“Shared joy, twice joy-Shared sorrow, half sorrow”
The morning I got the results of yet another PSA that was creeping up, I stopped one of my partners outside of an exam room and asked him if he would do a biopsy of my prostate at lunch. He agreed, and I told him I’d have my nurse come get him when I was ready. When the morning patients had been seen, I asked my nurse to set up the stuff for a biopsy, and within an hour of deciding to have my prostate biopsied, I find myself in the biopsy room. I pull down my scrubs, get on the table on my left side, assume the fetal position required for the procedure, and tell Tina, “go get Dr. Jones; I’m ready.” In one fell swoop I am exposing my naked backside to my nurse and my partner, and, in doing so beginning my journey as a patient. I had had many patients tell me over the years, “I was modest before I became a urology patient,” and now I was getting my “education.”
I did take an antibiotic to prevent infection, but I did not take anything for pain. My plan was to have the biopsy, go get lunch, and then come back to see my afternoon patients. Dr. Jones obligingly enters the procedure room to perform the biopsy I have requested just minutes before. “What is your PSA, John?” “Five or so. Will you check my prostate before you begin?” “Sure,” he says, “It feels normal.” He places the ultrasound probe in the rectal area, and there is an abrupt and intense sensation of needing to void. (Pressure on the prostate by the rigid probe irritates the prostatic urethra. The resultant sensation of needing to void is similar to that experienced by patients after radiation.) He then injects an anesthetic into the prostate to deaden the effect of the biopsies but tells me, “I don’t see the seminal vesicles very well.” What this means is that the medicine he is injecting may not control the pain of the biopsy. That’s a luck thing; my anatomy probably didn’t lend itself to a good nerve block. However, altered anatomy can also mean changes as a result of cancer, and my mind immediately went wild, wondering, why my seminal vesicles were difficult to see. He began the process of taking the specimens with a biopsy gun that fires a biopsy needle that, in turn, captures the prostate tissue. You hear a click when it fires and then feel a pain that is similar to a bee sting, but a bee sting that is accompanied by an intense burning at the tip of your “you know what.” It felt to me as if someone was popping a rubber band at the tip of my “private area” with each biopsy; he did 16. Somewhere in the middle of this ordeal, as I was debating the wisdom of doing this at lunch without the benefit of pain medicine, Dr. Jones says, “John, shared joy-twice joy, shared sorrow-half sorrow.” After these obtuse words of wisdom, which I failed to grasp, came another “pop.” I propped up on my elbow and looked back at Dr. Jones over my shoulder. “Twice grief, shared what? What in the world is that supposed to mean, Bill?” Tina says quickly, “He says that to everybody having a biopsy.” “Well John, you should share things with people. Don’t keep things to yourself; it is better to discuss your problems with friends.” Tina added, “Dr. McHugh only has one friend, Dr. Tolson.” I said, “What do you mean, share with my friends? Share what? I don’t have cancer yet. You just got started! Do you see something back there that you don’t like?” “No, not really anything bad, just an area that doesn’t look right. I’ll take just a few more in that area and we’ll be done.” The biopsies just kept on coming; a click, a pop, the bee sting, the rubber band, and the incessant feeling of needing to urinate. This adventure into being a patient ended after about 20 minutes. I got up, thanked Bill, and then went into the bathroom dripping blood from the front and back. That afternoon, I had to inform two people that their biopsies for prostate cancer were positive, all the while concerned that blood would show through the front of my scrubs. The next phase of my journey as a patient then began: waiting on the results and wondering if I had cancer at all, if I had the good kind, or if I could be the one with the “tiger” variety, (which is how the British describe the aggressive form of prostate cancer). Again, the dual nature of the disease is something that patients often don’t realize.
Prostate Diaries 
10/14/13 i had a biopsy around 4 pm ,every time i had to urine for the next few hrs my behind and penis was in pain ,its 6 hrs after the biopsy and I’m still in pain and scared to urine .I had to get Motrin for the pain and to sleep.this biopsy hurts !!!!!!
