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Prostate Cancer

Biopsy for prostate cancer

In this summary men we interviewed describe their experiences of biopsies. If the initial tests (rectal examination, PSA or ultrasound) show the possibility of cancer, men are usually asked to have a biopsy, in which a sample of cells is taken from the prostate to be looked at under the microscope. The biopsy is usually done through the back passage (rectum), but occasionally it can be taken through the skin behind your testicles (the perineum) or while you are having a cystoscopy examination (via the urethra).

Men we interviewed who had biopsies had very different experiences. Most reported that the biopsy was uncomfortable, but not painful. One man said that it was no more uncomfortable than having a blood sample taken, and others thought the description of a biopsy as 'being flicked with an elastic band', was a good description. One man found the procedure more embarrassing than painful and another man said that his privacy and dignity were not always respected.

 

Explains the process and reason for biopsies.

Explains the process and reason for biopsies.

Age at interview: 63
Sex: Male
Age at diagnosis: 59
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Basically we have to say that anything anybody has heard of that's aged more than 5 years about prostate cancer you can really forget it. Unfortunately most GPs go back into 1970 with their knowledge so that's a bit hard. But the biopsy if under a DRE which is with a digital examination by your urologist, he finds anything wrong with the shape of the prostate such as it might be expanding to one side or both sides then almost certainly he'll want a biopsy. Now these days the biopsy is done by a probe, which has ultrasound capability so it's inserted rectally, and the doctor or the surgeon can see on the monitor exactly where the prostate is. At the end of the probe, which is you know to put it bluntly is just rather like a banana, it has got needles that under a little stab of air pressure can shoot out and grab a sample of tissue. And the objective is to take between 3 and 6 samples round the prostate itself and they can come out as little cores, in very find needles and be sent away to examine for what content there is.

The sad fact is if they don't find anything in there that's a very limited shot of 6 little stabs with a needle. And they're not massively painful, that are going to make you shoot out of the bed or scream in anguish, you're normally lying on your side and you sort of 'ooh,' it's about, I don't know 1/10th of the pain you'd get from having an injection for a tooth, if you put it on a relative scale, so it's nothing to be terrified of. And they will then take them away and examine those cores. Some places they will mark the cores on a clock face, 'Core 1 was at 12 o clock', others they just take the cores. In my case they didn't note where they'd come from but they did note that 3 of them had 20% cancer and that's what comes back. If they come back and say none of them had cancer it's a shocking thing to think you probably may still have it but they just didn't hit the 3 places where it was because the whole gland is not normally cancerous, it's areas of it.

 

Describes the slight discomfort experienced during the biopsy.

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Describes the slight discomfort experienced during the biopsy.

Age at interview: 77
Sex: Male
Age at diagnosis: 75
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Do you mind describing how the biopsy was,for other people?

No it was conducted by the nurse who did the scans on me, the smaller scans, not the big body one and she said 'Well,' she said 'This may, you may feel a sensation here,' she said 'we are going to like prick you,' and she explained taking out a little core. She said 'I'll explain exactly what it is,' she said, and I forget to be honest how many places, it may be have been 3 or it may have been 6, something like that. And yes I did feel like a puncture but very, very quick, a slight discomfort and they also gave me some antibiotic tablets to take because they said because we have punctured it, there will be some bleeding, don't worry, that's what it is, it's the puncture, it may last for 2 or 3 days.

So that wasn't too uncomfortable?

Oh no, no, no I was, it was no worse than a wasp sting or something like that, no agony, no writhing around.
 

 

Compares the biopsy to the unpleasantness of being flicked with an elastic band.

Compares the biopsy to the unpleasantness of being flicked with an elastic band.

Age at interview: 57
Sex: Male
Age at diagnosis: 56
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The 6 point biopsy I was told would be uncomfortable and I might sort of feel slight pains like having an elastic band zapped at me you know sort of inside your backside and yes I suppose that really was what it was like. It was a bit unpleasant you know having sort of a big tube poked into your backside and then this gadget that sort of goes in and takes these 6 samples from you. But it's over in, I think it took about 20 minutes, something like that. I was counting them and unfortunately he said that 2 of them hadn't worked very well so I had 8 instead of 6.

 

Explains that it is more embarrassing and unpleasant than painful.

Explains that it is more embarrassing and unpleasant than painful.

Age at interview: 61
Sex: Male
Age at diagnosis: 61
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You had to remove your underclothes and it's a very small like pen like torch type thing, it inserts into your back passage and attached to this is a method of taking slivers off the cancer. And it's not a very pleasant experience, not a lot of pain was experienced except when they were taking the samples, it was just like a little red hot needle and I think they took about 6 or 8 of these samples which was sent off for biopsy. I wouldn't let this put anybody off. I was lucky enough to have a chap who knew what he was doing. The most discomfort I found was the fact that you are overlooked by, in my case a young nurse, who stood at the front of you telling you not to worry. But it was more embarrassment than pain owing to the fact that this young girl was just stood alongside you whilst it was being done. But I certainly didn't feel a lot of discomfort.

