What Is Prostate Cancer Screening
The diagnosis of prostate cancer usually follows a biopsy prompted by a significantly elevated initial PSA level, an increase in PSA levels over time, or an abnormal digital rectal examination. According to JAMA, patients with a prostate cancer history benefit from extended PSA monitoring. Elevated PSA levels may help determine when to go in for a prostate MRI and hopefully avoid unnecessary or repeat prostate biopsies.
The American Journal of Mens Health reports that prostate cancer diagnosis occurs most often in men older than 50. Other factors influencing the rate of prostate cancer are ethnicity and family history. Screening is vital because localized prostate cancer sometimes causes no symptoms or warning signs.
How We Approach Prostate Biopsies And Prostate Cancer Diagnosis At Ctca
When you come to CTCA for a prostate biopsy or a second opinion, youll have access to tests that may help increase the accuracy of each biopsy. Our team has expertise with these tests and procedures, allowing us to work quickly and efficiently.
If youre diagnosed with prostate cancer, a multidisciplinary team of genitourinary experts, which may include a urologist, a urologic oncologist, a radiation oncologist and a medical oncologist, will review your case and develop a personalized plan based on your specific circumstances and needs.
We only treat cancer at CTCA, which means our cancer experts are skilled at assessing risk associated with each persons circumstances. We give you the pros and cons of the treatment options available to you, allowing you time to talk with your team of doctors and other experts about those options.
Our cancer experts are also vigilant about what patients need and when they need it. We know that when men are told they have slow-growing prostate cancer, some of them wont keep up with the necessary follow-ups, so we help keep them on track.
If you choose to receive treatment with us, you may benefit from our integrative approach to cancer treatment. Our multidisciplinary team works together to help prevent and manage the side effects of cancer and its treatment, providing supportive care services, such as:
What Is A Prostate Biopsy
The prostate gland is found only in males. It sits below the bladder andwraps around the urethra . Theprostate helps make semen.
A biopsy is a procedure used to remove a small piece of tissue or cellsfrom the body so it can be examined under a microscope.
In a prostate biopsy, prostate gland tissue is taken out with a biopsyneedle or during surgery. The tissue is checked to see if there are canceror other abnormal cells in the prostate gland.
A prostate biopsy may be done in several different ways:
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Transrectal method. This is done through the rectum and is the most common.
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Perineal method. This is done through the skin between the scrotum and the rectum.
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Transurethral method. This is done through the urethra using a cystoscope .
Ultrasound is usually used to look at the prostate gland and guide thebiopsy needle.
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Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, you will be asked about symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.
Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.
After the exam, your doctor might then order some tests.
What Should I Expect My Urologist To Review Next If It Did Show Cancer
There are a lot of details within the biopsy report and this will really really help guide your treatment options. For prostate cancer, one of the most difficult aspects of coming up with a treatment plan is that there are choices. Its sometimes easier when there is only one option but oftentimes there are multiple excellent treatment choices that you can fall back on. If you want more details about choosing between surgery or radiation for prostate cancer, then click over here.
I am going to walk through how I review a biopsy report with my patients who have been diagnosed with cancer.
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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.
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What Abnormal Results Mean
A positive biopsy result means that cancer cells have been found. The lab will give the cells a grade called a Gleason score. This helps predict how fast the cancer will grow. Your doctor will talk to you about your treatment options.
The biopsy may also show cells that look abnormal, but may or may not be cancer. Your provider will talk with you about what steps to take. You may need another biopsy.
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How Do You Prepare For A Prostate Biopsy
Your doctor will get you tested for urinary tract infections . If UTI is detected, the biopsy will be postponed till the infection clears with antibiotics.
You need to stop taking blood-thinning medications such as aspirin and warfarin and any other medications as advised by your doctor several days before the surgery.
Your doctor or nurse may instruct you to take an enema before the procedure. This helps to keep the bowels clean during the surgery.
When Can I Expect The Results Of My Ultrasound Guided Prostate Biopsy
The pathology result generally takes a few days to be available to your doctor.
The time it takes your doctor to receive a written report on the test or procedure will vary depending on:
- the urgency with which the results are required by your doctor
- the complexity of the test or procedure
- whether more information is needed from your doctor before the test or procedure can be interpreted by the radiologist
- whether you have had previous X-rays or other medical imaging that need to be compared with this test or procedure
- how the report is sent to your doctor .
