Prostate biopsy report. What actually happens:pain,bleeding,etc...

Hi all,

Prostate biopsy report. What actually happensain,bleeding,etc...

This is a detailed report of what exactly happens during a
prostate biopsy. Before my procedure I couldnt really find a
comprehensive review, so here's my attempt.

Me, 55 yo male PSA 5.2 No cancer DX BPH.

The Procedure.
-------------------------------------------------------------

The patient goes into a room. The nurse explains what is going
to happen. You put on a gown and are positioned on a table on
your leftside, knees drawn up, with a pillow betwee the knees.

The doctor comes in, explains again what will happen and gives
a brief demo of the ultrasound wand, and the prostate gun.

The gun itself is a plastic tube, like a straw, about a foot
long with a green handle. He shows how it works and tells you
there might be a snap when it fires. I have heard the snap
bothers some people, but I could barely hear it.

The doctor puts some lido gel into the rectum, and sticks in
the wand. The screen is in front of you, so you can watch all
this. He manipulates the wand visualizing the anatomy from
several perspectives, and measures the prostate. The wand is
connected to a computer with a mouse, so he draws a line
with the cursor on the screen about the prostate from several angles and
the
computer calculates a size. Mine was 42G. Normal for a man
my age is 24G. I'm not sure of the difference between Grams
and cc's, but this one was done in Grams.
This part takes 4 or 5 minutes.

The doctor then numbs the prostate with a few lido injections.
This takes maybe a minute. Pain is minimal. Maybe a 2 at the
most. It really is just a slight sting.

He then takes the cores. Origionally he wanted to do 18 sticks,
but I said I didn't want that many, so he very amiably said
he would do 12. It was my choice. He was very agreeable.

The cores are taken very quickly. Maybe 3 minutes and it's done.
Again, the pain is just a brief sting, maybe a 2. I was actually
watching the needles go in on the ultrasound screen. I thought
this would bug me, but it didnt.

That's pretty much it. The whole procedure, start to finish, takes
maybe 10 or 12 minutes. Fear Factor is a 10, actual procedure is a 2.

The Other Stuff.
------------------------------------------------------------------

Pain
-----
OK, about 30 minutes after the procedure, I started to get some
pretty bad pain, which lasted about 2 or 3 hours. Nobody had told
me about this and I wasnt expecting it. It didnt last more than
a couple of hours, but it wasnt pleasant.
My wife was driving me home, which was good, because if I had had
to do it myself, I would have had a tough time. I havent heard
anybody mention this pain before so maybe it was just me. Maybe
the lido wearing off. I dont know. After this, there was basically
no more pain, just discomfort. But that 2 or 3 hours was pretty
tough. Worse, because I wasnt expecting it, and didnt know how
long it would last.

Bleeding
---------
I didnt have any rectal bleeding at all. There was no uriniary bleeding
the first day, but days 2 and 3 were substantial bleeding. Bright red
and frequent. Doesnt hurt, but spooky. This stopped after 2 days.
I knew this was coming, but its still pretty gruesome to look at.

I am now about 17 days post and I am still having some bleeding. Not
heavy, but there. The doctor says bleeding can go on for a month or
more,
the prostate being a very vascular organ which gets a lot of sticks
with big needles. 18g, I think. At any rate, he wasnt concerned, but
they never are unless your head actually falls off. This they call
slight discomfort.

Most of the people in the groups, seem to have minimal bleeding, or just
a couple of days. I dont know whats different about me. Maybe its just
that big prostate.

What specifically happens is this:

The urine is clear during the morning and early afternoon. Late
afternoon
or evening, there is some red tinging with the first part of the stream,
then it runs clear. It is not enough to discolor the water in the bowl,
and if you are not actually looking down at the time, you wont notice
it.

I have kind of a theory that this type of trace bleeding may be more
common
thatn most people realize, because, if you are not actually looking for
it, in good light, you wont see it.

Has anyone else had this? Or is it just me?

It seems to be very slowly getting better, but has lasted much longer
than
I was told to expect. This is another example of the stuff they tell you
afterword.

