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Posted 7/15/2007 1:46 PM (GMT -8)

Let’s talk some about biopsy pain. It’s a subject of interest to most men about to have one.

Before I had my prostate biopsied more than three years ago—which came up with 11 of 12 cores positive and each of the positives having a Gleason score of 7, 8, or 9—I asked a friend about the pain he experienced. He described it as “discomfort.” When a doctor tells me I may experience some discomfort, it usually means “hurt like the devil.” So I expected something less than dental pain, but nothing to cheer about.

What I experienced was a sharp burst of pain each time the needle was fired into my prostate. But it was amazingly brief, and ended. Period! There was no reduction in pain, no dropping off. The pain just ended. Until the next core.

I’m curious about other people’s perception of their biopsy pain. Maybe it will help a few men about to undergo the procedure.

Prostate Veteran

Posted 7/15/2007 3:00 PM (GMT -8)

Both my husband and father thought that the biopsy pain was far worse than the open surgery they both had.  For my husband it was so uncomfortable that they had to stop after a few tries and consider resceduling the procedure to be preformed under anesthesia.  He was nauseous and faint from the pain.  He recovered and the urologist continued to total 12 sticks.    It was a bit better, but he hated it.  By the way... he was supposed to have been given the novicane stuff to ease the pain.    

I've read that the biopsies are no big deal to some, but for these two men in my life who are not wimps, they had a hard time of it.   My guys are in the minority from what I have heard.

   Then again, there are some men who had a  tougher time recouperating from the open surgery as easily as my husband and father did, so it is an individual experience. 

They also described the snapping sound of the biopsy needle taking the sample,  as something they will never forget.

 

Wishing everyone here health and happiness!  :-)

 

 


Post Edited (Tim's Wife) : 7/15/2007 5:04:48 PM (GMT-6)

Posted 7/15/2007 3:11 PM (GMT -8)
Hi PV,
My experience was little unpleasant but not too bad. My urologist said I handled it well. I did not experience too much aftermath either, except finding out about my disease. For me to go under a similar procedure I would do it again if it had the value of saving my life. I would encourage all men on the fence about getting this done, that foolishness begins with fear. Simply put, if your told that a biopsy is recommended, then you need to do it. If someone is avoiding this procedure because they don't like the idea, or for some I bet, feel it's indignafied, then let me just say leaving it be can present you much tougher decisions later. No it's not fun putting your bare butt over the edge of a table and letting some nurse prepare you, or a doctor poke you for thirty minutes, but never lose sight of the fact they are trying to make sure you are OK. If they find something they go into life saving mode. That's not a bad thing.

Tony
Posted 7/15/2007 3:41 PM (GMT -8)
I don't want to sound like some kind of tough guy, but it wasn't as bad as I thought it would be. I drove myself to and from the biopsy. I was uncomfortable and sore after it for the rest of the day and the next day. I had some blood in my urine for several weeks, but I think that was partially because I take aspirin and Plavix daily, making me more prone to bleed. The doctor was very easy to work with and the worst part was the pressure when the probe went in. I hardly felt the actual biopsy needles, 12 samples. I do remember feeling a little woozy about halfway thru it, probably from the medication. But that quickly went away. My prostate was very large, 87cc, which I was told is about 3 times normal size.
Posted 7/15/2007 5:36 PM (GMT -8)
Hello Prostate Veteran,

On a scale of 1-10; 10 being the pain I experienced passing a .25 inch kidney stone with significant bleeding. The 14 pin biopsy was a 2-3 (it was more than just a discomfort), and if I had it to do again I would ask for a more potent pain med. My point is why suffer at all if you don't need to? I also requested pain meds for my severely separated shoulder prior to relocation into the socket, and the doctor quickly complied with a shot of morphine. After a biopsy, 3 surgeries, and a colonoscopy in just a little more than a year I have started to reach the limit of my tolerance for pain and discomfort.

Glen
Posted 7/15/2007 6:00 PM (GMT -8)

I would have to say, Shame on any urologist who causes any patient to feel pain during a biopsy.

I didn't know what to expect, but found later that I had an ultrasound guided biopsy.I think that is what it was called?  I had an IV with a sedative.  I lightly slept, awoke, went home.  Any thing more invasive might have been administered by a caveman.  (My apology to cavemen)

Maybe someone can tell me why any urologist would subject their patient to pain and poking. Are they way behind the times? or just ignorant?

