It took me three years to find a urologist in "progressive" Portland, Oregon that performed transperineal prostate biopsies. Very little pain, no antibiotic and I went back to work that afternoon.
My husband's Urologist doesn't use Cipro as a prophylactic antibiotic. He uses IV Rocephin (Ceftriaxone) which is a Cephalosporin antibiotic. Husband had no complications after his MRI Fusion Guided Biopsy.
"Perineal prostate biopsy is more painful than transrectal ultrasound prostate biopsy" is a myth. I had it with half of usual dose local anesthesia at my request. There was no pain at all, during and after the procedure. When I touched the area at home, there was no soreness. Compare this to a tooth extraction I would say the tooth extraction is much worse. I was back to regular activity the next day, no pain medication needed.
When deciding the best procedure, do doctors ever consider the patient perspective? With a transperineal procedure, I will be required to be naked from the waist down, my feet will be placed in stirrups, and my genitals will be up in the air for everyone to see. That means, at the very least, a doctor and an assistant, but often it involves more people, especially in a teaching hospital. So I would have to endure the humiliation of having my dick and balls in the air and on display for anyone in the room. Also, this procedure is often done under general. Like many people, I do not respond well to anesthesia, and frankly it's not a minor thing even under the best of circumstances. So I get there are pros and cons on each side of this issue, but as a doctor I would expect you to consider the patient's likely experience and their feedback to be extremely important factors in this decision. I am bothered it was not part of this mini lecture.
I’m with you. Most doctors completely ignore the humiliation factor of the transperineal approach as if it’s not a real concern of many male patients. My urologist did my biopsy transrectally and it was effective (accurately diagnosed my intermediate grade cancer) and quick with a fast recovery period - very little pain and no infections that this presenter claims are so prevalent. I met 5-6 guys durning radiation treatments and all had transrectal biopsies with no infections. I discussed transperineal biopsy with my urologist and he even said “I’m not doing THAT when I need a biopsy”. I can confirm the humiliation and pain of the transperineal approach when it was used to place spacer gel prior to my radiation treatments. Pants off, hop on table in front of two nurses, scoot down to hang testicles off table, then lay back. At that point a small towel was provided to cover genitals, but plenty of full exposure was already complete. They continue to observe as ultrasound probe is inserted in rectum. The numbing medicine shots into the perineum almost made me jump off the table and there were 3 (since distance to prostate s further from here). Some guys have no problem with any of this, but plenty do. When there are two effective ways to get the same result, no one should begrudge the guy who chooses the option that is far less humiliating and painful.
@@gregmatzinger7758 Thank you for supporting my thoughts. It's always great to know I'm not alone in this. One thing you said stimulated an area of thought: "...as if it’s not a real concern of many male patients." This is such an important comment. First, I know some men are not fazed with this. I've seen men state that once they had their first DRE, all dignity went out the window and they don't care anymore, that they don't care how naked they are or who looks at them. I believe them. I'm glad they don't experience humiliation or emasculation when these times come. But your comment points to how doctors don't ask and just assume. I think that happens far too often. And the thing about men is most men in the world follow the same code of masculinity that values stoicism, strength and invulnerability. So when a doctor makes a recommendation, they say "yup" and don't express concerns because that would reveal vulnerability and weakness. I frequent a couple Prostate Cancer discussion forums, and these men sign in and pour their hearts out about experiences during the process of treatment that left them feeling dehumanized, humiliated or even emasculated. Sorry for carrying on. In short, I think we need to put more resources and energy into the psychological aspects of PC treatment. And doctors need to learn to set up discussions with men that encourage them to speak more freely about their emotions and concerns. Thanks for listening to my Ted Talk.
Oh, there's plenty to think about here. Transperineal biopsies are more painful, as it is difficult to get local anesthesia to the right places to be effective, so doctors tend to administer general anesthesia. General carries its own risks and many people tolerate it poorly. Transperineal biopsies require a man to be naked from the waist down, his feet placed in stirrups, leaving his legs spread wide and his genitals exposed to anyone in the room to see. I have talked to men who have had the procedure and they unanimously found it to be humiliating. I had a transrectal biopsy. My doctor gave me the choice as he was adept at both procedures. With the transrectal procedure, I was able to lay in a fetal position. The whole procedure lasted ten minutes and was relatively painless and I felt I was able to maintain some degree of dignity. Accepting a 3% chance of infection was worth the risk to me.
Proponents of transperineal and haters of men who have dignity concerns over transperineal will argue “what are you so worried about? You will be draped”. What they fail to acknowledge is that you don’t show up draped and you don’t leave draped so those almost always female nurses will have plenty of exposure to your genitals while you are placed in position, draped, then undraped. Some guys enjoy or don’t care about this exposure. Many do. The choice is yours. I chose transrectal until I couldn’t.
It took me three years to find a urologist in "progressive" Portland, Oregon that performed transperineal prostate biopsies. Very little pain, no antibiotic and I went back to work that afternoon.
My husband's Urologist doesn't use Cipro as a prophylactic antibiotic. He uses IV Rocephin (Ceftriaxone) which is a Cephalosporin antibiotic. Husband had no complications after his MRI Fusion Guided Biopsy.
