Is there a consensus out there IV sedation verses Lidocaine shot for Biopsy?

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Regular Member

Date Joined Feb 2010
Total Posts : 183
   Posted 2/13/2010 5:56 PM (GMT -6)   
I am getting ready to make the move and get the biopsy done.
Needles scare the crap out of me.
I even had an enema!! egads.

sitting all night on a toilet can't be any fun, I only do that for the flu, but now self induced.

I have to urologist, one with Iv sedation at the hospital and will take a 20 core.
Or My friendly neighborhood urologist who will use the shot, a valium and a 12 core.
and drive mysef home!

rodg beaton
age 67
psa 4.5 for a year
negative dre, firm on right side

Veteran Member

Date Joined Dec 2008
Total Posts : 819
   Posted 2/13/2010 6:03 PM (GMT -6)   
Hey Berdoo,

No real consensus, it seems to vary a lot from person to person. Some guys do just fine without even lidocaine. Others, like me, well I think the lidocaine injections just didn't hit the right spot. This happens sometimes in dental work too. So my doctor even wrote in my chart that I should be sedated next time. There won't be a next time though, that puppy is outta here. Might not be a bad idea to go for more cores, though, in any event.

Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)
4/23/09, 07/30/09, Oct 2009 still undetectable!

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/13/2010 6:45 PM (GMT -6)   
The 20 core one might be more effective, and might negate you needing another one in the future.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days

Regular Member

Date Joined Aug 2009
Total Posts : 288
   Posted 2/13/2010 7:09 PM (GMT -6)   
Mine was done with a lidocaine injection although you couldn't prove it by me since each sample out of 12 stung like a strong rubberband snap on the tush. In hindsight though, I'm a baby with needles too. It did not take long and since I tend to have a queasy stomach recovering from anesthesia I would probably go through a 12 sample again with just a local. I do like David's point though about the 20 samples giving a better appraisal and I might opt for a light anesthesia then especially if they will give you that happy juice first.

Good luck,
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 01/19/10 started 39 sessions 70.2gy

Regular Member

Date Joined Dec 2009
Total Posts : 347
   Posted 2/13/2010 7:11 PM (GMT -6)   
Everyone one is different, they did mine in the uro's office with lidocaine and valium. Nobody particuraly likes having anything done in that area, but sometimes it just has to be done. A biopsy will tell alot more about what is or isn't going on in your prostate. It was no big deal for me 12 cores, 20 minutes it was done. (The valium really kicked in after i lkeft the office)
age 45
psa 3.09
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side - 0/6
CT & Bone scan negative
Davinci Feb. 5th 2010
Awaiting cath removal 2/16

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4119
   Posted 2/13/2010 7:40 PM (GMT -6)   
I had mine done in the Uro's office he gave me a few shots of lidocaine that hurt more than the biopsy. Neither were much of a big deal. Some people are more tolerant of pain than others. Only you can decide what you will do. Best of luck.

Jeff T
Cajun Country
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)

Regular Member

Date Joined Jan 2010
Total Posts : 87
   Posted 2/13/2010 7:54 PM (GMT -6)   
My biopsy gave me a shot of lidocaine or whatever with the biopsy device. It didn't hurt. No need to be knowed out imho as the procedure takes like 15 minutes tops.
Age 54
PSA 8/2009 5.6 Gleason 8
DaVinci surgery 11/2009
Pathology - totally contained in margins -one bundle spared
PSA now undetectable at < .05
Continance: Night and morning fine and improving
Doing 3 P's and now using trimix

Veteran Member

Date Joined Nov 2009
Total Posts : 7270
   Posted 2/13/2010 8:00 PM (GMT -6)   
I ended up doing IV sedation as they had a very quick opening in the OR room for that.
I would have had to delay a week for the regular biopsy.
I would go IV sedation again (but there won't be another time!)

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10

Regular Member

Date Joined Nov 2009
Total Posts : 254
   Posted 2/13/2010 8:00 PM (GMT -6)   
My biopsy was a 12 core with the shot of lidocaine and a valium.  It didnt really hurt. ( Perhaps after the cystocopy the month before nothing would have hurt) 
Good luck
Diagnosed 9/09 at age 54  
PSA 6/09 1.3
Stage 2b (biopsy done because of firmness felt on right side) 3 positive cores out of 12 (all less than 25%) Gleason 6
Surgery  1/13/10 at UP- Penn Presbyterian - Dr David Lee. Home 1/14/10 Nerves spared on both sides -Catheter removed 1/19/10  Path report scheduled for 2/11/10
Pathology Report Gleason score was upgraded to 7 (3+4)
no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, gland involvement 2-10%
Since report was good and recovery going well next appt is now  the first psa test appt scheduled for 4/22
Incontinence - Initial 6 pads a day, 3 Weeks - 3 pads a day relatively dry at night
ED - yes but seeing some improvements - levitra 10 mg 2x week

Regular Member

Date Joined Sep 2009
Total Posts : 41
   Posted 2/13/2010 8:08 PM (GMT -6)   
I had 12 cores done with only lidocaine. the lidocaine shots were the worse pain
of all for me. As Lou Reed sayed in Walk on the wild side,"valium would have helped that bash".LOL . the whole thing was over in about 20 minutes but it seemed like an hour. Glad i have nothing else to biopsy now. and psa was zero in Dec.