There should be NO discussion about pain, when a simple procedure exists that causes no pain and few after affects. It sounds like some urologists are practicing medicine from the last century.

Posted 7/15/2007 6:40 PM (GMT -8)
I am the ultimate weenie.

In the two months prior to my biopsy, I was obsessed with the possible pain of the procedure.  The night before my biopsy I googled "prostate biopsy pain" and became very alarmed at what I read.  I found out that many biopsies are done without local anasthetic (lidocaine I think is what it is).  When done that way they are about a 6 on a pain scale (1-10).  However, when a biopsy is done with a local, the pain grade is 2.

I did not get any sleep that night.  The next day, I refused my biopsy because I learned that lidocaine was not being used.  My wife got really mad at me for embarrassing her like that, but I don't regret it.

I called around and found my current urologist that would administer a local.  When the biopsy is done using that method, I would say a pain grade of 2 is about right.  The only discomfort really is having an instrument up your anus.

Posted 7/16/2007 11:09 AM (GMT -8)
Good for you Mozart! The only thing more uncomfortable than the biopsy was my interpretation of Gershwin's Rhapsody in Blue...

Some people should not touch a key board, and that would be me. I guess there would be no harm in buying a Bosendorfer 225, and just admirering it.

Glen
Posted 7/16/2007 1:47 PM (GMT -8)
I agree with mozart, the taking of the sample, the area having been treated with lidocaine was about a 2-3 on the discomfort scale.  Face it guys, the worse part of it is having the probe placed there with your backside hanging off the table ( as another writer said.)  My Dr. talked me through the whole thing, no sedative etc., and before he took the first sample warned me that it was about to happen. Then he said there are a total of 12. confused    Yipes!  He took the other samples and then said he wanted to take two more, what he called transitional samples.  I believe they go through multip[le section of the prostate.  My brain said "no way", but my mouth said "go ahead." 

 

It was good that he took the extras, because one found cancer that was not evident from the other samples in that section.

 

Bottom line:  think of the alternatives of not having the biopsy and the cancer staying undetected.  This is one of those times that men need to be strong and get the test done.

Posted 7/17/2007 3:32 AM (GMT -8)

I look at the biopsy very much like I look at colonoscopy, where it's not the procedure that's bad, it's the "what else" part.  (In colonscopy the prep was much worse than the procedure).

With the biopsy, I had no lidocaine and didn't really mind the sampling that much.  But the probe in the rectum was awful for me.  If I had to do it again, I think I'd have it done under conscious sedation.

Posted 7/17/2007 8:15 AM (GMT -8)

Interesting. I don't mind colonoscopies, either the prep or the procedure (though I'm in dreamland when its done). But if anything good came out of my prostate cancer it's that I'm never going to have to have another biopsy on that organ again.

Prostate Veteran

Posted 7/17/2007 4:10 PM (GMT -8)
I HATE needles!! (except for the erection injection) I asked for he lidocaine and got it. He gave me a pill to take a half hour before the procedure and another just before starting the procedure. I was one happy man by the time he started. I didn't mind the probe. It was just a little uncomfortable. The lidocaine shot HURT, a 4 or 5. The rest of the samples were about a 2. I was so doped up, though, I didn't really care.
Posted 7/17/2007 5:19 PM (GMT -8)

I posted above on this subject.  It is interesting that No One has noticed or responded.

My contention is that any Doctor (Urologist)who uses an outdated prostate biopsy procedure that causes the patient to experience pain is at best ignorant and at worst incompetent.

I threw that comment out as a challenge.  I genuinely wanted to know why some prostate biopsies are still being conducted in a manner that causes undo pain.

Since my surgery, I find that I have little patience with medical incompetents. I am much less accepting of the status quo.  This is one of those little things that "bugs me". Do an internet search (goog#el) for "prostate biopsy pain".  I'm sure you will join me in asking why these and others had to suffer for this diagnosis.

Posted 7/18/2007 5:01 AM (GMT -8)

I guess I didn't reply out of embarrassment--and I posted the initial topic. It never occurred to me to ask for a sedative or anesthesia, and at the time of my biopsy, I had been a science and medical writer for more than 30 years. I also didn't asked for a second opinion after being referred by a surgeon for and accepting radiation and hormonal surgery because 4 of my 11 positive cores were Gleason 9.  I was a month or more into my the hormonal part of my treatment before I ever sought the thoughts of another surgeon on my therapy (who assured me that he would have done the same thing). Why? I still can't explain it. I certainly wasn't thinking clearly, at least not in the early stages of my diagnosis.