At any rate, the procedure is nowhere as bad as you think it will be, so
I hope this puts at ease anyone who may be having one for the first
time.

BTW, interesting article on overdiagnosis and overtretment of pca.
There seems to be a lot of new research coming out of scandinavia
and holland.

http://sci.tech-archive.net/Archive/...r/2007-10/msg0
0047.html

A couple of additions...

On Sat, 3 May 2008 07:56:05 -0400, piker wrote
(in article <OoYSj.2999$_.403@bignews8.bellsouth.net>):

[snip]
> The Procedure.
> -------------------------------------------------------------

The patient arranges to pay for the procedure. Insurance is checked and any
copayment or deductible is paid up front. Then wait...and wait.... While
you are waiting you fill out a three page form about your medical history
even though you filled out the same one last time. A nurse calls your name
and asks what you are here for, even though she has your chart in front of
her.

> The patient goes into a room. The nurse explains what is going
> to happen. You put on a gown and are positioned on a table on
> your leftside, knees drawn up, with a pillow betwee the knees.

Then you wait... and wait... listening to music that makes your teeth clench.
Outside you hear the doctor yucking it up with a drug salesman.

> The doctor comes in, ...

and tells you about the new yacht he is buying and asks what you are here
for. After you remind him, he

> explains again what will happen and gives
> a brief demo of the ultrasound wand, and the prostate gun.
[snip]

> The Other Stuff.
> ------------------------------------------------------------------

[snip]

> Bleeding
> ---------
> I didnt have any rectal bleeding at all. There was no uriniary bleeding
> the first day, but days 2 and 3 were substantial bleeding. Bright red
> and frequent. Doesnt hurt, but spooky. This stopped after 2 days.
> I knew this was coming, but its still pretty gruesome to look at.

The bloody semen is worse :-)

The Wait.
--------

Now you loose sleep worrying about the results until the doctor calls you
which may take a week or more.


--
Dedman

** Posted from http://www.teranews.com **

"piker" <piker@d;lhdp.com> wrote in message
news:OoYSj.2999$_.403@bignews8.bellsouth.net...
> Hi all,
>
> Prostate biopsy report. What actually happensain,bleeding,etc...
>

<snip> ouch!

Whilst he was 'in there' I said 'How will this affect my golf handicap?'
His reply 'Puts a new perspective on a hole in one'
:0)

Six weeks post-radiation, infrequent (sore) bowel movements but other than
that fairly normal.
--
Rog
http://www.rog.richieward.com

piker wrote:
> Hi all,
>
> Prostate biopsy report. What actually happensain,bleeding,etc...
>
> This is a detailed report of what exactly happens during a
> prostate biopsy. Before my procedure I couldnt really find a
> comprehensive review, so here's my attempt.
>
> Me, 55 yo male PSA 5.2 No cancer DX BPH.
>
> The Procedure.
> -------------------------------------------------------------
>
> The patient goes into a room. The nurse explains what is going
> to happen. You put on a gown and are positioned on a table on
> your leftside, knees drawn up, with a pillow betwee the knees.
>
> The doctor comes in, explains again what will happen and gives
> a brief demo of the ultrasound wand, and the prostate gun.
>
> The gun itself is a plastic tube, like a straw, about a foot
> long with a green handle. He shows how it works and tells you
> there might be a snap when it fires. I have heard the snap
> bothers some people, but I could barely hear it.
>
> The doctor puts some lido gel into the rectum, and sticks in
> the wand. The screen is in front of you, so you can watch all
> this. He manipulates the wand visualizing the anatomy from
> several perspectives, and measures the prostate. The wand is
> connected to a computer with a mouse, so he draws a line
> with the cursor on the screen about the prostate from several angles and
> the
> computer calculates a size. Mine was 42G. Normal for a man
> my age is 24G. I'm not sure of the difference between Grams
> and cc's, but this one was done in Grams.
> This part takes 4 or 5 minutes.
>
> The doctor then numbs the prostate with a few lido injections.
> This takes maybe a minute. Pain is minimal. Maybe a 2 at the
> most. It really is just a slight sting.
>
> He then takes the cores. Origionally he wanted to do 18 sticks,
> but I said I didn't want that many, so he very amiably said
> he would do 12. It was my choice. He was very agreeable.
>
> The cores are taken very quickly. Maybe 3 minutes and it's done.
> Again, the pain is just a brief sting, maybe a 2. I was actually
> watching the needles go in on the ultrasound screen. I thought
> this would bug me, but it didnt.
>
> That's pretty much it. The whole procedure, start to finish, takes
> maybe 10 or 12 minutes. Fear Factor is a 10, actual procedure is a 2.
>
> The Other Stuff.
> ------------------------------------------------------------------
>
> Pain
> -----
> OK, about 30 minutes after the procedure, I started to get some
> pretty bad pain, which lasted about 2 or 3 hours. Nobody had told
> me about this and I wasnt expecting it. It didnt last more than
> a couple of hours, but it wasnt pleasant.
> My wife was driving me home, which was good, because if I had had
> to do it myself, I would have had a tough time. I havent heard
> anybody mention this pain before so maybe it was just me. Maybe
> the lido wearing off. I dont know. After this, there was basically
> no more pain, just discomfort. But that 2 or 3 hours was pretty
> tough. Worse, because I wasnt expecting it, and didnt know how
> long it would last.

