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Dr. Tharun
Dr. Tharun, Doctor
Category: Health
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Experience:  MBBS
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How horrible / risky is having a first transperineal

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How horrible / risky is having a first transperineal prostate biopsy under general anaesthetic? Can (early) cancer cells spread through 'needle tracking' or is this a myth? Not looking forward to it but is it too risky to avoid? What questions should I ask?
Rising PSA - 2.66 in 2006 at 51, recently 10.2 and 12.5 (I'm now 57) after an episode of lower abdominal infection / inflammation. CRP was 60, now reduced. PSA could also have reduced. Prostate feels a little large for my age but benign (smooth). 3T-MRI showed 2 suspicious lesions (different blood supply / water content) - Urologist says could be cancer or the results of inflammatory changes.
Should I go ahead with the (horrible?) biopsy or repeat the PSA, have a PCA3 test and repeat the MRI in say 3 months to see if the 'lesions' have grown or reduced?
DrTharun :


DrTharun :

Are you sure , it is transperineal biopsy they are planning '?

DrTharun :

Transperineal biopsy is the second choice technique in most of the patients unless the patient has severe rectal or anal condition.

DrTharun :

Your PSA and the MRI finding is a strong indicator for prostate biopsy and you should opt for it.But a trans rectal biopsy would be enough under local anesthesia in your case.


Some studies have been done and has found marginal improvement in cancer detection rates with Trans -perineal biopsy technique.But it still remains the second choice for all the urologists due to the discomfort and only marginal improvement over trans-rectal biopsy.

Please let me know if you have any questions.


Customer: replied 4 years ago.

Thanks you. Transperineal biopsy is increasingly used in the UK - less risk of infection and more of the gland can be sampled especially anterior zones.

Do you have patients with bad experiences of recovering from transperineal? Retained urine? Bruising? (Temporary) nerve damage affecting potency?

What about reports of spreading cancer cells through 'needle tracking' -a real risk or myth?

What do you think about repeating the PSA to see if it has reduced and seeing what PCA3 says about cancer risk? If PSA reduced and PCA3 says lower risk I'm tempted to put off the biopsy altogether and have another MRI-S in say 3 months - obviously a risk if there is an aggressive cancer there.....


That is an interesting news ,because we literally see so less of transperineal biopsy now a days.

It is true that more of the cancer bearing zone of the prostate is biopsied as we go in a longitudinal axis of the prostate.

Retained urine is normal side effect after any prostate biopsy and all have the same chances of retention.

Nerve damage is really rare as it is done under ultrasound guidance and needle is passed within the gland.

Spreading cancer in needle tract in unheard of in prostate cancer and should not be taken as a reason to defer it.

Better option would be to do a free PSA to total ratio and PSA density along with PCA3.These can be done immediately with out waiting much.

But I should tell you that these scores are more useful if the PSA was below 10.PSA above 10 more or less ends up in a biopsy.

MRI should not be used to diagnose cancer, but rather a guide to the biopsy and to characterize the cancer once it is detected.


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