You raised an excellent question, Lifeguyd, and an issue that urologists themselves should be addressing within their profession.   I don't believe you can call  a urologist incompetent for not recommending a biopsy without offering a sedative. Careless or uncaring, perhaps, and not the person I would recommend to a friend for a biopsy, but I would say incompetent is too strong a word. But as a patient community, I think we should spread the word, here and in other forums, that the option exists to have a biopsy without pain. However, never forget, there is always a some risk of complications any time a you get "put out."

Prostate Veteran

Posted 7/18/2007 5:56 AM (GMT -8)

Friends,

I too felt discomfort and pain as each sample was taken.  I must say that it seemed to be more of an emotional (fingernails on the chalkboard) reflex than severe pain.  I actually became very sad and experienced some kind of wonder......
Each sample was a nick that I felt to the core of my existence..... and to the tip of my penis....

I was given lidocain.  I asked for more during the procedure and was given more.
It didn't help.  I asked the physician as to why the procedure described by so many as painless with the lidocain was so "moving?"  He said that it seems as the patients get younger they are more sensitive in this area than the previous norm. I think now I wish maybe I had taken a Valium two hours earlier....  I'm not sure:

I have both a fairly high pain threshold and most painkillers/anesthesia give(s) me discomfort as well.  (An addictive response and/or a hangover I think.....) 
I don't feel a physician trying not to over-medicate a patient is being incompetent. 
Not to encourage masochism, but the memory of that cluster of pain nodes in that now missing organ is a strong, poignant memory -  an engine-starting diamond of light.
Physicians attempting the procedure at the patient's manageable pain threshold is less bizarre to me than say a woman refusing pain-control for natural child birth.
Sincerely,

CCedar
ICTHUS!

Posted 7/18/2007 9:10 PM (GMT -8)
Pain management is important to most Doc's I think. Some people really need that sedation in addition to a local. While a local works well for most, patient stress and various other factors should always dictate what a Physician does. It can come down to what is best for the patient. There are many Physicians who prefer their patients be sedated mildly for procedures while others prefer not to give anything more than is absolutely necessary.

My only thought about sedating is that it isn't a "local". Sedations (as in one that puts a pateint under) have side effects that require monitoring which makes for a slightly higher risk procedure. Patients also have to be closely monitored and their airway protected anytime they are not alert enough to protect their own. Not that problems are common, they are very rarely an issue. It is a consideration with all medical procedures.
Posted 7/19/2007 12:52 AM (GMT -8)
I was going to refrain from posting further until next week, but as I just had the biopsy last week I would like to tell those who have not had the experience yet that I didn't find it to be anything like I expected. I had no anesthetic and, although the pain of each sample increases slightly as the doctor proceeds, within a minute or two I was left with an aching feeling that was completely gone within an hour or so.  I had wondered if I would be able to sit afterwards and there is no pain associated with movement or position.  There will be blood when urinating but probably less than you expect and the major part of that was mostly in the first day or two for me.  There is still a very tiny bit of blood leaking a week later, but defintely no need ever to worry about having to wear adult diapers.  I do recommend wearing a condom the first time that you have sex as there will be a lot of blood in your semen and the lady may find this unpleasant.  Otherwise there has been no pain associated with going to the bathroom or sexual activity.  I had the biopsy done on Wednesday and took it easy until Saturday when I worked all day in the yard with no problems.  Maybe I was lucky (not with the results, more about that later) but the experience was not that bad.  I have to say that if you delay having a biopsy done when the doctor says you need it you are making a mistake. 
Posted 7/19/2007 4:47 PM (GMT -8)

To Tim's Wife

and to every man who has had to endure a painful prostate biopsy...  May God Bless Each and Every One of You. My uncle and our neighbor both had several of these procedures done and I was told by my aunt and our neighbor's wife... several years apart how their husbands both hated it when they it became time for them to go and have another one done because they did hurt. Also, I had a urologist tell me that this procedure could be quite painful.

 So, you can probably imagine what my thoughts and feelings were when my husband came home and told me that his urologist had set up an appointment for him to have this done.  I have read that some urologists put their patients in the hospital and do the biopsy under anesthestic.  And for many reasons, I believe every man should be given this option.

 My husband's biopsy came back positive and he just finished 25 radiation treatments and a 90 seed pallidium implant.  However, he told me awhile back that out of all of the treatments he had done that having the biopsy was the worst experience for him.

