What should I do next?

Transperineal biopsy will be the primary method in 5 years, but right now rectal is the most common. If you can find someone that does transperineal, go for it. As far as rectal, I had one 3 years ago and will have another on Friday. Make sure the Doc has done lots and lots of them, uses a rectal numbing gel and a local anesthetic directly into the prostate. Also, make sure it's an Ultrasound / MRI Fusion guided biopsy. A valium to relax is also very helpful. Anyway, I had all the above and the first one was a breeze, some discomfort and minor pinching type pain. The worst part was the anxiety beforehand, hence the valium. I'm hoping the same this time around. Yes, there is a small chance of infection, but even if that happens (watch carefully for any fever up to a week after), it would suck, but will not be life-threatening if you get immediate treatment. Yes, bloody urine, semen, maybe small rectal bleeding also, but no pain afterward. If you can't stand the sight of blood, just don't look and your stuff for a week or two. Move forward, you'll feel much better once you know exactly what's going on with your prostate and the steps to take. All the best. DISCLAIMER: I am not a medical professional.

Similarly, I was diagnosed with prostate cancer last summer at age 57. I had no DRE abnormalities, and 3.7 was my highest PSA. I thought things were still OK while under 4.0, but later learned from two different Urologists that if you are under age 60, a PSA over 2.5 can be a concern. In addition, I had a rising PSA trajectory for several years, so biopsy was recommended. I was told that biopsy is the "only definitive way" to diagnose prostate cancer. Mine was transrectal as well, 12 cores taken, guided by ultrasound. 12 core biopsies appear to be the norm these days, and as I understand it, are statistically very effective at locating cancer if cancer exists. The left side and right side each are "divided" into 3 sections and two cores are taken from each. The ultrasound/MRI can show possible "areas of interest" and an experienced Urologist will know how to read that and act accordingly. A 12 core biopsy taken by an experienced Urologist guided by imaging should be a very effective biopsy. As already mentioned, local anesthetic is the key -- with anesthetic, the whole thing is very tolerable, almost a non-issue. Without it is a completely different story -- I had fiducial markers transrectally placed later without anesthetic, and that was miserable. For both procedures I was presecribed a levaquin to take several hours beforehand, and really liked the idea of having a strong antibiotic in my bloodstream prior to the procedure. I suspect that is commonplace, but if not, I would ask about it -- I was concerned about infection caused by the procedure, but I felt much more confident with the Levaquin. One last note, there is genetic testing that can be done on the biopsy cores as well. It can "corroborate" what the pathologists see under the microscope. My cancer was slow growing Gleason 6, and the genetic testing confimed that. It might be useful to verify that the Urologist plans to order that. Best of luck to you! Though we are not doctors, we are very happy to share whatever we can!

UniqueD Prior to my prostate biopsy I read everything I could and asked about the possibility of being totally knocked out. I would agree the worst part is all the stress and anticipation. I was prepared for the worst ( and yes we all react differently) and while not comfortable, it was no where near what my imagination had conjured up . Agree on finding an MD who has done many of these. My guy had done over 4 thousand and assured me he was using numbing agents. If he says no find another MD.
I did have some blood in my urine the next day and any ejaculate for a few days was a bit colorful. I was given an antibiotic prior to the test and also after the test to avoid any infections.
Here how I would sum it up. While we are all different ...Our imaginations and built up fears prior to testing are understandable. The process is embarrassing and a bit uncomfortable but it was manageable and done properly. Good luck and let us know
Dennis(ProstateCancer.net TEAM)