Forum Moderator

Date Joined Sep 2008
Total Posts : 4274
   Posted 2/13/2010 8:23 PM (GMT -6)   
Berdoo, as I told you in another thread, I had the IV sedation and the biopsy was no big deal at all.  Consensus doesn't really matter as each man is different as is each doctor.  If you have concerns about it, go with the IV.  Also, the 20 core biopsy is certainly more state of the art and gives you a better chance of really finding out what's going on.
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

New Member

Date Joined Feb 2010
Total Posts : 3
   Posted 2/13/2010 10:03 PM (GMT -6)   
Each guy reacts differently. In my case there was no lidocaine just the 12 core shots. The first two were not too bad but each got progressively worse. It kind of felt like being snapped with a wet towel on the testicles. Not a fun thing. I definitely was counting at the end. Onece it was done I was light headed for a while but that happens each time I have any medical procedure done including a blood test. After I got up I drove home and had no problem with pain. It was a bit un-nerving watching blood come out while urinating. Overall I would not put it as one of the 10 most pleasurable things that I have done in my life but you can get through it. The pain is a lot less then getting a tooth drilled without having it numbed in my opinion. But as I started out each guy reacts differently. Good luck and I hope that you have good results from your biopsy.
dx August 2009 age 50 PSA 3.9 Free PSA 9
Biopsy Sept 2009 Gleason (3+4) 7 2 out of 12
RPE November 2009 Contained in Prostate no exterior involvement
6 week PSA < 0.03

Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 2/13/2010 10:14 PM (GMT -6)   
I had it done twice - the first time with just lidocaine was living hell. and I have a pretty high pain thresh hold - two back surgeries...and went out to dinner the day after the second surgery. He apologized...second time with valium and a lidocaine was better, but second time I had my wife drive me home.
Each man is different...and there is no shame in pain, or medal for tolerating it.
Paul ED website for PCa guys

46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
Two year PSA - undetectable!

Regular Member

Date Joined Mar 2009
Total Posts : 39
   Posted 2/13/2010 10:44 PM (GMT -6)   
I consider myself rather wimpy....and the lidocaine was fine for me. No valium either. Drove home - 30 miles. Pain level was very low. The biopsy was uncomfortable, but not painful.
Dx T1c in April, 2009 at 45 years old after recent PSA tests ranged from 2.93-3.25
2 of 14 cores positive at 5% and Gleason 3+3... 2 cores taken from a "protuberance" were "ASAP"
Proton radiation at LLMC May-June 2009

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 2/13/2010 11:02 PM (GMT -6)   
two biopsies, no lidocaine, no problem. I can stand a little discomfort, is what I would call it, I can't stand sedation.

Really, it's not a big deal, but do what yoiu think is best. One guy on here called biopsies without sedation barnyard medicine.

It's your body. I would say based on your posts, that I would probably go for the sedation. The doctor may have to sedate you to pry your but cheeks apart. ( just kidding a little )

Good luck.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01

Forum Moderator

Date Joined Jan 2010
Total Posts : 7084
   Posted 2/14/2010 12:00 AM (GMT -6)   
I agree with Jeff - the shots hurt briefly, the biopsy was just annoying.

I would have been up the creek if I had been seriously sedated - no one here to help drive me home. So my choice was the one allowed, and "in the end" wasn't so bad.

The big choice is 12 vs. 20 cores, and then taking what that brings.

Hang in there.

Regular Member

Date Joined Jul 2009
Total Posts : 137
   Posted 2/14/2010 6:46 AM (GMT -6)   
My Uro says that more than 12 cores and men get uncomfortable, so sedate. Less than 12, the Lidocaine worked fine with me.
70 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0. Doubled from 3.5 to 7.0 in one year.
Neg. CT and Bone Scan
4 of 8 biopsies positive (all right side) Gleason Score 3+4=7
Robotic assisted total prostatectomy and node excision July 2009 in Luzern, Switzerland by Dr. A. Mattei in the Kantonsspital. New Gleason was 4+4=8
pT2c G3 pN0 (0/14 nodes +, Margins, etc. clear
Catheter out in 5 days (home in 3 days). No incontinence
Positional neurpraxia in hip and knee resolved 90+% in 5 months.
Potency: beginning tumescence??? at 3 weeks post-op. Still happens at 3 months PO. Nearly usable one month later. At 5 mo. with 100 mg Vitamin V, pretty good. Now beginning 5 mg Cialis daily.
3month PSA less than 0.01, 6 month PSA less than 0.01

Regular Member

Date Joined Aug 2009
Total Posts : 152
   Posted 2/14/2010 8:56 AM (GMT -6)   
I was out, in the surgery room and all. Woke up about 45 mins later.

