Biopsy with transrectal ultrasound?

Thanks for your quick reply. He hasn't been given option of a general and to me this would be more preferable. I imagine it would be best to be unaware of what was happening. I suppose it depends on the individual. He had retention after bladder scan not long ago so he could possibly be facing this again after biopsy under general. So basically this guides the needle nothing else. In one way then you could say that they are going in blind as they don't know where areas of concern, if any, are. Just wanted to clarify that. Can I ask if local is adequate for this procedure if he does go ahead with it? I know they have a numbing agent of some sort but is it enough? Maybe an epidural would be an option.

I didn't feel pain or distress with the local / awake bopsy I had. However, we are all individual and I am not naturally anxious so I prefer the awake option. It did feel  the impact of the biopsy sampling. Remonded me of the sound of a nail gun, or a stapler for some reason! Also it was somewhat undignified, but I remember commenting that it was a kind of gender justice, as my wife had had much more personal invsion due to pregnancy and childbirth!

I have had two biopsy and both were done with a small shot to the area of entry and a pill to relax me. I would not get the general unless you had to. Can create a lot of issues that are not nesscary. The procedure for 12 samples is about 20 minutes or less. The pain starts with the 6th or 7th samples since the prostate tissues get a little inflamed at that point. By the 12th you are glad it is over. The problem is you usually can heard the small needle punch being cocked just before they actually take each sample, which means by the 12th the sounds mean some pain. There are usually two individuals in the room .. The Doctor taking the samples and the another person handling the ultrasound. Some individuals bring their music with them which is helpful. If not the two individuals usually will talk to you about anything which helps.

If you can get the biopsy done by using 3T MRI, then I would take that route since it gives the doctor a better chance of finding the area of concern and getting a larger number of samples from that area. The ultrasound is almost a shot in the dark method targeting only the areas where cancer is usually found.

Loved that Pepasan...My wife said the same.."don't know why you guys make such a fuss, We get put though this type of invasion very regularly, and as for child birth...don't start me" ^^^

My doctor said he does not do many transrectal biopsies now due to the infections. He prefers transperineal, where he can get at all the prostate and infections are pretty well nil. When he will do a transrectal is when the patient has had a MRI and there is a lesion to target and he will only use one or two needles via MRI guided.

I think in this day and age, the ultrasound might be ok if you live nowhere near 'decent' medical facilities and have no choice. Considering what we are looking for, I would demand the best diagnostic method available.  

Maybe I was lucky not to get any infection complications. I was given preventive antibiotics as a precaution, and was fine.

I had one with a local  anesthetic and one without from a b***h of a Uro who had misconstrued a letter I had written to my MP who was also the Health Minister with her chief who had just retired permission about the hospital having stopped the Free PSA test due to withdrawal of funding by the NHS accountants. To get one I had to get my GP to do the blood test and send it to a Lab in Sheffield for testing at my expense. When it came back I had to explain the result to him. You know more about this than I do he said.

As she was doing her preparation I asked if she was not going to give me an antibiotic. We don't do that at this hospital she said. Well don't forget the local  anesthetic I replied. I don't do that either she said but you can write to your MP about it. That was when the penny dropped, I should have got off the table at that point.

As 16 needles went in I swore at her 16 times. That was the time I started passing blood and clots after it and was kept overnight. She came round later to see how I was and smirked as she told me that she had just been appointed head of urology. You won’t last long I told her. The patient before me had been in for a vasectomy and it had taken her forty minutes to do it and had made two phone calls for advice during it.

She was gone within a few months. 

Hi Caz,

It's my understanding that they can tell the difference with 3T.

I have had 2, and they both said I had prostititus, and didn't have cancer.

Neal

Thanks Neal, that's good to know. Amazing the technology we have now. Thank God for it

Caz

When it was over and I was out of the theatre a nurse took my BP. It was 184/**and she asked how long I had neen hypertensive. I said that I was not and she said no wonder it is high after what you have just been through.

325 euro sounds like a great price to me. congraduations. 

 

Yes, it almost sounds too good to be true. We are well pleased.

MRI charges vary wildly. Some London clinics (probably not for the one you want) have cheap rates in evenings and weekends. I could not take advantage of them as I have an MRI compatible pacemaker that needs ones who can meet the required protocol.

 

The 325 euro sounds good...for a 3T MRI. You just hope they have an experienced technician for the images and a better radiologist for the report. Make sure when they give you a copy of the images on a DVD, there is the image reading software installed. 

Are  you commissioning the MRI or is it via a referral from a doctor? The reason I ask is because the radiologist will prepare a report of what they find. Usually, you do NOT get this report, it goes to the referring doctor. However, if you commissioned the images, make sure they give/send you the report. It might take a few days to be released as it need to be read by a radiologist. 

Hi Geoff, he is asking his consultant for referral letter, this is only way it can b booked. Didn't realise that about software, thanks. We get a copy and his consultant will also get one. It's in a hospital department and v professional from what I can see x

Great Caz. The software is usually built into the DVD so that you can view the images. I am sure they will provide every thing for you. 