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The biopsy needle probably crossed the prostatic urethra or you have some underlying enlargement. Certainly if it continues you need to notify your doctor. Also there is a much wider comment range on the post called “The dreaded prostate biopsy” on this site. Just Google that title and add yours there and you’ll probably receive numerous responses. Jm
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Hi Dr. McHugh,
I’m 54 and my urologist has been monitoring my PSA for a few years. When I first had my PSA taken about 4 years ago it was 4.98. My urologist did a DRE and did not find anything out of the ordinary except that my prostate was enlarged, so he put me on antibiotics for a 3 weeks after which my PSA went back to normal. For the next few years, I would have my PSA tested annually and it would always be normal. This year however I had it taken and it jumped to 9. My urologist did another DRE, found nothing out of the ordinary, and put me on Floxel for 3 weeks. After the 3 weeks, my PSA went down to 7.85 so my doctor recommended a biopsy which is due to be performed this week. I did not really know what to expect till I chanced upon your blog and I am most grateful for it. My doctor seems to be the type you describe. You know the one who says the procedure won’t really hurt and that it would be done in 5-10 minutes. He said that we would apply a topical anesthetic similar to what dentists use prior to injecting the stronger anesthetic for an extraction for instance. He has not mentioned taking any pain medication which, after reading your blog, has me a bit concerned. I suppose my question is two fold:
1. Should I get a second opinion regarding having a biopsy and
2. Should this be the Doctor to do it.
Thank you for whatever advice you can give.
Martin Wong
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Hi, I think all you’ve said is reasonable and no one can say you have rushed into this. I don’t feel you need a second opinion however very little is ever lost in getting one. I never discourage a second opinion.
Regarding the pain management, I think you would be surprised how open doctors are to requests. I think I’d just ask, ” Is it possible to have something for pain before the procedure?” I’d be surprised if you urologist did not accommodate that.
Good luck and if you have the biopsy I hope it goes well and that your results are good. JM
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Thank you for your reply. One last question regarding pain management. I’ve been reading the different comments on your blog and I’m not sure what the best meds to take are. I’m kind of torn between valium and some other pain med(not sure what) or just getting sedated and sleeping through through the whole thing. Any ideas/recommendations? Thank you again!
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It seems that men can’t go anywhere, for any procedure without some female be it a cna,lpn,rn, ma and all the other little tittles that some how entitles them
to be present wether their presence is needed or not for a private medical
procedure for men. What is up with that? A quick look on the Internet reveals
it’s female healthcare workers that post patient data on facebook, post your
pics on facebook, peek under your gown when you are unconscious in the
Hospital and even when you are not their patient. They just have to be everywhere. Yet, there are no male mammographers, no male nurses in
L&D and no male nurses in post-op gyn. Female trauma patients are quickly
covered up while the nurses let male patients just lie there nude after the
trauma has been over for some time. Double standard, disturbing, unprofessional it is.
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Dr. Michael Koch told my wife and me that I probably had cancer and should have an immediate biopsy, and then meet with him as soon as possible to find out which treatment options are appropriate. He did so solely on the basis of elevated psa. He did not tell us about any causes of elevated psa other than cancer. He did not tell us about any other treatment options. When he completed the biopsy he told me I could get off the table even though he saw I was pasty and knew he should have provided me more time and support getting off his operating table. I fainted and fell. I regained consciousness in pain, naked and scared. I was on the floor. Four women were standing around me. Dr. Koch came in and stood above and behind me. No one tended to me. No one offered to check my vital signs. No one offered me a blanket or water. I told them I had a pain in my hand, and no one suggested an examination of it. Dr. Koch discharged me with an unexamined injury that ultimately required surgery. No one helped me off the floor of Dr. Koch’s operating room. When I left his offices, I had to find a public restroom to steady myself and rehydrate.