 

He felt that there was a lack of concern for privacy and dignity during investigations such as...

He felt that there was a lack of concern for privacy and dignity during investigations such as...

Age at interview: 48
Sex: Male
Age at diagnosis: 48
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Privacy and dignity I think remains a challenge for the National Health Service. And much as with health information for patients I did encounter some truly fantastic practice from some truly admirable practitioners but I also had some exposure to the other end of the spectrum, people for whom privacy and dignity of a patient is clearly not a particularly dominant concern. There were occasions when whilst going through some pretty undignified procedures either with the biopsy for example or the cystogram for example, there were occasions when doors were flung open and people would just walk in and out and not introduce themselves and they clearly had nothing to do with what was going on with me. And whilst I can tolerate that up to a point in a dentist's chair if the dental nurse walks in and out it's quite different from when, put bluntly, your ass is sticking up in the air.

I'll illustrate it with just one or two examples. At the pre-operative outpatient stage after the TRUS biopsy (the trans rectal ultrasound biopsy) whilst waiting in a crowded corridor full of other patients and their relatives a clinician whom I'd not encountered at any stage during the procedure itself and who had her coat on ready to leave stuck her head into the crowded corridor to shout in my general direction that I should expect to see blood in my semen for a period of time after this biopsy. Now admittedly that's useful information to have, I don't deny that but the circumstances under which the information was delivered was far from ideal. It caused all heads to turn in my direction for what was for me the unique experience of being in a crowded corridor of a bunch of people who all were probably thinking about my semen [laugh] and I'd rather they weren't. Now that was a highly avoidable example. It would have taken literally just seconds longer for me to be taken to a room somewhere or even just behind a curtain somewhere for this information to be imparted to me with a little greater discretion. So I firmly believe that that has nothing to do with resources. It has to do with personal choice, personal practice. It has to do with training. It has to do with culture. Perhaps it has also has to do with managerial performance management practice because these things go on because we work in a system that allows them to go on. If we stopped allowing them to go on then they wouldn't go on. So that, that is one example.

So it's at that kind of level that I think that privacy and dignity are not always well attended to. Although I hasten to add that I did have plenty of exposure to the other end of the spectrum as well. Some really admirable clinicians and wonderful human beings who did a first class job of plying me with information and also attending to my privacy and dignity. They deserve the credit but I'm just making a particular point about what I hope would be the minority of people at the other end of the spectrum. But it's a minority that can make a fundamental difference to the patient's experience of the process of care.

However, a number of the men we interviewed found the biopsy painful and quite distressing. One man likened the biopsy to 'an air gun in reverse', and another said that the procedure 'brought tears to your eyes'. A man who had a biopsy done in a private hospital in 1994 described the biopsy as 'ghastly'. In 1997 he had another biopsy, this time within the National Health Service, but he found the experience equally painful, and refused to allow more than four cell samples to be taken. The use of Periprostatic nerve block (PNB) with local anaesthesia before a prostate biopsy is now considered standard care, patients should not undergo the procedure without it. 

 

Comments that he found the biopsy very painful and unpleasant.

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Comments that he found the biopsy very painful and unpleasant.

Age at interview: 68
Sex: Male
Age at diagnosis: 67
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It was very painful, in fact I had to have a lay down after it. I think I might have been a bit of a wimp, I don't know because other people didn't, they found it very uncomfortable, but they didn't seem to need a second sort of resting session whereas I felt, I think the whole series of events that has happened through this I think that the biopsy was the worst thing I had. And obviously it's not a big deal or anything like that but it was, it was painful. I think may be it's because you've got the sound of the sort of snip and what have you, you know, and I mean it's to you but anyway I found that very, very unpleasant, very, very unpleasant.
 

 

Describes the extremely adverse results he had after the biopsy.

Describes the extremely adverse results he had after the biopsy.

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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And a biopsy was done in '94 from which I got septicaemia and almost died.

Oh dear, tell me about that a bit more please, the biopsy, is that very painful or just uncomfortable?

It was ghastly, I suppose I have a very small anal area and that I find, I found the sampling procedure somewhat traumatic, it was very painful and very unpleasant.

Yes, I'm sorry. So did the pain last afterwards or just during the procedure?

Well it was during the procedure, I didn't feel anything afterwards. But the strange is that I wasn't given any tablets or anything like that, I wasn't given any medication afterwards and of course I thought I had flu and it got very bad indeed. And I was rushed to the hospital and given, I was in hospital for 4 days with an infection.

So you picked up infection having the biopsy?

That's right there was a cross infection yes.

Oh dear.

And had it lasted another, I was told if it had lasted another 8 hours we wouldn't be having this interview now.

A disaster.

Yes.

I'm so sorry. Right so your experience of the biopsy was awful.

Well it was, it was not a, it wasn't pleasant in so much I don't think the, I didn't think that the, I suppose it was because I'm a person that suffers anxiety and I get tensed up and I suppose not being in a relaxed situation and having that style of I suppose treatment done was not, well I didn't find it appropriate.

Was that a National Health Service?

No that was privately.