When you read the report....it is like seeing if you won the lottery...No PCa, you won.....

Make sure that 325 includes the cost of the report, the CD and the cost of the postage to you.

I had to pay for each on top of the MRI cost. When I had a CT scan at another hospital it was all included in the price but the promised report in two days did not happen. Despite repeated phone calls it took eleven days. I was actually seeing my consultant when his secretary managed to get it faxed to her.

You can browse through the CD/DVD and wonder and worry about what you are actually seeing.

They said they give us a copy and send other to urologist, I hope its not extra. Seems very cheap for a high-quality scan. I agree, we probably would be sitting looking at it trying to work out what we were seeing, and see things that probably aren't there!! Best not to look. Hopefully we won't have to chase it up as biopsy is pencilled in for end of January.

For private that is all a long time. Tony Blacknurn was diagnosed and operated on in 24 hours and was found not to have cancer.

https://patient.info/forums/discuss/dj-has-prostate-surgery-after-a-day-in-pain--521372

 

Hi Derek, I know, it seems like a bit of a long time. What has happened is that urologist has put him on his NHS list which is end January. He has been in touch with the secretary to ask about going on private list and getting it done sooner. One bit of good news today is that they have said his PSA has gone down from 9.5 to 7.6!! We pray it continues declining. It's still high for a 50-year-old but better than the last couple of tests. They are doing another test before biopsy but that's the other side of Christmas.

I think we will both be too scared to look!! He has found out this evening that his levels have gone down slightly from 9.5 to 7.6 so it's a step in the right direction.

Really 7.6 is not high if you have BPH or prostatitis. When mine was 9.8 it did not bother me as my prostate was 75 grms then from 5.1 when it was 35 grms.

I assume that as he is having the MRI in Dublin he has an NHS Urologist that will be in N.I. 

That's right Derek. His NHS urologist is based in Belfast but he is on his private consulting list. He pays each time he has an appointment. It will be interesting to find out the size and weight of prostate, the scan will probably tell us that. I read that a normal one should weigh 20-25g!!

He is more fortunate with his consultant that I am with mine. Mine all say that that they cannot switch patients from their private list to their NHS one and you need a new referal to get on it. Posters from N.I. all complain of long waiting times and Pro TURP old fashioned attitudes.

After my PVP on my 75grm prostate in 2004 it regrew to 135 grms. by 2013.  Prostates are like weeds in that respect  if they are not removed by the root. 

People used to talk of "Woman's troubles" but it seems that we men have a problem that is very often not solved.  

Caz, that is a 20% reduction. When you have PCa, it is usually a one way incline, upwards. Hopefully, the MRI, while expensive, will give you some answers and you can get on with your lives. 

The PSA 'number' and monitoring has commenced in your partners life. Eventually, until the number stabilises within some range, I would have a new test every 3 months, and when stabilised, every 12 months. 

We were feeling upbeat and optimistic today until the consultant emailed in response to our request for referral letter for MRI. He will give us one but makes it plain that he doesn't see any advantage over a normal scan available locally and apart from giving him some guidance during biopsy it's not really going to help. His reasoning is if it is a high grade cancer it will not be visible on scan if too bulky?? What is high grade, aggressive?? I don't understand. It's like he already has decided what the verdict will be without having seen scan or biopsy results. We are naturally extremely concerned but will push on with 3T MRI and biopsy. Maybe then we will have an answer.

Hmm, I wonder if any of the posters from Northern Ireland have been under my partners consultant? He is not old, middle age I'd guess but I think he is being very clinical and cold about the whole thing. I suppose it's all in a days work for him but this is the most precious thing in my life he is meant to be taking care of. You are right about mens troubles though, I never knew this existed until about four months ago. I used to say "It's a mans life", not any more. x

The number of top Uro's in NI must be quite limited. The same applies in some areas of England. There was a lady posting about her husband’s PSA/prostatitis and BPH with a similar problem to you a few months ago in the Wigan/St Helens area who could not find a good one in Manchester.

This is the link to two of her threads where some may interest you and keep you up all night. I don't think that she ever came back with what eventually happened.   

https://patient.info/forums/discuss/bph-currently-cic-still-get-natural-urge-530906  ;

https://patient.info/forums/discuss/urodynamic-tets-booked-for-male-who-is-cic-532829?page=0#2325535

 

 

Thanks for that Derek, I'll definitely have a look. I just hope the uro my partner has is good at what he does. It's like anything else I suppose, some are at the top of their game and then there are the rest

With the NHS we are supposed to be able to choose where we are treated and by whom particularly if a treatment is not available in our area. However area health authorities now claim that they cannot afford to pay for it.

When we lived in Edinburgh it took some persuading to get referred to Newcastle who were doing PVP trials. Here I got a referral to one of the top two British Uros who sees patients in Brighton as well as a London hospital.  At the time he judged that I was coping well and could wait a while. I then found that the TURP only one I had been seeing locally had not told me about one of his colleagues who specialised in advanced laser surgery