Please feel free to ask the private practice, clinic, or hospital when the written report will be provided to your doctor.
It is important that you discuss the results with your doctor, either in person or on the telephone, so that they can explain what the results mean for you.
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What You Need To Know About The Prostate How Do They Do A Biopsy Of The Prostate
The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.
A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
What Are The Advantages And Disadvantages Of Having A Biopsy
Your doctor should talk to you about the advantages and disadvantages of having a biopsy. If you have any concerns, discuss them with your doctor or specialist nurse before you decide whether to have a biopsy.
Advantages
- Its the only way to find out for certain if you have cancer inside your prostate.
- It can help find out how aggressive any cancer might be in other words, how likely it is to spread.
- It can pick up a faster growing cancer at an early stage, when treatment may prevent the cancer from spreading to other parts of the body.
- If you have prostate cancer, it can help your doctor or nurse decide which treatment options may be suitable for you.
- If you have prostate cancer, youll usually need to have had a biopsy if you want to join a clinical trial in the future. This is because the researchers may need to know what your cancer was like when it was first diagnosed.
Disadvantages
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Why Are Prostate Biopsies Done
To learn about the health of your prostate, your doctor may ask questions about your medical and family history and conduct a physical examination known as a digital rectal exam . You also may require a PSA blood test. PSA stands for prostate-specific antigen, a type of protein the prostate produces. Certain PSA levels may indicate that something is abnormal within the prostate.
If PSA results are abnormal, a prostate biopsy may be ordered. In general terms, a biopsy is a medical test that involves extracting cells or tissue from a part of the body to look for the presence of disease. In the case of a prostate biopsy, prostate tissue from the prostate gland is removed and examined under a microscope by a pathologist. Its an important procedure because only a biopsy can definitively diagnose prostate cancer. The PSA blood test and DRE are only indicators that cancer may be present.
What Are The Limitations Of Ultrasound
A biopsy can only show if there is cancer in the tissue samples. It is possible to miss cancer in unsampled areas of the prostate.
For MRI-guided biopsies, you must remain perfectly still to ensure the technologist captures high-quality images. If you are anxious, confused, or in severe pain, it may be hard to lie still. If so, the images may not be of high enough quality to be useful.
Likewise, the presence of an implant or other metallic object sometimes makes it difficult to obtain clear MR images. A person who is very large may not fit inside certain types of MRI machines.
Bleeding may sometimes occur in the prostate after a biopsy. MR imaging cannot always tell the difference between cancer, inflammation, or the presence of blood. To avoid confusing them, your doctor may perform a repeat MRI six to eight weeks after the biopsy to allow residual bleeding to resolve.
An MRI exam typically costs more and may take more time than other imaging exams. Talk to your insurance provider if you have concerns about the cost of MRI.
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What To Watch For Afterward
Here are the most common complications of prostate biopsy:
- Pain in the area between the anus and scrotum for a few days to a week.
- Blood in your urine for a few days to several weeks.
- Blood in the stool for a day or so. If it lasts longer, notify your physician.
- Blood in the semen for three to six weeks, and possibly longer.
Make sure to notify your doctor if rectal or urinary bleeding get worse. Also, be on guard in the first 24 to 48 hours for signs of a serious infection in the urinary tract or prostate gland. “The alarm signs are fever or chills,” Dr. Garnick says. “If you experience this, get to a hospital immediately for intravenous antibiotics.” A runaway infection can be dangerous, so don’t ignore the signs.
Another uncommon but dangerous complication is urinary retentionthe inability to pass urine caused by an infection. Seek care immediately if you stop being able to urinate after a biopsy.
What Can You Expect During A Prostate Ultrasound And Biopsy
The procedure is short and generally only takes about 10 minutes. Your urologist, a doctor specializing in mens genital and urinary problems, will perform the procedure.
- Upon arrival in the examination room, you will be given antibiotics to prevent infection.
- You will be asked to lie on your side and bring your knees to your chest.
- The area being tested may be numbed to help reduce any discomfort.
- A lubricated probe is inserted into the rectum to generate the ultrasound.