When I ultimately asked Dr. Koch the causes of elevated psa, he said he may not be able to answer all my questions because he works 15 hours a day.
Dr. Koch subsequently lied in denying his blatant malpractice and reckless negligence.
Dr. Koch is the Chairman of the urology department at the Indiana University Medical school.
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My prostate biopsy experience was nothing like those that I’ve read about. Background: I am a physician… and about as nervous and scared about the procedure as anyone could be.
The Experience: First of all, the urologist I saw was incredibly patient about my reluctance to have the biopsy at all. Once I made the decision to do it, that’s when my anxiety really escalated. But I was literally astounded by how easy the whole procedure was. A Fleets enema and a day of antibiotics before the procedure were easy. A little topical anesthetic gel, and the insertion of the ultrasound probe was less uncomfortable than a regular digital exam. He did 4-quadrant anesthetic injections… because the injection site is “above the dentate line”, I felt nothing at all… not even that uncomfortable pressure like from dental injections. The biopsies themselves (all 12) were such that I felt nothing at all, and only the “click” of the instrument told me how many were being done. (I even lost count because my mind wandered!) That was it. Nothing even significantly uncomfortable happened. My immediate reaction to it was, “if he wants to do this again tomorrow, no problem!”
Afterwards: About an hour after the procedure, when the anesthetic wore off, I got uncomfortable enough to take a pain pill. After about 24 hours, I was down to a Tylenol… and that only lasted two more days.
My Final Assessment: In the right hands, the biopsy is no big deal! Don’t be nervous or afraid.
Signed: A Big Baby
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Thanks Big Baby…I actually put off my biopsy for six months for fear, due to the story at the top of this as well as the infamous “knitting needle” one by a reporter…as my PSA numbers climbed. Finally decided to man up, and my experience was similar to yours. Piece of cake…literally 8 minutes, a little discomfort, but nothing I’d call pain…at all. Bothers me that those with negative experiences are usually the ones who post. STFU, you may be costing lives!
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Just had a biopsy much like Big Baby. Now 2 hours after biopsy. Discomfort in that area but not real pain. Will take a tylenol to get ahead of pain.
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Appreciate reading patient experiences before having a biopsy – not for possible cancer but prostatitis (nasty condition). I’ll be ready with meds and expect the post procedure issues. Much more confident being prepared for the worst. Thanks!
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Just completed my prostate biopsy this afternoon. I had a lot of anxiety regarding the potential pain with the procedure. I read everything I could get my hands on via the internet. My experience……..it was far easier then I had expected. Perhaps my taking an opiate pain pill from my doc taken an hour before the procedure helped a lot. Just be sure to ask for a pain med, as it may not be offered to you without asking. I also walked about 2 miles at my health club to burn off nervous energy, that helped too. Also, I drank a shot of whiskey about 90 minutes prior to the procedure. That helped to calm my nerves. My uro doc also used a local lidocaine injection into both ends of the prostate into nerve endings, and a topical numbing agent on his probe. I was surprised the doc began taking samples immediately after numbing the prostate. No waiting for the lidocaine to take effect as I expected. The doc took 13 core samples. I had no pain at all, just a slight amount of pressure when the core gun was fired off. The only real discomfort was the doc pushing the probe rather forcefully at the start of the procedure all around the prostate to measure size or irregularities, or something. This only lasted a couple of seconds. I knew to expect a penicillin shot in the rump, and I sure got one. What surprised me was the amount of penicillin. It must have taken 5 seconds to inject all the serum. After the procedure, my butt hurt, and ached from the shot for several hours, where as my prostate is not bothering me much at all. It has been about 6 hours now, my butt ache is now minimal. I don’t see any blood in my urine, very little in my stool.
My conclusion, is that prostate biopsy is civilized these days. IMO, the procedure has a bad reputation from 15 to 20 years ago, when no pain abatement was offered to the patient. Patients were tortured during those days, and stories persist from those days. Pain management is far better now. Pretty much on the level of going to the dentist to have a tooth drilled and filled using lidocaine. No need to worry, and get worked up about a prostate biopsy.