I think there are several possible sources of such pain, but I doubt
that any of it comes from the prostate. The rectal wall can get painful
particularly if you have hemorrhoids. I had some pain of that sort. I
called my surgeon and he prescribed a suppository, but by the time I
got it from the drug store, the pain had lessened and I never used it.
I would guess that one could also have a colon spasm, and that pain can
be pretty bad, particularly if it persists. I've had my share of those,
but not from the biopsy.

>
> Bleeding
> ---------
> I didnt have any rectal bleeding at all. There was no uriniary bleeding
> the first day, but days 2 and 3 were substantial bleeding. Bright red
> and frequent. Doesnt hurt, but spooky. This stopped after 2 days.
> I knew this was coming, but its still pretty gruesome to look at.
>
> I am now about 17 days post and I am still having some bleeding. Not
> heavy, but there. The doctor says bleeding can go on for a month or
> more,
> the prostate being a very vascular organ which gets a lot of sticks
> with big needles. 18g, I think. At any rate, he wasnt concerned, but
> they never are unless your head actually falls off. This they call
> slight discomfort.
>
> Most of the people in the groups, seem to have minimal bleeding, or just
> a couple of days. I dont know whats different about me. Maybe its just
> that big prostate.
>
> What specifically happens is this:
>
> The urine is clear during the morning and early afternoon. Late
> afternoon
> or evening, there is some red tinging with the first part of the stream,
> then it runs clear. It is not enough to discolor the water in the bowl,
> and if you are not actually looking down at the time, you wont notice
> it.
>
> I have kind of a theory that this type of trace bleeding may be more
> common
> thatn most people realize, because, if you are not actually looking for
> it, in good light, you wont see it.
>
> Has anyone else had this? Or is it just me?

I didn't have a rectal bleeding and din't notice anything in my urine.
I had some blood in my seminal fluid, but my doctor had prepared me
for that and said it was innocuous. I gather it can last up to six
weeks, but I wasn't paying much attention after I got the cancer diagnosis.

>
> It seems to be very slowly getting better, but has lasted much longer
> than
> I was told to expect. This is another example of the stuff they tell you
> afterword.

Didn't you call your doctor and ask for help? I'm sure there are
several things he could have done to help you.

>
> At any rate, the procedure is nowhere as bad as you think it will be, so
> I hope this puts at ease anyone who may be having one for the first
> time.
>
> BTW, interesting article on overdiagnosis and overtretment of pca.
> There seems to be a lot of new research coming out of scandinavia
> and holland.
>
> http://sci.tech-archive.net/Archive/...r/2007-10/msg0
> 0047.html
>

piker wrote:
>
>
> BTW, interesting article on overdiagnosis and overtretment of pca.
> There seems to be a lot of new research coming out of scandinavia
> and holland.
>
> http://sci.tech-archive.net/Archive/...r/2007-10/msg0
> 0047.html
>

I didn't read the article carefully, but my general impression is that
it doesn't say anything particularly startling. It is well known that
it is difficult to determine just which early cancers really need to be
treated and which can be followed by expectant management. The article
seems basically a review of the literature, and, as far as i can tell,
doesn't contribute anything particularly new to the discussion.

