Biopsy and pain/discomfort

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BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/17/2008 7:33 PM (GMT -6)   
I am intrigued to read of some members experiencing pain or at least quite a bit of discomfort during biopsy. Why do some urologists do it this way. In my case I was sedated to about the level of having a colonoscopy and was completely unaware of the whole process. What was your experience?
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 5/17/2008 7:39 PM (GMT -6)   
I was completely awake and aware of everything going on.  Doc gave me a slight prick of lidocaine to deaden things, so I did not experience pain.....but I was wide awake.

Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 5/17/2008 8:07 PM (GMT -6)   
Hi BillyMac.

Like DanmanBob, I was wide awake as well and I was given Lidocaine. I did have some discomfort, but I think it was the size and movement of the probe that was difficult to get used to.

The nurse and doc did a great job, though, and I have never regretted it.

Kind regards,

Barry ~ (a.k.a. "Idaho") - Prostate Cancer Forum Moderator

 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA  09/11/2007  <0.04 (undetectable)

2nd PSA 12/10/2007  <0.04

3rd PSA  03/17/2008  <0.04

My web site: http://pca-info.blogspot.com


Gordy
Veteran Member


Date Joined Jun 2005
Total Posts : 528
   Posted 5/17/2008 8:17 PM (GMT -6)   
The quack who did my biopsy used lidocaine but didn't wait for it to take effect. As a result the first 5 or 6 sticks hurt like hell and the rest were painless. Idiot!

-Les
1/2005 Dx PSA 26.5 Gleason 7 (4+3) @Age 61
1/2005 Start Casodex and Zoladex
PSA drops to <0.01
7/2005-8/2005 5 weeks of IMRT and then HDR brachy
1/2007 Rad Oncologist orders CT scan of pelvis
because of complaints of pain in both thighs
MRI confirms pain not caused by cancer BUT
1/2007 CT scan of pelvis picks up a nodule at bottom of left lung
5/2007 CT scan of lungs shows 1/2007 nodule has grown and
there are numerous nodules on both lungs.
6/2007 Thoracic surgeon removes wedge of left lung for biopsy
6/2007 Path report says 95% chance of metastatic PCa, but she's
never seen cells like this before.
8/2007 2nd opinion at M.D. Anderson in Houston.
They confirm: mutated PCa, very rare, but seen there 2 or
3 times. Recommendation: have CT scans every 6 weeks
and watch for change. At that point start chemo and will
survive for 22 - 24 months thereafter.
PSA still undetectable, but get Lupron shot to bring T down from 27
2/2008 Trip to Houston – PSA now 0.5 and nodules larger. Lupron shot.


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 5/17/2008 8:19 PM (GMT -6)   
I was awake during mine. Dr. gave something for the pain. The probe felt like a baseball bat but really no pain during the procedure. about two hours later was a different story. I had to take a pain pill I had left over from my broken arm the year before.

Mika
age at dx 54 now 55
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
wear one for insurance now
ED still a problem
last PSA undetectable
 


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 5/17/2008 9:07 PM (GMT -6)   
I was awake during my colonoscopy (2004) and the prostate biopsy (2006). Had an injection of lidocaine or something like that just before the biopsy. Because of the 'cheap' attitude of the medical system here in Canada, I was in some discomfort during both procedures, but it was bearable. 
 
Magaboo

Born Sept., 1936
PSA 7.9
Stage T1C
-ve DRE
Gleason's Score 3+4=7
2 of 8 positive
Open RP 28 Nov 06
Post op staging T3
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06
Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA test Mar., 08 =.04 
 
 


Gary H
Regular Member


Date Joined May 2008
Total Posts : 34
   Posted 5/18/2008 7:10 AM (GMT -6)   
I was awake also no real pain, but the snap of the biopsy needle scared the crap out of me.
 Age 48
 PSA 46 Oct (07)
 Gleason 3+4=7
 Biopsi 11 of 12 pos.
 DaVinci Jan 08 Dr W. Johnston
 Evanston Northwestern Illinois
 Post Op  PSA .7
 Started Lupron April 1st
 Radiation June (08)?????


