Nor I, Nick. Frankly, I thought the ultrasound wand was the most
uncomfortable part of it and a topical is not going to do a thing for
that. They should either give you the stuff they do when you have a
colonoscopy or at least have you breathe NO2 like some dentists do.

Bill Denton
RP 2/12/02
PSA .96
Memphis

Except, of course, those who experience SEs, some of which can be
serious. Many doctors -- and some whole countries -- would object
strongly to using a general just to avoid some possible, very
controllable, discomfort. It's even banned in Great Britain for some
tasks such as routine dentistry, which hurts one helluva lot more than
any prostate biopsy. And, of course, it must be administered and the pt
monitored only by a certified anesthesiology team and is highly advised
to be done only in a hospital that can handle full-scale
life-threatening emergencies.

And "best experience" is in the eye of the beholder, considering some of
its more common and mild SEs such as grogginess or nausea. Many of us
aren't willing to forego driving (by law) for at least 24 hours or to
risk some nausea and/or giving up a day or three of clarity just to
avoid a 20 minute nuisance. Then there are the hassles like fasting,
avoiding some common meds, avoiding making important decisions for a day
or two, etc. (If your uro didn't do all that with general anesthesia,
I'd not let him NEAR my prostate or a bad pimple.)

At the very most, for the most fearful of patients, who won't even TRY
doing it the usual way, I suspect more prudent doctors would recommend a
lighter sedative just to reduce the fear (anesthesiology doesn't curb
fear), and, if they are still truly scared to death of all this despite
its benign track record, maybe having the anesthesiologist hook
everything up, stand by, and see how the pt tolerates that first core
sample (I'd bet most pts wouldn't even realize that first core had been
taken if the doc kept his mouth shut). Then if the pt still couldn't
stand the pain of the first sample, he'd be under in seconds for the
rest of the procedure. At least that way he's risking a long list of SEs
for a reason other than simple uncertainty and a very slight risk of one
second of pain. No one ever dies from not using a general for a prostate
bx, but at least four would die in the U.S. alone just from the general
if we all got generals for our biopsies.

I also advice anyone that worried about and intolerant of pain to avoid
ANY surgery for ANY reason . . . CERTAINLY if it involves cutting a
muscle. A bx carries a very slight risk of 12 or 16 seconds of pain; the
slightest surgery (not to mention jamming a finger) virtually PROMISES
many hours of some degree of discomfort or even pain.

Once again, Dr. Yew . . . how do you feel about using a general for a
routine prostate bx? Am I being overly cautious?

I.P.