I'd then come off the private health and gone back into the NHS and I was then treated to another sampling technique which I found very unpleasant because the guy insisted on taking 4 samples.

Another biopsy?

Yes another biopsy.

Was that equally painful?

Worse this time really and he wanted to take a fifth and I said there was no way that he was taking a fifth. Yeah I thought it was quite unnecessary. But anyway that was, I had the antibiotics then, so no infection back from it. The results of those, this was in 19, early I suppose 1997, late 1997 early 1998.

 

The biopsy was painful. He still had blood in his urine and blood in his sperm three weeks later...

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The biopsy was painful. He still had blood in his urine and blood in his sperm three weeks later...

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The biopsy itself was interesting, well I find it interesting because I'd had a chat with my elder brother who'd gone down the same path, you know 10 days earlier, and gone to the same team and I said, “How did you find it?” And he said, “Oh, you won't worry at all, uncomfortable at the worst.” And so I went along feeling, you know, pretty relaxed about it, and my own view was that I had always had a very much higher pain threshold than my brother and was much more pain tolerant. So I thought if he just thought it really was hardly worth calling discomfort it would be exactly the same for me. But in fact it was very painful. I was quite surprised how painful it was. The sort of pain that made you, you know you're lying there all bundled together in the fetal position and one shot up as the pain... and I think the amount of pain people get depends on the size of the prostate, how much distension there is, and how much bleeding there is. If you get bleeding into quite a big prostate you get the capsule stretched and then you do get pain. If you've got a smallish prostate or if you don't bleed [the pain will be less]. I hadn't stopped bleeding from my prostate by the time I had the surgery, whatever it was, three weeks later. I still had haematuria [blood in urine], I still had haemospermia [blood in sperm] and so I think it was the bleeding into the prostate which gives rise to the pain.

That was quite unpleasant and surprising?

Well, one didn't show it after the first initial surprise, but yes, it was unpleasant. I certainly wouldn't suggest that people didn't have trans-rectal ultrasound and biopsy because of it, but one realised in some people it is not terribly easy. And when a few years later I was involved in a research project and the surgeon said in a jolly way, “Well, I think we'll take 36 biopsies from each man” I just said, “Oh no, that's not happening on any account.” 

Others found the procedure painful, but said that the pain was relatively short lived.

 

Comments that although the biopsy is unpleasant it is over with very quickly.

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Comments that although the biopsy is unpleasant it is over with very quickly.

Age at interview: 58
Sex: Male
Age at diagnosis: 57
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Can you explain a little bit more about the biopsy, what was that like please?

The biopsy I went down the road and it was done you know sort of the next day, everything was done very fast. The PSA test before I had the results of the PSA test the biopsy, I didn't like it, it's a thoroughly unpleasant business but it's quick and sharp and it doesn't last long and I think that my tolerance for that sort of test whatever you'd like to call it is fairly good er judging from the way doctors have responded. I think some people don't like it, it's not something I liked.

 

Explains that the professionals involved were very helpful and understanding.

Explains that the professionals involved were very helpful and understanding.

Age at interview: 66
Sex: Male
Age at diagnosis: 57
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Can you tell other people what it's like to have a biopsy in as much detail as possible.

Unpleasant because you have, it's... you have a tube, it's a tube that goes up your rectum and they take a bit of the prostate away and it's an unpleasant feeling until the end, and that is painful to the end, but that's again only a minute and they were very good. The doctor or technician I don't know who did this, because they said 'When you feel the pain we'll then stop and then you can get yourself ready for the last bit,' and they actually said to me 'because it will be painful.' But it's you know it's a quick pain and then it's all over, but they were very, again the person who did it was very thoughtful because they understand what it's like.

 

Bob recalls that he had his biopsy done under general anaesthetic so he did not know anything...

Bob recalls that he had his biopsy done under general anaesthetic so he did not know anything...

Age at interview: 64
Sex: Male
Age at diagnosis: 64
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Occasionally biopsies are done through the perineum.
 

John recalls what it was like to have a trans-perineal biopsy and why he decided to have a robot...

John recalls what it was like to have a trans-perineal biopsy and why he decided to have a robot...

Age at interview: 57
Sex: Male
Age at diagnosis: 54
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At the new hospital, the biopsy was a trans-perineal, I think it’s called, biopsy, which takes twenty four samples instead of twelve, and it was quite a painful experience, and there was a lot of blood and the outcome of it was that it revealed what the first biopsy hadn’t revealed, which was that the cancer was right in the centre of the prostate and it was fairly advanced, so as a result I was told that brachytherapy would have been the very worst possible treatment for me because it wouldn’t have been possible to have surgery after the brachytherapy, because of the amount of scar tissue created by the brachytherapy, so there was only one option which was a prostatectomy. The hospital I was at now, it was able to offer robotic laparoscopic prostatectomy, so I was, referred for an operation and so it had been quite a long process from seeing the GP at the, where I was originally living in August 2008 to being operated on in April 2009.

 

For more experiences of biopsy for prostate cancer see the Healthtalk - PSA testing website.

Last reviewed July 2017.

Last updated July 2017.

 
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