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How Do They Do A Biopsy Of Your Prostate

Day Before Prostate Biopsy

How Safe is Prostate Biopsy?

You will be given a prescription for an antibiotic that should be the day before and the morning of your biopsy. Enough antibiotics have been given for you to continue taking them for two more days after the biopsy. You will also have to purchase two fleets enemas at your local pharmacy. Follow the instructions in the box and take one the evening before and one two hours before your biopsy. You should also not eat any solid foods after dinner the night before your biopsy. You may drink any type of liquid that you choose right up to the point of your biopsy. It helps to have some fluid in the bladder during the biopsy.

Transrectal Biopsy Of The Prostate

Today this procedure is usually carried out in the office of an experienced physician such as a urologist. However, it can also be carried out in a hospital or a day surgery center. It is commonly carried out with the accompanying use of a local anesthetic, but always ask the urologist if he or she is going to give you an anesthetic: prostate biopsy can quite often be painful without it.

The patient is asked to lie in one of several possible positions. The physician normally uses a special prostate biopsy gun to drive ultra-fine biopsy needles through the wall of the rectum and into the prostate. This gun is used in combination with a transrectal ultrasound probe, which enables the doctor to see where the biopsy needles are being placed into the prostate. Each hollow needle will remove a fine cylindrical core of prostate tissue in about a second.

This entire procedure, properly called transrectal ultrasound-guided prostate biopsy or TRUS-guided biopsy is usually completed in about 20 minutes, from start to finish.

The Number of Cores Removed

Many different theories exist as to the best way to sample the prostate so as to find any cancer that may be present. There are no absolute prostate biopsy guidelines. In general, however, an experienced physician will seek to take prostate biopsy specimens as follows:

Support Surveillance Use Alternative Tools

Surveillance protocols after the initial two-year surveillance biopsy should rely more heavily on regular PSA checks, prostate exams, and possible MRIs, says Dr. Stephenson.

Were fully supportive of active surveillance for men with low-risk prostate cancer, and weve found that ongoing ordering biopsies every two years is overly cautious and may have the unintended consequence of steering patients away from surveillance because of the high treatment burden, says Dr. Stephenson. Our analysis shows that you have to see a lot of patients before coming across one who would actually benefit from having the follow-up surveillance biopsy after two years.

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How It Is Done

Some people have a prostate imaging test, such as an MRI or a CT scan, before their biopsy. The test results are used during the biopsy to select the areas of the prostate to sample.

Before your biopsy, you may be given antibiotics to prevent infection. You may be asked to take off all of your clothes and put on a hospital gown.

You may be given a sedative through a vein in your arm. The sedative will help you relax and stay still.

If you have a general anesthetic, you will be in a recovery room for a few hours after the biopsy.

Prostate Biopsy At A Glance

Injection of 99m Tc
  • A prostate biopsy is the removal of tissue samples from the male prostate gland so a laboratory can examine the tissue for the presence of prostate cancer.
  • A biopsy is generally recommended when a prostate-specific antigen screening, a digital rectal exam or an imaging test indicate a suspicious area that requires further examination.
  • We will discuss our findings with the patient and the prospect of conducting a prostate biopsy to learn more.
  • Urologists perform the removal of the tissue in our offices using transrectal ultrasound and a small needle to obtain cell samples from the prostate for a biopsy.
  • The biopsies are sent to the pathology lab where they are stained and reviewed by a pathologist, with results typically available within one week of the biopsy.
  • Prostate biopsy is the only method of definitively diagnosing prostate cancer.

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What Are The Symptoms Of Prostate Dysfunction

Not all prostate cancer patients experience prostate symptoms. However, according to the National Institute on Aging, the most common symptoms of prostate problems include:

  • Increased frequency of urination
  • Sexual dysfunction
  • Painful back, hips, pelvis, or rectum

If you are experiencing these symptoms, please seek medical care as soon as possible. They may indicate inflammatory conditions like BPH , prostatitis , an infection of the prostate, bladder, or other organs, or other diseases like STDs and cancer.

Benefits Of Getting A Prostate Biopsy

A prostate biopsy is the only way to definitively determine whether you have prostate cancer and, if you do, how aggressive it is.

While prostate biopsies arent always conclusive, in general, a biopsy gives men the reassurance of knowing whether they have cancer or not. If you know you have prostate cancer, youre more likely to be appropriately treated.

Appropriate prostate cancer treatment options depend on several factors, including the stage of the cancer, your age, your general health and which risk category your cancer falls into.

Localized prostate cancer is categorized into six risk categories, which range from very low-risk to very high-risk. The risk group is determined by the stage of your cancer, your PSA levels and the Gleason score obtained from the biopsy pathology report.

The National Comprehensive Cancer Network guidelines outline appropriate treatment options based on risk categories and whether the cancer has already metastasized.