I think we are still left with the same situation as before. For men
with a life expectancy of less than ten years, the great majority of
cancers need not be treated aggressively since they will probably not
bother the patient much during the rest of his life. Many such men
should not even have PSA tests. For men with lifespans of at least 15
years, it doesn't seem feasible not to treat a cancer of at least
Gleason six, since there is no trustworthy method to estimate how long
it will take for the cancer to metastasize, or even if it will. Perhaps
some of the new markers for prostate cancer will change this in the near
future.

>
>I think there are several possible sources of such pain, but I doubt
>that any of it comes from the prostate. The rectal wall can get painful
>particularly if you have hemorrhoids. I had some pain of that sort. I
>called my surgeon and he prescribed a suppository, but by the time I
>got it from the drug store, the pain had lessened and I never used it.
>I would guess that one could also have a colon spasm, and that pain can
>be pretty bad, particularly if it persists. I've had my share of those,
>but not from the biopsy.
>
>>

great idea. i never thouoght of that. yes, I do
have them and that may explain a lot. I guess if the
needle punctured a hemorrhoid it would hurt.

I wonder if that might explain the extended bleeding also.
Not quite sure how though. Seepage into the urethra from
a hemorrhoid? I dont know. I dont recall any rectal bleeding,
and as of now, the urine seems to have finally cleared up.

Thanks for the suggestion. I'll mention that to the doctor. You
think he would have said something. Thanks again.

>

piker wrote:
>> I think there are several possible sources of such pain, but I doubt
>> that any of it comes from the prostate. The rectal wall can get painful
>> particularly if you have hemorrhoids. I had some pain of that sort. I
>> called my surgeon and he prescribed a suppository, but by the time I
>> got it from the drug store, the pain had lessened and I never used it.
>> I would guess that one could also have a colon spasm, and that pain can
>> be pretty bad, particularly if it persists. I've had my share of those,
>> but not from the biopsy.
>>
>
> great idea. i never thouoght of that. yes, I do
> have them and that may explain a lot. I guess if the
> needle punctured a hemorrhoid it would hurt.
>
> I wonder if that might explain the extended bleeding also.
> Not quite sure how though. Seepage into the urethra from
> a hemorrhoid?

I think that blood in the urine has nothing to do with any problem you
may have in your rectum or colon. If I remember correctly, blood in the
urine is not uncommon after a biopsy, but it doesn't usually last very
long and in any case is usually of no particular consequence. Blood in
the semen is much more common, and I certain had some of that. It is
also usually of no consequence. After all your prostate, which makes
most of the seminal fluid, has just been punctured repeatedly. It would
not be surprising if some of the blood in the prostate leaked into the
urine.

> I dont know. I dont recall any rectal bleeding,
> and as of now, the urine seems to have finally cleared up.
>
> Thanks for the suggestion. I'll mention that to the doctor. You
> think he would have said something. Thanks again.

My experience is that doctors often don't go through everything that may
happen. They describe the most common side effects and they tell you
about anything you should watch out for which might indicate a serious
problem. If something else happens, you have to ask about it. I at
least call the triage nurse at the medical office I use if I have a
question.
>
>

Leonard Evens wrote:

> My experience is that doctors often don't go through everything that may
> happen. They describe the most common side effects and they tell you
> about anything you should watch out for which might indicate a serious
> problem. If something else happens, you have to ask about it.

Well said so far, but here is where problems can arise if pts don't do
exactly what Piker has done: ask elsewhere. We've seen far too many pts
come here with problems, some quite serious, that we knew about but
about which their doctors were clueless even upon direct questioning.
Keep asking.

I.P.