Regular Member

Date Joined May 2009
Total Posts : 476
   Posted 2/14/2010 9:48 AM (GMT -6)   
Six biopsies, local anestetic only, 24 core each. If the doc hits the right spot with the anestetic there is no pain, just discomfort of a large object moving in your rear end.

I would agree with others that number of cores taken is the criteria you should use - the more cores, the less chance of false negative.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10

Heavy Leaker
Regular Member

Date Joined Feb 2010
Total Posts : 63
   Posted 2/14/2010 11:35 AM (GMT -6)   
I had 4 biopsies over 4 years all done with IV sedation.  My Dr. did not even mention an alternative to the sedation.  I do not regret the sedation as I had a nice nap each time & my wife drove me home.  My only regret is having to go through 4 years & 4 biopsies to find my cancer.  BTW, 4th biopsy showed Gleason 6 in 5% of one core but pathology report from DaVinci surgery showed Gleason 3+4 in 30% of prostate.  How can biopsies be so inaccurate?  I can understand a small difference but why couldn't they find the cancer with the first 3 12 core biposies?

4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.

Veteran Member

Date Joined Jul 2008
Total Posts : 981
   Posted 2/14/2010 12:16 PM (GMT -6)   
I'm one of those from "hey it's no big deal" camp. A normal biopsy with lidocaine while not being fun is no more than 10-15 minutes of minor discomfort for me. Those who panic and need to be sedated I just don't understand. Now when I had a 45 needle 3D saturation biopsy sedation was mandatory and needed being it's not done through the rectum.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
April 2009 12 of 12 Negative biopsy
10/12/09 - Psa .30

Post Edited (realziggy) : 2/14/2010 11:34:03 AM (GMT-7)

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 2/14/2010 1:18 PM (GMT -6)   
I had 13 biopsies of every type and size. If you are getting a 6 core, there is no problem without lidocane; it's just one more needle prick. If you are getting more than 8 cores lidocane really helps.
Take a Vicodine 30 min before procedure and another after the procedure and you won't have a problem.
I had a 16 core without licodine and it hurt. I had a 26 core with licodine and it also hurt. I never was sedated and never had a problem.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


Regular Member

Date Joined Dec 2009
Total Posts : 163
   Posted 2/15/2010 3:14 AM (GMT -6)   
I had 12 core biopsy in URO office. Gave me a valium 30 min before and URO did a lidocaine shot 15 min before he started. Lidocaine shot was about a 4 on scale of 1 to 10 for pain. Subsequents biopsy harvests were just uncomfortable not painful. I was not allowed to drive my self home. All in all, I would say after lidocaine shot.. it was not so bad.
Age 55,  PSA = 4.97 on 11/17/09, DRE negative,
Biopsy 12/2/09: 1 of 12 cores positive with less than 5% volume
Gleason 3 + 3 = 6
Prostate Size Estimate on 12/2/09 = 28 cc
RALP is scheduled for April 7, 2010 at Vanderbilt University MC with Dr. Joseph Smith (over 3000 RALPs)

Regular Member

Date Joined Jan 2010
Total Posts : 75
   Posted 2/15/2010 9:04 AM (GMT -6)   
I had the 12-core biopsy with Lidocaine only. Glad I loaded up the iPod with some interesting podcasts to keep my mind off the procedure!

Frankly, the intrusiveness of the doc fooling around up my rectum was the worst part of the whole deal. The collection of biopsy samples was not really either painful nor especially uncomfortable with the local anesthetic.
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, no lymph node involvement (0/9), perineural invasion present, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: essentially no incontinence 9 weeks post-op
ED pretty complete: some erection possible but current non-functional

Tim G
Veteran Member

Date Joined Jul 2006
Total Posts : 2362
   Posted 2/15/2010 5:49 PM (GMT -6)   
I had a 12-core biopsy with topical lidocaine gel.  It really helped that the doc waited long enough for the lidocaine to work before doing the biopsies (There have been some forum members who have reported that the doc didn't wait long enough).  For me the anticipation was the worst part, and after the first sample the rest were no problem since I knew what to expect.  The procedure was uncomfortable rather than painful. 

PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE negative  1 of 12 biopsies positive (< 5%) 
Open surgery June 2006 at age 57
Organ-confined to one small area, Gleason 5   
PSA's undetectable  < 0.1  

Post Edited (TimG) : 2/15/2010 3:54:05 PM (GMT-7)

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