Patients whose cancer is confined to the prostate and falls into the very low-risk and low-risk categories tend to have slow-growing cancers. Treatment options for these patients often include active surveillance, radiation therapy or surgery. Similar treatment options may be recommended to patients in the low-risk and favorable intermediate prostate cancer risk categories.

The NCCN guidelines recommend immediate treatment for patients with high-risk disease or those patients whose cancer has metastasized.

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What Are The Risks Of A Prostate Biopsy

You may bleed more than expected or get an infection in your urinary tract or prostate gland. The infection may spread to your blood and the rest of your body. Your bladder may not empty completely when you urinate. You may need a catheter to help empty your bladder for a short period of time. Cancer cells may be missed during your biopsy procedure. You may need another prostate biopsy to check for cancer again.

How Doctors Determine Whether To Recommend A Prostate Biopsy

How is a Prostate Biopsy Performed?

No two patients are alike, and a urologist needs to take many variables into account before recommending a prostate biopsy, including a patients:

  • Age and life expectancy
  • Comorbidities
  • Change in PSA values across time.

The decision of whether to undergo a prostate biopsy should be determined after an individual conversation with your doctor during which he or she presents you with the big picture of your situation.

Compare, for example, the case of two 50-year-old men: One of them has been diagnosed with heart failure and is in poor overall health. The other has no pre-existing health conditions. I probably wouldnt advise a prostate biopsy for the 50-year-old with heart failure because prostate cancer is unlikely to cause his death within the next five years.

But I would recommend that the healthy 50-year-old get a prostate biopsy, because even if his cancer isnt aggressive right now, missing a prostate cancer diagnosis may result in his death from the disease in 15 years. In his case, it would be better to risk the prostate biopsy to catch the cancer early and improve his chances of long-term survival.

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What Happens After An Mri

You may resume your normal activities and diet immediately. You may be sore for a few days, and you also may see small amounts of blood in your urine, stool, and semen. However, these symptoms usually last only a few days. A high fever or flu-like symptoms within a few days of the biopsy should cause you to seek attention in a local emergency room to get treated for an infection.

Last reviewed by a Cleveland Clinic medical professional on 11/03/2016.

References

Prostate Biopsy And Drug Therapy

Prior to a prostate biopsy, patients should make sure that their urologist is advised of all medications that they are normally taking on a day-to-day basis. Patients who take such drugs as aspirin, warfarin, and clopidogrel or other so-called blood thinners are normally asked to stop taking such drugs for a period of time prior to a biopsy procedure, and should discuss the appropriate time to stop taking such drugs with their primary care physician or their cardiologist, as appropriate.

Content on this page last reviewed and updated August 2007, 2012.

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Precancerous Cells And Pin

Sometimes, the results will show that precancerous cells, or prostatic intraepithelial neoplasia , are present.

If these PIN are low grade, the doctor will not consider this a matter of concern. Many men have low grade PIN.

However, if the PIN are high grade, there is a chance that cancer may develop. In these cases, a doctor may suggest further tests.

Carcinoma in situ refers to cells that are not yet cancerous but could become so. They can occur almost anywhere in the body.

The outlook depends on the results of the biopsy and other tests.

If results show that cancer is present in or around the prostate gland only, there is an almost 100% chance of surviving at least another 5 years. This is because effective treatment is available, and because many types of prostate cancer are slow growing.

However, if cancer has spread to other organs, such as the liver or lungs, the chance of someone surviving another 5 years or more falls to 30%.

Factors that affect the outlook for a person with prostate cancer include:

  • their age and overall health
  • the type of cancer present
  • how far cancer has spread

Get Ready For Your Procedure

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  • When its time to change for procedure, youll get a hospital gown, robe, and nonskid socks to wear.
  • The exact starting time of procedure may depend on the length of the procedure scheduled before yours. Your nurse will speak with you if there are any unexpected delays.
  • Before youre taken into the operating room, youll need to remove your hearing aids, dentures, prosthetic device, wig, and religious articles.

Your procedure will take about 20 to 30 minutes.

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Temporary Effects On Your Bowel Movements Urine And Semen

  • You might see blood in your bowel movements. You might also have a small amount of bleeding from your rectum. These can happen right after your procedure or for the next few days when you have a bowel movement.
  • You might see blood in your urine for 7 to 14 days after your procedure. This bleeding might come and go.
  • Your semen might look rust-colored for up to 12 weeks after the biopsy. This is because small amounts of blood might be in it.

How To Make Your Prostate Biopsy Go Better

Before a prostate biopsy, discuss all thesteps you or your doctor can take to makethe experience as comfortable, safe, andinformative as possible.

Here is what men need to know to minimize discomfort of a prostate biopsy and get the best results.

Many men choose to have prostate-specific antigen blood tests to check for hidden prostate cancer, despite the uncertain benefits. Having an abnormal PSA test result often leads to a prostate biopsythe only way to confirm the presence of cancer. Biopsies are invasive, but they have become routine.

