From the information I gleaned from the ASPI presentation on TP biopsy, I knew to ask for TP if and when a new biopsy was needed. My annual MRI indicated a new "area-of-concern"; so I insisted (voted) that it must be a TP. And because of the MRI, it needed to be a Fusion. Which means it would need to be done under GA. My current Urologist, Dr. Cochran-Dallas, supported my decision and was the referring physician to get me to Dr. Walsh in NE Texas. Dr. Walsh uses the Matt Allaway device.
The TP was a more positive exercise than the TRUS I had 3 years ago. By at least a universe!
Yes, I voted with my prostate.
Yes, I'm an experienced advocate for TP.
Yes, I got a much more accurate/improved data set about what is happening and where it is happening in my prostate
Yes, no infection; and better recovery in all urinary and sexual aspects.
Background: Original biopsy was standard TRUS since I was uninformed and didn't know better. 1 year of infection, prostatitis, and general urinary misery until I got to Dr. Cochran who recognized the issue and got me healed through a more lengthy antibiotic regimen. I fired 3 urologists before I got to Dr. Cochran.
This is a great and timely newsletter for me. Do you know if there is anyone in Colorado who does MRI-guided transperineal biopsy? I will need one soon since the most recent MRI shows a new PIRADS 5 lesion. Thanks.
Mike. I don't know anyone to refer you to in Colorado. I thought Dr. Allaway referred you to a second group in Denver. You might consider traveling. I can refer you to a group in Chicago. What about Mayo Clinic in Rochester?
I've read that thicker gauge needles are required for TP biopsies because the perineal tissue is much thicker and denser than the rectum. Also, for the same reason, more force is required to traverse the perineal tissue and to keep the needle trajectory accurate. I wonder if pushing 10-20 thicker needles through the perineum may results in trauma, soreness or permanent injury to the prostate.
Dr. Richard Szabo said: Same biopsy needles, same effort, less trauma as no danger of puncturing hemorrhoidal vessels (2.5% transrectal biopsies wind up in ER for bleeding requiring intervention.
Unfortunately my uro doesn't do them. He's part of Kaiser, a large system that is woefully behind on technology (for instance, they don't even have a 3T MRI machine in my area) so I'd doubt any of them are trained in anything but good old transrectal. And I don't even live in the Upper U.S.!
Hi, John. Do they do TPs elsewhere in the Kaiser system. Like in Irvine? What area are you in. Less powerful mpMRIs that are newer machines can be OK. Howard The Active Surveillor
Thanks for replying, Howard. I actually went somewhere else for my last MRI on a 3T. The one at Kaiser, unless they've changed it in the last few years, isn't the latest model. Dunno about your first question but I'll certainly ask next time they want to poke me.
J-B. Transperineal preceded transrectal. TRUS (transrectal ultrasound) seemed to improve things because the old TP was considered extremely painful. TR gave the urologists a quick (and dirity, unfortunately) way to do biopsies to monitor prostate cancer. But the docs have resisted the new and improved TP because it takes more time--hurting the workflow and the income stream and bottom line. So urologists have fought change and protected their income in the U.S. This is far different from Norway, Australia, UK and Holland, where TP has become the standard. The European Association of Urologists last year made TP the preferred biopsy. Medicare in Australia pays docs who perform TPs a bonus. But the US has lagged. There's been a choice, J-B, but seeminly it is not in the self-interest of the "efficient" docs to offer it. Bim, bam, thank you, sir/ Meanwhile, if they used TP they would find more cancers--which is in the patient and doctor interest. Howard The Active Surveillor
From the information I gleaned from the ASPI presentation on TP biopsy, I knew to ask for TP if and when a new biopsy was needed. My annual MRI indicated a new "area-of-concern"; so I insisted (voted) that it must be a TP. And because of the MRI, it needed to be a Fusion. Which means it would need to be done under GA. My current Urologist, Dr. Cochran-Dallas, supported my decision and was the referring physician to get me to Dr. Walsh in NE Texas. Dr. Walsh uses the Matt Allaway device.
The TP was a more positive exercise than the TRUS I had 3 years ago. By at least a universe!