- A small needle is inserted through the probe to take several tiny tissue samples from the prostate. Some men may feel mild pressure or discomfort during the procedure.
- After tissue samples are taken, they are sent to a lab for an analysis.
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What Is An Mri
MRI stands for magnetic resonance imaging, a test that creates a detailed image of an area inside the body. An MRI provides a more detailed image than the ultrasound procedure, and allows doctors to spot parts of the prostate that dont look healthy and should be examined with a biopsy needle.
Doctors have started using ultrasound and MRI images together in what is known as a fusion-guided biopsy. An MRI is taken and the image is examined to identify areas that look suspicious. Later, the doctor who performs the biopsy uses an ultrasound probe along with special software to fuse the MRI and ultrasound images into one image that makes it easier to spot targets for the biopsy needles.
When Do I Need A Biopsy
Your doctor may order a biopsy if your prostate-specific antigen level in your blood work is elevated or there is an abnormal lump found during a digital rectal exam. During a digital rectal exam, your doctor inserts a finger up your bottom to feel if your prostate is enlarged or has bumps. Another option before a biopsy is an ultrasound. Instead of a finger, a small probe is inserted to take pictures of the prostate.
An MRI-guided prostate biopsy may be used in patients who have a rising PSA level, yet a negative ultrasound-guided biopsy. It also may be used in situations where a diagnostic prostate MRI performed because of rising PSA demonstrates a very small abnormality that may not be easily targeted by ultrasound. An MRI image to guide a biopsy can improve the ability to detect prostate tumors which may require treatment.
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What Can You Not Do After A Prostate Biopsy
After a prostate biopsy, people can expect to continue to live normally. However, there are some cautions to be practiced, generally for a few days after the biopsy.
Experts recommend avoiding having sex for seven days after the biopsy. This is because sexual activity activates the prostate gland. It is essential to give the prostate gland some rest and time to heal.
Additionally, it is a good idea to avoid severe physical activity. Especially avoid sports that put stress on core muscles like exercising, lifting weight, golfing, and more. Generally, a week of caution is more than enough for most people.
One should also avoid straining when living with bowel movement issues. For example, if a person lives with chronic constipation or other bowel moment problems, it is good to consider stool softeners.
When taking medications for some preexisting conditions, it is good to consult a healthcare provider. For example, medications like blood thinning agents may increase the risk of bleeding.
Furthermore, if a healthcare provider has prescribed antibiotics to prevent or manage infection, avoid drinking alcohol for a few days.
Discuss Prognosis Of Your Cancer
With the biopsy report, there is now a LOT of information to process and interpret. There are numerous risk calculators, or nomograms, that can further help provide information to help understand the overall burden of your cancer.
These nomograms will often taken into account your age, PSA level, rectal exam findings, and biopsy report. These nomograms will spit out information ranging from your overall survival to the likelihood the cancer has spread to the lymph nodes or beyond. These help to kind of recap all the details of your situation and give you a better understanding of your new diagnosis.
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Should I Get A Prostate Biopsy An In
Rising or elevated prostate-specific antigen levels, an abnormal digital rectal exam , or both, may indicate the presence of prostate cancer, and having those conditions may lead your doctor to recommend a prostate biopsy. But controversy surrounding the PSA blood test and concerns about prostate biopsies cause many patients to ask:
- Should I get a prostate biopsy?
- Are the risks of a prostate biopsy worth it?
- Are there alternatives to a prostate biopsy?
- If I have prostate cancer, is treatment necessary if Im not experiencing symptoms?
If youre looking for answers to these questions, you may find conflicting and confusing information across the medical field, in the news and on prostate cancer websites. Some dispute the necessity of prostate cancer screening and discourage men from getting a PSA test to begin with. Others suggest that prostate cancer is overtreated and that the risks associated with biopsies and treatment arent worth the potential benefit.
While the 10-year survival rate of men with a diagnosis of prostate cancer is approximately 98 percent, prostate cancer remains the second leading cause of cancer deaths in American men. The American Cancer Society estimates that 248,530 new cases of prostate cancer will be diagnosed in the United States in 2021 and that one in every 41 men diagnosed will die from the disease.
To help you better understand this topic and whether you should get a prostate biopsy, this article will cover: