The wait for the biopsy appointment was difficult. It eventually came through for the 29th November 2022.
I was nervous but not overly so - (or so I thought) - My wife drove me there, and was there for moral support. When the nurse took me in to take my history and carry out blood pressure etc, my blood pressure was sitting at 170/105! They wondered if they should proceed. A few subsequent blood pressures were a little less. In the end they were reassured by my previous normal 24 hr blood pressure monitoring results and agreed to proceed.
I have not read much on the forum, so far, about biopsies - but they are really not much to worry about. I had spent a lot of time looking them up on the internet in the weeks beforehand and got varying reports from the horrific to "no big deal".
The standard now should be Trans-perineal biopsies and not trans-rectal biopsies. This avoids the main risk of infection and even sepsis with trans-rectal biopsies and also affords better access to all areas of the prostate for the biopsies. With the transperineal approach the biopsy needles go in through the skin between the back of the scrotum and the anus. It sounds scary but it is not too bad. Anxiety perhaps makes the experience worse.
I was shown into the biopsy room and was able to undress in an adjoining toilet, removing pants and underpants and putting on a gown. I then had to sit on a motorised chair which tilted back and allowed me to put my legs up in supports for the biopsies. A nurse specialist carried out the biopsies and there were three other nurses including a student nurse in the room! I did not really find it embarrassing - perhaps because I was more anxious than anything. The obligatory DRE followed and then injections of local anaesthetic (lidocaine) to the skin on each side of the mid line just above my anus.
The next thing was the ultrasound probe which had to go into my back passage. She squirted a large syringe of lube into my rectum and then got the probe. I offered to "bear down" to make it easier but the nurse said not to do that. She then unceremoniously shoved it in. That was sore - but not unbearable. in fairness they probably reckon this is the best way to do the insertion - get it over with quickly!
I was not able to see everything, but once the LA had taken effect the nurse specialist inserted a guide canula on each side of the midline just above my anus, and then inserted a long needle through this to inject more local anaesthetic around the prostate itself. This was sore but not much more than that. It allowed my prostate to be visualized on the ultrasound screen and allow the LA and the biopsies to be accurately positioned.
The next step was to do the biopsies themselves- first one side then the other. These were done using a long hollow biopsy needle which was repeatedly inserted through the guide canula - so there were no further punctures to the skin. The biopsy needle was guided visually using the ultrasound live images. To visualize properly, the rectal probe had to be manipulated a bit. They had told me that the sore part of the rectal probe would be inserting it, but I have to say some of the manipulation was uncomfortable if not painful. Most of the biopsies I really did not feel - apart from when the biopsy "gun" was fired and you feel a little flick inside. About 6 biopsies were moderately painful ( I guess the local did not work as well in that area). it is hard to describe the pain - but it is deep inside but only momentary. I had 23 biopsies taken in total. The procedure itself only took 15 minutes.
Afterwards they put a pad on me held by gauze underpants just to manage any bleeding, and I was able to get up and get dressed. They monitored me in a side room for an hour or so after and I got tea and biscuits!! Everybody was very kind and attentive.
RESULTS: I did not get these until the week before Christmas - 19 out of the 23 biopsies were positive and the Gleason Score was 7 (3+4). This together with the high PSA which had risen to 23.9 and the possible extra-capsular involvement put me in the high risk category requiring treatment. I was reassured to a degree by the Gleason score anyway.
