9-10 I prostate biopsy will make it spread

[@JasonRoberts556]

How do you know? I’m curious.

[@JasonRoberts556]

You and I are of the same mindset Terrell. I am a 42 black male with a PSA of 17, 9mm lesion. I’d love to talk to you.

[@simonnorth185]

Is it safe to have a prostate biopsy when there are fiducial markers present inside the prostate gland? Small pieces of gold were placed inside my prostate because in 2020 my case was considered high risk, so I was preparing for proton beam radiotherapy. My case was later downgraded to low risk, so I decided to pursue active surveillance. I want to know if there is any risk of complications if I have a biopsy with the gold markers present (for example if a biopsy needle contacts or dislodges one or more of them?) Do you know if there is a risk of complications? Either during or after the biopsy? Could there be long-term side effects such as ED (erectile dysfunction), incontinence, or lasting pain?

[@notofthisworld5998]

We have had PSMA scans and MRIs that have missed clinically significant tumors. Also the PSMA scan contrast is ridiculously expensive. The system cannot bear the cost of that scan being a frontline tool that everyone should request. The only way to truly rule out prostate cancer with total certainty is an autopsy. No modality or practitioner is infallible. Transperineal biopsies are very burdensome logistically. If people will need anesthesia the availability will severely diminish. Getting OR clearance for a simple biopsy is ridiculous. The cost will skyrocket. Everyone loses. I keep finding that the advice given here is really meant to funnel the well-to-do into a crony referral network. The poorest amongst us will not be getting these modalities which are touted here.

[@ga6589]

We give routine Propofol anesthesia for colonoscopies now. The first one I ever had was extremely painful, even with a sedative. My husband had a prostate biopsy 18 months ago that was incredibly painful for him. Had he known ahead of time, he might not have had it done at all and would likely be counting down his last days. It would seem to me that we would want to make it easier for men to be screened and have biopsies, rather than making it harder. The goal is to prevent advanced disease, which is much more difficult and expensive to treat. Currently, the PSMA PET scan is done when the biopsy/PSA shows evidence of metastasis and is much more reliable than any other scan. It has guided my husband's treatment and he's now in remission after a stage 4 diagnosis. Your comment suggests that we should just throw up our hands and hope for the best, because medical care is just too expensive. BTW, it's the insurance companies who are laughing all the way to the bank.

[@notofthisworld5998]

@@ga6589 wrong. PSMA is not MUCH more reliable. Only slightly. Your anecdote does not discount the simple points I made. I am happy you and your husband are rich enough to access these things. But the standard if care has not, and cannot be for such things. The system cant bear it. Most transrectal biopsies are not excruciating. Typically it causes mild to moderate discomfort. Patients drive themselves home. This is a time tested process. Scaring patients away from the actual standard of care, which has saved more lives than we can count, is very unethical. I agree we should always strive for better options, but the feasibility of these ideas is poor at best. BTW, propofol still requires pre-op processing, intra-operative and post-pp monitoring and pts cannot drive themselves. In the population I serve, many cannot make appointments when their spouse or caretaker is working. Requiring a driver is a dealbreaker. Again, i am happy your husband had a good outcome. From an objective perspective we need to do the most good for the most people.

[@ga6589]

@@notofthisworld5998 Interesting that you assume my husband and I are rich, when the reality is we are as middle-class as they come. However, he is fortunate to have decent insurance through his employer, which paid for the PSMA PET scan after he had met the deductible. They should be available to all men suspected of having advanced disease. Regarding biopsies, the reality is that people will avoid tests/procedures that they think will be painful. Colonoscopies have been made far more tolerable and lives are saved because of it, including my own as colon cancer runs in my family. Your assertion that "most" transrectal biopsies are not excruciating is based on what... extensive surveys? If you're the doctor performing them, you're already coming at it from a biased perspective. You, least of all, want to cause a patient pain. My own husband didn't complain to the urologist for fear of being considered a whiner and a wimp. How many people will be truthful or just suffer in silence? Furthermore, we are seeing more cases of advanced disease, due to a men having been discouraged by some medical authorities from having routine PSA screenings, as they could lead to "over treatment." This was what happened to my husband. Regarding the reliability of PSMA PET scan, I saw the comparisons between it and the bone scan, CT and MRI. Even I, a lay person, could see the difference. As I said, it guided treatment. Those other scans don't come cheap either and the standard of care is that you always need the three of them to do the job of just one PSMA scan. BTW, while I sat waiting during my husband's biopsy procedure (He was in no shape to drive afterward), a gentleman came out and told his wife that he tapped out of his biopsy because he couldn't take it and they had to reschedule with anesthesia. Anecdotal, I know. However, I wasn't the only one sitting in that waiting room hearing about this man's experience. Any guy hearing it would have a good reason to be discouraged about having a prostate biopsy.

[@ga6589]

@Dave Alexander He's being treated at Mayo Clinic, Rochester, MN. He finished 26 rounds of radiation a year ago to the prostate and pelvic lymph nodes. He has been on Lupron injections and Abiraterone/Predisone for 15 months. His PSA has been negligible (remission) since he finished the radiation. Because his metastasis is considered low volume, he won't need chemo, unless his PSA starts to rise and/or a PSMA Pet scan shows evidence of cancer growth. His treatment plan follows the recommendations gleaned from the results of the Peace 1-phase 3 study. Good luck to you!

[@916000BB]

Your thoughts on the studies that say there is no difference in mortality rates between men that decide to do a biopsy vs men who choose to not do a biopsy. That would certainly point me towards not doing a biopsy.