Johnny Canuck
Regular Member


Date Joined Jan 2008
Total Posts : 88
   Posted 5/18/2008 7:55 AM (GMT -6)   
Gary H said...
I was awake also no real pain, but the snap of the biopsy needle scared the crap out of me.
If you had literally done that, it would have been fair payback to the doc for not warning you. I was in a similar situation, and advised him that a little "Here we go..." would have helped the process along. I just didn't like sitting in a semi-open corridor afterwards in the diagnostic imaging section, waiting for my butt to clot while I bled into a pad, whilst draped in my stylish hospital gowns.
"I'll just get dressed and go" I told the nurse, who wanted me to hang around 15 minutes or so. "Not if you don't want to bleed through your clothes" she advised.
This was my introduction to the whole deal, beyond the DRE, and I still had my dignity in place. Not that I subsequently lost it, but I did manage to put it aside somewhere when it wasn't integral to the proceedings at hand.
As I told my wife...I hadn't had this much attention paid to my butt since I was dating.
In the end (no pun intended) we...patients and medical staff...are all on the same team, and that's what's important.


Age: 54
Gleason Score: 3+3=6
PSA: 3.33
Biopsy:7/8 Positive
Stage: "Bulky" T1c
Prostate Size: 27cc
 
Diagnosed: December 05, 2007
Brachytherapy: February 26, 2008
68 seeds, (Iodine 125). 
 
Walk my path at:
 
 

Post Edited (Johnny Canuck) : 5/18/2008 10:16:55 PM (GMT-6)


Gary H
Regular Member


Date Joined May 2008
Total Posts : 34
   Posted 5/18/2008 8:37 AM (GMT -6)   
Johnny after I jumped the Dr then said he should have warned me. I didn't bleed after. But after it was over I sat up the nurse said to stay put for a few minutes, but in that few minutes I fainted don't know why but scared the crap out of my wife. I am a little pron to needles even if I don't see them.

Gary
 Age 48
 PSA 46 Oct (07)
 Gleason 3+4=7
 Biopsi 11 of 12 pos.
 DaVinci Jan 08 Dr W. Johnston
 Evanston Northwestern Illinois
 Post Op  PSA .7
 Started Lupron April 1st
 Radiation June (08)?????


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 5/18/2008 8:58 AM (GMT -6)   

I had no obvious bleeding during/after the procedure, but the doctor advised that I would have blood in my semen and urine for a while.

Being a curious sort, I m@sturb@ted that night.  When I ejaculated, it was blood, blood and more blood....and my prostate hurt like heck for about 15 minutes.

My wife, being a neat, clean freak who loves every inch of our home, would have had a fit if I had gotten blood on any of her things, particularly when the blood originated from that particular act.

So much for an old man's curiosity....lol.


Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 5/18/2008 12:04 PM (GMT -6)   
I to was awake with no pain medication. It was a most unpleasant experience, and I to found the first crack of the biopsy gun rather loud and alarming. The things we have to go thru to get healthy. I just kept telling myself that my troubles are minor compared to many. can't say it made the biopsy any better but I did survive it.

peace and love to all
Dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
 


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 672
   Posted 5/18/2008 2:40 PM (GMT -6)   

In the past, I have given my opinion of urologists who try to maximize their profit by performing prostate biopsies in their office without full anesthesia.  Some of the stories I have heard make the medical profession seem rather ignorant and uncaring. nono Fortunaly, my biopsy procedure was done in a mini-surgery center, with full anesthesia.  I slept lightly, woke up, my wife drove me home and I had some minor bleeding for a day or so. My doctor did it right.

