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Extreme pain during prostate biopsy is unnecessary and inappropriate

By Keith Roach, M.D. on

DEAR DR. ROACH: My friend had a biopsy on his prostate three weeks ago. During the biopsy, he was crying and in excruciating pain. They took four samples, and the doctor said: "I need a total of eight samples. Do you want me to continue?" He replied "no," and the doctor stormed out.

Is it normal to have that kind of horrible pain? Two nurses held him down while the doctor was doing the procedure. They won't send him the pathology report. He's not sure which doctor is getting the report. -- R.M.

ANSWER: That degree of pain is NOT appropriate, although I have talked to other men who have noted that the pain from prostate biopsies without anesthesia can be excruciating. But it doesn't have to be that way. There are several ways to reduce pain, such as an injection of lidocaine (a local anesthetic) near the nerve to the prostate. The prostate itself also can be injected (with small needles, much smaller than the biopsy needle), and a combination of the two is better still.

It's also possible to have an anesthesiologist do what is termed a "regional block." This can successfully prevent the pudendal nerve from sending pain signals, and is appropriate for men who have had a bad experience, such as your friend, or people who are very anxious about the procedure.

I am increasingly seeing MRI of the prostate being used to guide biopsy -- this can dramatically reduce the large number of biopsies traditionally done, as well as improve the results. I think this will become the standard of care.

I am disturbed to hear about the doctor's behavior as reported by your friend. He should get the results of the biopsy, and I would recommend a second opinion about whether further biopsy is needed, and if so, to decide on a plan of anesthesia ahead of time.

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