To reduce discomfort and get the best results, discuss the procedure in detail with your doctor. Certain practices can improve the overall outcomefor example, make sure you get a shot of anesthetic into the prostate to numb pain during the procedure. “Local anesthesia makes a world of difference between having a tolerable biopsy experience and an unpleasant one,” says Dr. Marc B. Garnick, Gorman Brothers Professor of Medicine and a prostate cancer expert at Harvard-affiliated Beth Israel Deaconess Medical Center.

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Prepare For The Immediate Complications

A prostate biopsy usually has the primary complication of bleeding. You can see blood in the urine, in the stool, or in your semen. Also, you may feel pain in your pelvic floor for up to one week. You need to understand before the procedure why this happens. That way, you will be able to tell when the bleeding is too much. Be sure to ask your doctor what to expect in your case.

Are There Any Problems To Expect After A Prostate Ultrasound And Biopsy

When should You Have a Prostate Biopsy?

In some cases, men can develop a urinary tract infection or an infection in the prostate. These infections are rare and easy to treat with prescribed antibiotics.

Blood in the urine and/or stool is common for three to five days after the biopsy. It is also common to have blood in your semen for up to two to three months after the biopsy. This is not harmful to you or your partner and will eventually go away on its own. You should avoid heavy lifting for two to three days to help avoid bleeding issues.

Some men may also have trouble urinating after the procedure. Most problems are minor and go away on their own after a few days. If you arent able to urinate at all, call your healthcare provider or go to the emergency room. Make sure that you tell them that you just had the ultrasound and biopsy.

  • A fever of 100 degrees F or higher.
  • Shaking or chills.

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Stop Taking Certain Medications

You may need to stop taking some of your medications before your procedure. Examples include anticoagulants, aspirin, medications that contain aspirin, multivitamins, and vitamin E. Talk with your healthcare provider about which medications are safe for you to stop taking. Follow their instructions. You can read about medications that contain aspirin and vitamin E in the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.

Genetic Testing For Some Men With Prostate Cancer

Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.

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Biopsy During Surgery To Treat Prostate Cancer

If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .

The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.

Choosing Between A Prostate Mri Vs Biopsy

Infection on the Rise After Transrectal Prostate Biopsy

Whats worse than a false-positive PSA? A false-negative biopsy.

Research shows that 35% of biopsy results are false negatives. This means despite the invasive sampling of tissues, cancer can go undetected and continue to grow while symptoms persist.

Thats why having a prostate MRI before a biopsy is preferable. It shows the location of potential cancer, which helps direct the biopsy sampling.

Before you decide to get a prostate MRI vs. biopsy, here are a few things to know.

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What Is A Transperineal Biopsy

This is where the doctor inserts the biopsy needle into the prostate through the skin between the testicles and the back passage . In the past, hospitals would only offer a transperineal biopsy if other health problems meant you couldnt have a TRUS biopsy. But many hospitals have stopped doing TRUS biopsies and now only do transperineal biopsies.

A transperineal biopsy is normally done under general anaesthetic, so you will be asleep and wont feel anything. A general anaesthetic can cause side effects your doctor or nurse should explain these before you have your biopsy. Some hospitals now do transperineal biopsies using a local anaesthetic, which numbs the prostate and the area around it, or a spinal anaesthetic, where you cant feel anything in your lower body.

The doctor will put an ultrasound probe into your back passage, using a gel to make this easier. An image of the prostate will appear on a screen, which will help the doctor to guide the biopsy needle.

If youve had an MRI scan, the doctor may just take a few samples from the area of the prostate that looked unusual on the scan images. This is known as a targeted biopsy.

What Are The Side Effects Of A Biopsy

Having a biopsy can cause side effects. These will affect each man differently, and you may not get all of the possible side effects.

Pain or discomfort

Some men feel pain or discomfort in their back passage for a few days after a TRUS biopsy. Others feel a dull ache along the underside of their penis or lower abdomen . If you have a transperineal biopsy, you may get some bruising and discomfort in the area where the needle went in for a few days afterwards.

If you receive anal sex, wait about two weeks, or until any pain or discomfort from your biopsy has settled, before having sex again. Ask your doctor or nurse at the hospital for further advice.

Some men find the biopsy painful, but others have only slight discomfort. Your nurse or doctor may suggest taking mild pain-relieving drugs, such as paracetamol, to help with any pain.

If you have any pain or discomfort that doesnt go away, talk to your nurse or doctor.

Short-term bleeding

Its normal to see a small amount of blood in your urine or bowel movements for about two weeks. You may also notice blood in your semen for a couple of months it might look red or dark brown. This is normal and should get better by itself. If it takes longer to clear up, or gets worse, you should see a doctor straight away.

Infection

Symptoms of a urine infection may include:

  • pain or a burning feeling when you urinate
  • dark or cloudy urine with a strong smell
  • needing to urinate more often than usual
  • pain in your lower abdomen .

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