Any doctor, in my opinion, who does not follow that procedure is wrong and out of touch. I hope that this is just one of the things that we can influence by sharing our mutual experience.


biopsy 10/16/06
T2A,  PSA 4.7
Gleason  4+4=8  right side
DaVinci Surgery  1/16/07
Post op confirms gleason 4+4=8
no extension or invasion found
no continence problems
PSA 90 day -.01  , 6 month -.01 , 9 month +.02 , 1 year +.02
Ed problems continue
Now using Bi-mix
 
 


Roger G
Regular Member


Date Joined Apr 2008
Total Posts : 150
   Posted 5/18/2008 7:09 PM (GMT -6)   
Guess I must be a wose. I was completely awake and aware of everything going on. Doc gave me a slight prick of lidocaine to deaden things. The first four were fine, the next four kind of hurt, and the last four really hurt. When I went home I had a strong urge to urinate and passed out.

Man I'm glad I will NEVER EVER have to have a 45 needle biopsy!!!!!


Age: 43 (2008)
DRE Small Ridge on prostate, PSA 1.5
07/2007: Diagnosed cancer, T2c, Gleason 3+4=7
09/2007: Laparoscopic prostectomy @ Hamilton General, 4 hrs.
              Both nerve bundles spared
              Pathology Report: Tumor confined w/in prostate
              T2c, Gleason is 3+3=6
              Went home with JP drain
10/2007: Made return trip to hospital.  All urine was comming out JP drain.
10/2007: Catheter removed. Next to no leakage
11/2007: 1st PSA <.003 :)
              ED: Started Viagra, no response yet.
12/2007: Had confidence to go padless!!!!!
12/2007: ED:  Stopped Viagra as it's causing hemroid problems.
01/2008: 2nd PSA <.003 :)
              ED: next to no response.
04/2008: 3nd PSA <.003 :)
              ED: next to no response.  Changed the Viagra prescription.
 


ace06
Regular Member


Date Joined May 2008
Total Posts : 28
   Posted 5/18/2008 8:17 PM (GMT -6)   
I was given something local but, it sure didn't ease the pain. I actually sufferd more from the biopsy, including several hours afterward, than I did from the surgery.

el paso rudy
New Member


Date Joined Apr 2008
Total Posts : 8
   Posted 5/18/2008 8:54 PM (GMT -6)   
I had two biopsies, the first in 1999. I was a bit nervous because my father said the procedure would be painful: he underwent a biopsy at an army hospital in 1980. My family doctor told me to take two Ativan
for anxiety prior to the biopsy, so I was fairly relaxed. The biopsy, without lidocaine, was not painful. Felt
like a slight pinch. I was so relaxed that I gave the urologist permission to have five student nurses observe
the procedure ... My second biopsy, in 2005, was not painful and I was wide awake like the first one.
The only discomfort was from the lidocaine injection.

wiggyann
Regular Member


Date Joined Apr 2007
Total Posts : 171
   Posted 5/19/2008 6:15 AM (GMT -6)   
Billy Mac,

It sounds like you are doing great with an undetectable psa :-)

When my husband had his biopsy, the urologist put something
on the ultrasound probe. It may have been lidocaine. He had a
12 core biopsy and the last four did hurt. His urologist told him this was a sensitive part of the prostate. I did some research on the prostate later and found that the apex was more sensitive then the rest of the prostate.

I would like to ask if you requested sedation for the biopsy or if
your urologist chooses to sedate his patients for this procedure?Some urologists do them this way now. I wish my husband's urologist would have. Neither one of us knew when he had his done that he could have requested to have the biopsy done in the hospital under general anesthesia. He was bleeding some from the rectum when the nurse got him up after the biopsy was completed and he passed out while he was trying to get himself cleaned up.

There is no reason why men should have to experience a very invasive and sometimes quite painful procedure without being given a local anesthetic which will numb the prostate. Pain control should be the number one priority in the urlogist's office.

