Is Active Surveillance a Good Choice?

Given the risks of prostate biopsy and the major potential side effects of a radical prostatectomy, many men are choosing to monitor their prostate symptoms, rather than seek invasive treatments.  The decision to pursue Active Surveillance (AS) varies based upon a number of factors and should be carefully discussed with physicians.

“AS is a safe and effective approach which spares any properly selected men younger than 60 years with low risk prostate cancer from intervention, provides adequate time for intervention if required, and shows durable disease specific survival.” 

Transperineal or Transrectal Prostate Biospy

If you are like me, the thought of serious infection or sepsis is a very scary prospect if you must have a prostate biopsy.  Prostate cancer is bad enough, but it usually isn’t an immediate threat and is often treatable.  Sepsis is a very real and very urgent life-threatening risk.  In the case of resistant bacteria, treatments may not be guaranteed.

Here is a nice guide to compare trans-rectal (TRUS) to trans-perineal biopsies (TPB):

Transrectal or transperineal biopsy: which is best?

There is apparently less risk of infection for this type of biopsy that goes in through the skin under the anus, rather than from inside the rectum.   It may also allow for better sampling of some areas of the anterior prostate, such that it’s the preferred method when extra cores saturating more of the prostate are needed. The main drawback seems to be that it is usually done under general anesthesia, which isn’t necessarily a bad thing in my experience.  This does usually mean at least one night in the hospital in many cases.   I have survived two trans-rectal biopsies without infection, but consider myself lucky. I will seriously consider a TPB in the future if the option is available.

Prostate Biopsy Recovery, Side Effects & Complications

My Personal Experience with Trans-Rectal Ultrasound MRI Fusion-Guided Prostate Biopsy: A Guide of what to expect after your prostate biopsy.

Since 10 years ago, there is a lot more information on what to expect after your trans-rectal ultrasound (TRUS) prostate biopsy.  Back then, many websites omitted some key side effects, such as blood in your ejaculate.  Even some very reputable health and medical websites buried things like the possibility of serious infection or sepsis as a small bullet point.  It turns out, this is a very real, increasingly likely and possibly fatal complication.  Urinary infection or inability to urinate are also possible complications.  Urinary incontinence and erectile dysfunction are less common risks.

Of all the potential side effects, I was most shocked 10 years ago when my semen looked like thick blood because it wasn’t on my care sheet or mentioned by the medical staff.  So, I created an article back then to help others that generated over 600 comments. Please feel free to reply with your experiences as a comment after this article, you are welcome to use an anonymous username and email. Thankfully, more websites and care sheets acknowledge blood in the semen now compared to a decade ago.   This is good because if you aren’t expecting it, you might think you have a serious bleeding issue or internal hemorrhaging.   You aren’t. Opaque red or rust-colored ejaculate is not unusual after a prostate biopsy and can last a month or longer after the procedure, hopefully diminishing over time and number of ejaculations.  Even my doc, nurse and care sheet mentioned it this time, unlike 10 years ago.

This new care sheet is pretty good based on my experiences.  Here is another reasonable webpage more centered on the risks, except that “…you also may see traces of blood in your semen” doesn’t come remotely close to describing it for some men:

How common is hematospermia (or hemospermia)?  One report indicated that various studies showed that between 5% of men and 90% of men had blood in their semen after a biopsy.  When eliminating men who did not ejaculate after the procedure, they found about 90% had blood in the semen that lasted around 4 weeks and 6 ejaculations after the procedure.  A similar study had very similar results.  As you can see in these studies, it is not all that uncommon to have blood red semen, rather than having a tint or “altered color.”

I’m going to discuss my own, personal recovery experience following my second TRUS guided prostate biopsy, done under local anesthesia.  It was pretty similar to my first one.  If you are squeamish or don’t like the TMI type of details, STOP READING NOW.  The rest of this article is definitely Too Much Information unless you really want to know from first-hand experience. Continue reading Prostate Biopsy Recovery, Side Effects & Complications

What to Expect After Your Prostate Biopsy?

You’ll probably get a care sheet from your urologist.  Maybe you found a website with a list of possible side effects on the internet.  Beyond that, there aren’t a lot of reports with personal experiences from a prostate biopsy.  Probably for obvious reasons.  Most guys don’t want to talk about it.  Some are just too tough or too cool to tell it like it really is.  With a careful Google search, you can find some personal experiences on the procedure.  There are even a few horror stories.  If you’re squeamish when reading about unpleasant medical complications, STOP READING NOW! Continue reading What to Expect After Your Prostate Biopsy?

2nd Visit to NIH for UroNav fusion MRI/TRUS Prostate Biopsy

Almost 10 years ago, I headed to the National Institutes of Health, National Cancer Institute for a 3T MRI/Ultrasound fusion Prostate Biopsy. You can read about it here:

This week, I made a second visit due to increasing PSA levels. I again flew into Reagan airport in Washington DC.  I used the DC Metro for everything, no need for cabs, buses or ride shares.  Last time, I stayed at the Hyatt Regency Bethesda, which is literally right on the Metro, 1 stop from NIH.  This time, I found a much better rate at the nearby Hilton Garden Inn Bethesda, about a 2 block walk from the Metro, also easy and very reasonable.

After arriving at NIH, I started with blood and urine tests, an EKG and an IV for administering contrast during the MRI.  No chest X-ray was done this time. The MRI sure seemed longer than I recall from last time, but was apparently done in about half the time at just over 30 minutes of motionless time on my back.  Thankfully, they apparently no longer use the endorectal coil, which was as unpleasant as it sounds.  MRI results were not in by my appointment later in the afternoon, but given my history, the resident physician at the consultation confirmed that a biopsy was indicated.  I had pretty much assumed that.  Last time it was unpleasant, but this time was going to be local anesthesia rather than general, so I was still anxious.  My PSA level was 4.7 in their test, a bit lower than before but still within daily variations.

So, the next morning, I started at 5AM with the enema, unpleasant in itself.  After my bowels calmed down, I arrived at the NIH at 7AM for my 7:30 am appointment.  And waited, and waited, and waited.  Others arrived later but had their procedures earlier, including one gentleman who was clearly angry when he hadn’t been admitted 15 minutes after he sat down for his 9:30 appointment and began demanding to be seen with every nurse that came into the room.  I was about to tell him I had been there almost 3 hours already, when a nurse came to have me fill out some paperwork.  I also then asked if my MRI results were available and she went to get them.  As she returned, she also gave the other gentleman his forms to complete, and then he was off to OR before me…  Squeaky wheel, as they say.

Here is a very good guide on the procedure from a physician’s perspective:

The 5 hours waiting for the procedure was also pretty difficult for me, but eventually, my name was called just after noon.  Basically, under general, you’re wheeled in, put to sleep and wake up in post-op.  Under local anesthesia, it’s a bit different.  Okay, a lot different.  Here it is from a patient’s perspective. If you don’t want the details, don’t read on.  STOP HERE.



. Continue reading 2nd Visit to NIH for UroNav fusion MRI/TRUS Prostate Biopsy