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I'm 68 years old.  I had my J-Pouch surgery in October of 1999 after 19 years of UC.  I was diagnosed in March of 2020 with low risk prostate cancer. 3 + 3 on the Gleason scale.  I'll now be going in for my second round of biopsies after an MRI back in January of this year.

Not knowing then, March of 2020, what I know now, I've done a little bit of research.

The stepper technique was used to take biopsies from me back in 2020.  Seepage/leakage has been the challenge after that 2020 procedure.   I didn't know at the time that there are two techniques available.  Free hand is the other.  If one technique is used at one surgical center organization, the other is not and vice versa at the other organization.   

This stepper technique is done with a general anesthetic, many skin punctures, as many as the number of biopsies needed and possibly leaving with a catheter.

The Free Hand technique has local numbing, two skin punctures and no catheter.  Both are treated as out-patience.

  I am so fortunate having a choice with either technique at one of the two different health care organizations.

Any thoughts and input from anyone?

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I went ahead and researched the two methods. The literature seems to suggest that freehand will give similar outcomes to the stepped method.
if it was me, and btw I have a bouncing PSA that runs high, I would lean towards the freehand.

I have had over the last ten years, two trus  biopsies prior to TPC/IPAA surgery and can’t and won’t have future similar traditional biopsies.

please keep us up to date as this is a very important topic for some of us.

btw, does your care team have a preference/recommendation on this?

thank you,


Last edited by New577

Hello Eric and thank you so much for your thoughts.   My options are with two different physicians at two different hospitals.  One in CT, the other in MA.  Both physicians are non-committal.  The location that does the stepper technique are not authorized to do the free hand.  The doctor that would use the stepper technique has done this on men with a J-Pouch, he just hasn't done biopsy fusions on one with a J-Pouch.  The free hand physician has done about 6.

The upside is that both procedures take about 20 minutes unless you've heard otherwise.  I am leaning towards the free hand technique because of it being less invasive as far as the skin punctures are concerned.   The local numbing is what's challenging for me.  I'm thinking the worse too when it comes to the pain.  Although he has offered me a valium an hour before the procedure and told me he would abort if needed.  I'll be checking with my Pouch surgeon this week for his input on the two techniques.

I'm not sure what you mean by TPC and IPAA are.

Thanks again...


TPC/IPAA is shorthand for total procto colectomy/ileo pouch anal anastomosis.

I agree with you, the less invasive the better, as long as you can achieve accurate results.

i assume you are on active surveillance and are following up as per your AS protocol.

I have lots more questions, so if you want me to private message you I will.

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