Wishing you the very best.
Wiggyann

TOMC
New Member


Date Joined May 2008
Total Posts : 3
   Posted 5/19/2008 6:42 AM (GMT -6)   
WHEN I HAD MY BIOPSY 2 PEOPLE WERE IN HOSPITAL ROOM, THE DR & NURSE. I WAS TOLD WHAT WOULD HAPPEN BUT....... THEY NEGLECTED TO TELL ME about THE 2X4 THEY WOULD SHOVE UP THERE. I HAD A SHOT OF LIDOCANE, BUT THEY STARTED RIGHT AWAY(DIDN'T WAIT FOR IT TO WORK). I HAVE HAD A HEART ATTACK, 7 STENTS, 18 ANGIOGRAMS AND 15 ENDISCOPES AND NOTHING BOTHERED ME QUITE LIKE THIS. I WANT THE NEXT ONE IN 6 MONTHS HANDLED BETTER....AN NO 2X4.

TOMC

TOMC
New Member


Date Joined May 2008
Total Posts : 3
   Posted 5/19/2008 6:44 AM (GMT -6)   
I AM LOOKING TO CHAT WITH PEOPLE WHO ARE ON "WATCHFUL WAITING" FOR PROSTATE CANCER. IT MAY BE THE LOGICAL THING TO DO, BUT NOT THE BEST ON THE EMOTIONS.

TOMC

Bluenose
Regular Member


Date Joined May 2008
Total Posts : 260
   Posted 5/19/2008 6:56 AM (GMT -6)   

 

   ah, I had a nice little ten minute nap and didnt feel a thing.....some parts of this twenty-fiirst century medicine I do appreciate..


 
   age: 53
   Pre-0p PSA  Feb. 08, 5.0
      4.22.08, 4.1
      PSA had spiked once about 8yrs ago to 5.0 three months later
      back to 2.9...then into the 1.2 range until my re-scheduled 
      "missed" appointment this past Feb.
      Biopsy 5.1.08 
      Gleason-3+4=7
      T2a
      5 of 15 cores positive
      Da Vinci scheduled..7.29.08..as I read somewhere on this 
      site....."the first show of the day"


Jonar
New Member


Date Joined Mar 2008
Total Posts : 9
   Posted 5/19/2008 10:57 AM (GMT -6)   
I received no anesthetic of any kind for my 12 cores.  It was a pretty bad experience. I have not returned to that urologist for my advanced disease follow up. 

Age 55
Routine physical 9/18/07 showed PSA to be 13.5.
Diagnosed PCA 11/14/07. Biopsy 2 positive cores out of 12.
Gleason scale 4+3=7.
Da Vinci prostatectomy on 1/30/08.
Negative lymph nodes, negative margins, positive seminal vesicles.
Post op Gleason 4+4=8. Stage T3b.
Dry after 4 weeks.
First Post Op PSA at 4 weeks = 2.6.
Second Post Op PSA at 7 weeks= 2.1.
Started on Lupron 3/21/08
Will begin IMRT in the fall.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 5/19/2008 11:10 AM (GMT -6)   

Mine was in the doctors office although I would say they have a fairly sophisticated operation in the office.  They do some surgeries right there. 

It was just the doctor and his nurse and I don't believe they gave me anything.  He did prepare me for what would happen - the insertion of the tube and then the shotgun blast for each needle and that each one would be progressively more uncomfortable.  That is just what happened.  I wouldn't call them painful exactly but very uncomfortable. 

I didn't bleed at the time but had substantial blood in my semen right up until my surgery about 6 weeks after the biopsies.  No blood in urine at least not enough to notice.  David


Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
Great wife and family who take very good care of me


Gordy
Veteran Member


Date Joined Jun 2005
Total Posts : 528
   Posted 5/19/2008 4:58 PM (GMT -6)   
"Why do some urologists do it this way"

Wanna know why? When my quack told me I had to have a biopsy and I had a horrified look on my face, he said "it's not so bad". I then asked him if he'd ever had a prostate biopsy. At least he was honest and replied "no".

