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. — 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.

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.

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 am disturbed to hear about the doctor’s behavior as reported by your friend.