I realize that many men have little or no pain while undergoing this procedure and I think that is wonderful and these men should be very thankful. Actually, I believe their experience has nothing to do with them being "macho" as much as they would like to believe, but everything to do with whether or not their urologist has "state of the art" equipment, uses numbing agents, a local anesthetic, and for some it could very well be that they have a high pain tolerance. I have an aunt who doesn't feel pain and had to be very careful each time she had a child because she never experienced pain while having contractions. 

 My husband's gleason score was a 7.  His psa was 6.6 at the time of his biopsy, but had been as high as 7.2 which he had not known. Out of 12 cores taken, 8 came back positive for androcarcinoma. (sp?) Seven were 3+3=6 and one core was a  3+4=7, which is why his gleason score had to be a 7.

He had 25 IMRT (radiation treatments) and a 90 seed pallidium seed implant and he is almost three months out of treatment.

His psa at one month post treatment was 2.60, his next psa will not be until the last of November.

 'And what is as important as knowledge,' asked the mind?  Caring and seeing with the heart,' answered the soul.

 

 

 

 

 

Posted 7/19/2007 5:21 PM (GMT -8)
The last comment was honest and sincere and I believe with all of my heart that you should make such comments, share your experience and that helps everyone know that everyone's experience is not the same.  I therefore have given this comment a lot of thought and the last thing that I want to do is offend anyone.  If this comment bothers you then anyone who has the power to do so is welcome to delete it.  It is simply this:  I believe that the worst experience for me would be to tell my wife "I'm sorry that I didn't have the biopsy done."
Posted 7/19/2007 7:16 PM (GMT -8)
GT,

Oh, please don't ever be sorry for sharing what you experience. It would be a shame to hear only the bad OR just the good. We need that balance! Thanks!

Swim
Posted 7/19/2007 7:42 PM (GMT -8)
I don't believe Jeff was given lidocaine - it hurt too much for that to have ocurred. He did have some kind of sedative - one valium, I think, or something like that to help him relax. The biopsy and the catheter are the 2 things that bothered him the most, I think more than the surgery.

bec
Posted 7/19/2007 7:43 PM (GMT -8)
I dreaded the thoughts of a prostate biopsy. However, I would NOT describe my actual biopsy as an unpleasant experience. My urologist made a few injections of a numbing medication into my prostate through the rectal wall--I felt a little brief pin prick which wasn't that bad. He then proceeded to take 29 samples of my prostate--I recall only feeling one slightly uncomfortable moment when a sample was taken--perhaps the numbing medication had not yet taken effect in that area of the prostate. When you describe your biopsy, it sounds like no numbing medication was given to you. If that is the case, the biopsy experience would not be too pleasant. Each PCa patient should discuss with his urologist the exact procedures to be followed before the biopsy and what kind of medication will be given to the patient so that having a biopsy will not be an uncomfortable experience.

Dave
Posted 7/20/2007 6:17 AM (GMT -8)
I have no tolerance for pain. My wife's brother had a biopsy in which the first two "bites" were very painful and the rest were OK. So I was quite worried about the pain before my biopsy (partly because I had had an awful experience six weeks after a TUNA procedure where I was hospitalized for blood clots and they put in too small a catheter and the pain was unstoppable). As it turned out, they used lydocaine and it really felt more like pressure than pain when they snipped it. Not even as bad as the snips from a colonoscopy. Of course, there was the emotional pain of lying there with my butt hanging off the edge of the table while the doctor hands the 10-inch needles to his young female assistant. It wasn't the most dignified situation.

So I think in my brother-in-law's case maybe the lydocaine hadn't fully taken effect, or maybe they didn't cover the entire area. I do agree with those above who say urologists should pay much more attention to eliminating this pain. They seem to think it's something people can tough out.
Posted 7/21/2007 9:21 AM (GMT -8)
I posted about this somewhere else around here.

My first three biopsies I was wide awake for the "bee sting" as it was described to me. 

"Bee sting" my rosy red hiney.

The fourth session was by a urologist who had been biopsied himself.  Guess what?  He used the local anesthetic, which was still unpleasant, but it made the 12 pokes totally painless.  They do have to attend a course to learn how to do it, but I think it's only one day or less.

The fifth time I was under general anesthesia because he took 44 samples.

Posted 7/23/2007 7:20 PM (GMT -8)
If you have your first biopsy coming up, I've been surprised to find 12 days later that there is still bleeding, usually in the morning.  I'm assuming that this is nothing unusual.
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