Yes, I voted with my prostate.
Yes, I'm an experienced advocate for TP.
Yes, I got a much more accurate/improved data set about what is happening and where it is happening in my prostate
Yes, no infection; and better recovery in all urinary and sexual aspects.
Background: Original biopsy was standard TRUS since I was uninformed and didn't know better. 1 year of infection, prostatitis, and general urinary misery until I got to Dr. Cochran who recognized the issue and got me healed through a more lengthy antibiotic regimen. I fired 3 urologists before I got to Dr. Cochran.
Thanks, Tim. You are a great model for taking control of your care. Howard
Hi Howard,
This is a great and timely newsletter for me. Do you know if there is anyone in Colorado who does MRI-guided transperineal biopsy? I will need one soon since the most recent MRI shows a new PIRADS 5 lesion. Thanks.
Mike. I don't know anyone to refer you to in Colorado. I thought Dr. Allaway referred you to a second group in Denver. You might consider traveling. I can refer you to a group in Chicago. What about Mayo Clinic in Rochester?
Howard, in response to your question: Dr. Katsuto Shinohara
Always ask before they poke.
There's a sex joke in there but I'll leave it to everyone's imagination.
I have asked the gurus. Namaste. Howard, The Active Surveillor
I've read that thicker gauge needles are required for TP biopsies because the perineal tissue is much thicker and denser than the rectum. Also, for the same reason, more force is required to traverse the perineal tissue and to keep the needle trajectory accurate. I wonder if pushing 10-20 thicker needles through the perineum may results in trauma, soreness or permanent injury to the prostate.
Dr. Richard Szabo said: Same biopsy needles, same effort, less trauma as no danger of puncturing hemorrhoidal vessels (2.5% transrectal biopsies wind up in ER for bleeding requiring intervention.
Dunno about the vessels but I have a friend whose first TRUS biopsy awarded him sepsis and 10 days in the hospital.
Not much of a gift. Maybe a BBQ set the next time? Howard The Active Surveillor
I asked. Matt Allaway said: The PrecisionPoint overcomes this issue. Please check out our website Perineologic.com
Dr. Matthew Allaway
Founder/CEO Perineologic
Perineologic.com
Matt@perineologic.com
A very interesting question. Haven't heard any answers to it so far.
Unfortunately my uro doesn't do them. He's part of Kaiser, a large system that is woefully behind on technology (for instance, they don't even have a 3T MRI machine in my area) so I'd doubt any of them are trained in anything but good old transrectal. And I don't even live in the Upper U.S.!
Hi, John. Do they do TPs elsewhere in the Kaiser system. Like in Irvine? What area are you in. Less powerful mpMRIs that are newer machines can be OK. Howard The Active Surveillor
Thanks for replying, Howard. I actually went somewhere else for my last MRI on a 3T. The one at Kaiser, unless they've changed it in the last few years, isn't the latest model. Dunno about your first question but I'll certainly ask next time they want to poke me.
Good article, Howard. I hope my UCSF urologist
goes to transperineal soon as a result of research. Tain’t good, not bad! lol Rick
RR, Who is your doc? Howard--The Active Surveillor
Fascinating - my urologist did transrectal, and my urinary oncologist did transperineal - neither let me know there was a choice!
J-B. Transperineal preceded transrectal. TRUS (transrectal ultrasound) seemed to improve things because the old TP was considered extremely painful. TR gave the urologists a quick (and dirity, unfortunately) way to do biopsies to monitor prostate cancer. But the docs have resisted the new and improved TP because it takes more time--hurting the workflow and the income stream and bottom line. So urologists have fought change and protected their income in the U.S. This is far different from Norway, Australia, UK and Holland, where TP has become the standard. The European Association of Urologists last year made TP the preferred biopsy. Medicare in Australia pays docs who perform TPs a bonus. But the US has lagged. There's been a choice, J-B, but seeminly it is not in the self-interest of the "efficient" docs to offer it. Bim, bam, thank you, sir/ Meanwhile, if they used TP they would find more cancers--which is in the patient and doctor interest. Howard The Active Surveillor