I will get my lab results in about a week. It will be what it will be. Can’t worry about what might be.
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I had my biopsy today and was very much afraid of what I have heard of it being very painful. To my surprise, the only that hurt was the shot in the butt that I received before the biopsy. Not really the shot but afterwards for about 10 minutes my butt was sore. It was a antibiotic. The initial anesthetic he injected in my prostate I felt a slight sting, but the biopsy was painless and I heard a clicking sound but with no pain. I was relieved after that and was able to relax throughout the procedure.
So, many people may have different experiences, but I was very happy mine was not none of the horror stories I have heard about. I had no blood in my urine and no stinging sensation while urinating. My only complaint was the doctor left me on the examination table sitting up and said to wait a minute or 2 and the. He would see me back in 2 weeks and then walked out. He did not give me anything to wipe the blood off my butt that was left after the procedure so I had to use the paper from the table and dispose if it myself. I mean…really? A tissue would have been nice.
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That’s the “bedside manner” that is so missing today. Sorry about that…gives medicine a bad name.
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My understanding is There are different technologies and procedures for doing a biopsy . My doc used three different sets of MRI images merged with the ultrasound probe image and biopsy tool. I took the anabiotic’s the day before the day of and the day after. Within an hour after the biopsy I was fine. No issues urinating , No blood.. No pain, I did go ahead and take three Tylenol just in case, and about two hours afterwards I had a couple of beers at a local pub and then took my dog out swimming in the river. I didn’t get in the water past my knees for sanitary reasons, just in case. That evening , the next day and ever since , I’ve been 100% no issues. My doctor took 14 samples, four of which were out of a small tumor on the left side. I’ve read many stories of painful biopsies and lots of issues,. I think it has to do with the doctors experience, the technology available, and the team the doctor works with. Mine were top notch And this prostate biopsy was hardly even a blip on the radar of my day. I’m thankful. Best wishes.
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A 12 or 18 core blind biopsy, holey prostate! One million dangerous prostate blind biopsies are performed in the USA each year and they should be banned: Men with a high PSA tests result are often sent to a urologist for a blind biopsy. This technology is (obsolete) 30 years old. Would you use a cell phone or drive a car that was designed 30 years ago? Blind prostate biopsy cost in the USA is at least $3 billion annually. False positives and false negatives can occur. Men should be told about other options; Percent free PSA test, 4Kscore test, PCA3 test or a 3T MRI test before receiving a blind biopsy. These tests can often eliminate the need for a risky and invasive blind biopsy. Unfortunately, sometimes insurance companies may not pay for other tests. Insertion of 12 or 18 large hollow needles through the dirty rectum into a gland the size of a walnut, a blind biopsy can result in pain, infections, a risk of temporary or permanent erectile dysfunction. Biopsies can cause, urinary problems, 6.9% hospitalization within 30 days from a complication, sometimes even death from sepsis (About 1.3 to 3.5 deaths per 1,000)[5]. There is also debate that a biopsy may spread cancer because of needle tracking. A blind biopsy is degrading and can also increase PSA reading for several weeks or months, further frightening men into unnecessary treatment. Blind biopsies are almost never performed on other organs. One prestigious hospital biopsy information pamphlet states: semen color has a rust tint. Another well-known hospital describes semen as: reddish or brown. These statements can be an extreme exaggeration (mostly lies). After a biopsy, a man’s semen can turn into a jet black goo. This could be an unpleasant surprise for a man and especially for his unsuspecting partner. However, if a biopsy is performed before Halloween or April Fools’ day this may be of use to a few men. If some prestigious hospitals are not factual about the color of semen, what other facts are being misrepresented?
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I’d be curious to know if stats exist on what proportion of blind prostate biopsies prove to be cancerous.
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