Was he under GA?
What about if you’re having a MRI-TRUS fusion biopsy?
If the risk is getting sepsis then the choice is obvious. How 32% still chose TR biopsy is beyond me. Maybe they are future HMO administrators.
Had two already much better and back home in half an hr two days results and week later healed fully .
Forgot to say...General anesthesia for a transperineal biopsy? Didn't need it .
I would expect a couple of shots would make the procedure go better less rush of course every pacient has different pain thesholde
"Perineal prostate biopsy is more painful than transrectal ultrasound prostate biopsy" is a myth. I had it with half of usual dose local anesthesia at my request. There was no pain at all, during and after the procedure. When I touched the area at home, there was no soreness. Compare this to a tooth extraction I would say the tooth extraction is much worse. I was back to regular activity the next day, no pain medication needed.
When deciding the best procedure, do doctors ever consider the patient perspective?
With a transperineal procedure, I will be required to be naked from the waist down, my feet will be placed in stirrups, and my genitals will be up in the air for everyone to see. That means, at the very least, a doctor and an assistant, but often it involves more people, especially in a teaching hospital. So I would have to endure the humiliation of having my dick and balls in the air and on display for anyone in the room. Also, this procedure is often done under general. Like many people, I do not respond well to anesthesia, and frankly it's not a minor thing even under the best of circumstances.
So I get there are pros and cons on each side of this issue, but as a doctor I would expect you to consider the patient's likely experience and their feedback to be extremely important factors in this decision. I am bothered it was not part of this mini lecture.
I’m with you. Most doctors completely ignore the humiliation factor of the transperineal approach as if it’s not a real concern of many male patients. My urologist did my biopsy transrectally and it was effective (accurately diagnosed my intermediate grade cancer) and quick with a fast recovery period - very little pain and no infections that this presenter claims are so prevalent. I met 5-6 guys durning radiation treatments and all had transrectal biopsies with no infections. I discussed transperineal biopsy with my urologist and he even said “I’m not doing THAT when I need a biopsy”. I can confirm the humiliation and pain of the transperineal approach when it was used to place spacer gel prior to my radiation treatments. Pants off, hop on table in front of two nurses, scoot down to hang testicles off table, then lay back. At that point a small towel was provided to cover genitals, but plenty of full exposure was already complete. They continue to observe as ultrasound probe is inserted in rectum. The numbing medicine shots into the perineum almost made me jump off the table and there were 3 (since distance to prostate s further from here).
Some guys have no problem with any of this, but plenty do. When there are two effective ways to get the same result, no one should begrudge the guy who chooses the option that is far less humiliating and painful.
@@gregmatzinger7758 Thank you for supporting my thoughts. It's always great to know I'm not alone in this. One thing you said stimulated an area of thought: "...as if it’s not a real concern of many male patients."
This is such an important comment. First, I know some men are not fazed with this. I've seen men state that once they had their first DRE, all dignity went out the window and they don't care anymore, that they don't care how naked they are or who looks at them. I believe them. I'm glad they don't experience humiliation or emasculation when these times come.
But your comment points to how doctors don't ask and just assume. I think that happens far too often. And the thing about men is most men in the world follow the same code of masculinity that values stoicism, strength and invulnerability. So when a doctor makes a recommendation, they say "yup" and don't express concerns because that would reveal vulnerability and weakness. I frequent a couple Prostate Cancer discussion forums, and these men sign in and pour their hearts out about experiences during the process of treatment that left them feeling dehumanized, humiliated or even emasculated.
Sorry for carrying on. In short, I think we need to put more resources and energy into the psychological aspects of PC treatment. And doctors need to learn to set up discussions with men that encourage them to speak more freely about their emotions and concerns.
Thanks for listening to my Ted Talk.
Nothing to think about here. This is the best, simplest, common sense dialogue in which truth and nonsense are engaged in a game of chicken.
Oh, there's plenty to think about here. Transperineal biopsies are more painful, as it is difficult to get local anesthesia to the right places to be effective, so doctors tend to administer general anesthesia. General carries its own risks and many people tolerate it poorly.
Transperineal biopsies require a man to be naked from the waist down, his feet placed in stirrups, leaving his legs spread wide and his genitals exposed to anyone in the room to see.
I have talked to men who have had the procedure and they unanimously found it to be humiliating.
I had a transrectal biopsy. My doctor gave me the choice as he was adept at both procedures. With the transrectal procedure, I was able to lay in a fetal position. The whole procedure lasted ten minutes and was relatively painless and I felt I was able to maintain some degree of dignity. Accepting a 3% chance of infection was worth the risk to me.
Proponents of transperineal and haters of men who have dignity concerns over transperineal will argue “what are you so worried about? You will be draped”. What they fail to acknowledge is that you don’t show up draped and you don’t leave draped so those almost always female nurses will have plenty of exposure to your genitals while you are placed in position, draped, then undraped. Some guys enjoy or don’t care about this exposure. Many do. The choice is yours. I chose transrectal until I couldn’t.