-Les
1/2005 Dx PSA 26.5 Gleason 7 (4+3) @Age 61
1/2005 Start Casodex and Zoladex
PSA drops to <0.01
7/2005-8/2005 5 weeks of IMRT and then HDR brachy
1/2007 Rad Oncologist orders CT scan of pelvis
because of complaints of pain in both thighs
MRI confirms pain not caused by cancer BUT
1/2007 CT scan of pelvis picks up a nodule at bottom of left lung
5/2007 CT scan of lungs shows 1/2007 nodule has grown and
there are numerous nodules on both lungs.
6/2007 Thoracic surgeon removes wedge of left lung for biopsy
6/2007 Path report says 95% chance of metastatic PCa, but she's
never seen cells like this before.
8/2007 2nd opinion at M.D. Anderson in Houston.
They confirm: mutated PCa, very rare, but seen there 2 or
3 times. Recommendation: have CT scans every 6 weeks
and watch for change. At that point start chemo and will
survive for 22 - 24 months thereafter.
PSA still undetectable, but get Lupron shot to bring T down from 27
2/2008 Trip to Houston – PSA now 0.5 and nodules larger. Lupron shot.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/19/2008 6:44 PM (GMT -6)   
wiggyann said...
Billy Mac,

It sounds like you are doing great with an undetectable psa :-)



I would like to ask if you requested sedation for the biopsy or if
your urologist chooses to sedate his patients for this procedure?Some urologists do them this way now. I wish my husband's urologist would have. Neither one of us knew when he had his done that he could have requested to have the biopsy done in the hospital under general anesthesia. He was bleeding some from the rectum when the nurse got him up after the biopsy was completed and he passed out while he was trying to get himself cleaned up.


Wiggyann

Many thanks for your good wishes. I wish your husband well and a completely successful treatment.
No, I did not make a request for the sedation. The urology practice I originally saw is in the grounds of a local private hospital and that is the way they do their biopsies. Similarly I underwent a colonoscopy a couple of weeks back at a different practice and location and that is the way they do things as well. Not deeply anesthetised but under just enough that that you are unaware of anything. An hour or so later and your'e as bright as a button. To me, it just seems so unnessarsary to inflict needless discomfort when it's so easily overcome. I think that Gordy's experience hit the nail on the head, as it would generally be fairly true that very few urologists have actually undergone a prostate biopsy. Perhaps if they received one as part of their training their approach to the procedure may be somewhat different.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 5/19/2008 6:56 PM (GMT -6)   
I had twilight on an outpatient basis for both of my biopsies with no regrets. I listened in my uro's office to a patient getting a biopsy while I waited for an appointment. I could tell evertime the needle hit. I think its up to the individual. Its a personal decision. I don't like pain so if there is an alternative I go for it. Macho doesn't even enter my mind.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C 
5/15/08- 1st Post-Op PSA 0.07 Undetectable


smilingoldcoot
Regular Member


Date Joined Jan 2008
Total Posts : 338
   Posted 5/19/2008 8:02 PM (GMT -6)   
My last biopsy was painless.  Only felt a little pressure.  Last week when I had my seed markers implanted (reverse biopsy) again there was vertually no pain. 
 
After the implants the first balloon experience (prep for proton) was a little painful as my prostate was still tender from the implant procedure.  But again nothing that was unbearable.
 
Richard yeah tongue yeah
Retired USAF Richard & Debbie on The Shores of Toledo Bend Lake Louisiana
Biospy 1/10/08 Gleason 10, Stage T1C  8 of 12 samples positive all Less Than 5% 
U of Florida Proton Therapy Institute
5/2/2008 LUPRON & Casodex
IMRT to start 5/16/2008 for approx 4 weeks with Proton to follow for approx 4 weeks
Turn Stumbling Blocks into Steping Stones and Keep Smiling
Our Journey is on WWW.GLEASON10.COM
 

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