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How Is A Prostate Biopsy Done

Preparing For A Prostate Biopsy

How is a Prostate Biopsy Performed?
  • Do not take medications containing aspirin or ibuprofen for 10 days prior to the prostate biopsy. These brand name medications include Plavix, Advil, Motrin, Aleve and Naprosyn. Tylenol is allowed. Patients can continue their medications with aspirin and ibuprofen after the biopsy.
  • Patients should stop taking Coumadin, Pradaxa, Effient, Eliquis or Xarelto 5 days before their prostate biopsy, unless otherwise directed by their urologist.
  • Patients may need a consultation with their primary care provider, cardiologist or hematologist to consider bridge steps between stopping their blood thinner medications and the prostate biopsy. They will be counseled on how to start back on those medications after the biopsy.
  • Biopsy patients should eat before arriving for their procedure.
  • Patients need a Fleets Enema 2 hours before their prostate biopsy.
  • We will give patients a prescription for antibiotics with instructions on when to begin taking the medication before their scheduled biopsy.
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    Preparing For Your Biopsy

    You have the biopsy under local or general anaesthetic.

    Having the biopsy under local anaesthetic means you should be able to eat and drink normally before the test.

    Having the biopsy under general anaesthetic means that you wont be able to eat or drink for a number of hours beforehand. You usually stop eating at least 6 hours before the biopsy and stop drinking at least 4 hours beforehand. Your team will give you instructions.

    Take your usual medicines as normal, unless you have been told otherwise. If you take warfarin to thin your blood, you should stop this before your biopsy. Your doctor will tell you when to stop taking it.

    You have antibiotics to stop infection developing after the biopsy. You have them before the biopsy and for a few days afterwards.

    You might have a tube into your bladder to drain urine.

    Your doctor will ask you to sign a consent form once you have all the information about the procedure.

    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.

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    Prostate Biopsy Risks And Side Effects

    The most common side effects of a prostate biopsy are:

    If the patient experiences more severe symptoms, including chills, pain or high feveror if he is concerned about any of his symptomshe should contact his doctor immediately.

    It usually takes a few days to get the results of a prostate biopsy. If they indicate the presence of cancer in the prostate, imaging exams may be conducted to see how far the cancer has spread. After that, various prostate cancer treatment options are available.

    References

    Trabulsi EJ, Halpern EJ, & Gomella LG. . Ultrasonography and biopsy of the prostate. Campbell-Walsh Urology, 10th. ed.

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    What Are The Advantages And Disadvantages Of Having A Biopsy

    What you Need to Know About Prostate 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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    The Digital Rectal Exam

    The prostate gland comprises three zones. Most cancers originate in the peripheral zone. Proctologists, urologists, and oncologists are trained to feel this area while performing a digital rectal exam .

    Here, digital doesnt refer to technology. Instead, it refers to the fingers . In a DRE, your doctor inserts a well-lubricated gloved finger gently into the rectum to reach the prostate. Prostate enlargement and suspicious lesions may be felt during a DRE.

    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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    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.

    How Long Do Prostate Cancer Biopsy Results Take

    How is a Prostate Biopsy Done?
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    Lymph Node Biopsy As A Separate Procedure

    A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.

    Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.

    How Does Your Doctor Do Prostate Biopsies

    So the time has come for a whole bunch of reasons for actual and potential prostate cancer patients to start asking their urologists about whether they are able to carry out transperineal as opposed to transrectal biopsies.

    Once upon a time back in the 1970s before we had PSA tests to screen for risk of prostate cancer, and transrectal ultrasound equipment to help guide transrectal biopsies, and a relatively low risk for biopsy-related infections with antibiotic-resistant bacteria, older forms of transperineal biopsy were a very normal way to carry out prostate biopsies. But they werent very good and they werent easy to do.

    So, to be clear, a transperineal prostate biopsy is carried out through the skin between the rectum and the testes . By comparison, transrectal biopsy is carried out through the skin inside the rectum and comes with a relatively high risk for prostatic infections, including serious infections like septicemia that can lead to hospitalization and even death.

    This link to information on the Mayo Clinic web site provides a pretty straightforward introduction to the relative merits of transperineal as opposed to transrectal biopsies. It is worth noting, in particular, the following:

    The reasons that most urologists here in the USA dont use the transperineal method for carrying out prostate biopsies are:

    The bottom line here is that there is an increasingly credible amount of data suggesting that:

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    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:

    Use In Men Already Diagnosed With Prostate Cancer

    Prostate Biopsy

    The PSA test can also be useful if you have already been diagnosed with prostate cancer.

    • In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
    • The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
    • PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .

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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.

    Controversies And Misconceptions Surrounding Prostate Biopsies

    The PSA test measures the levels of PSA proteins in the body, and when it was first developed, it was quickly implemented by many physicians as a screening test for prostate cancer. The thought was that since PSA proteins are only produced by the prostate, elevated levels could be an indication of prostate cancer. As a result, most men with an abnormal PSA test underwent a prostate biopsy.

    The increase in biopsies resulted in the number of advanced, untreatable prostate cancers decreasing significantly because more prostate cancers were caught earlier, when the disease is easier to treat. But the problem with many patients being diagnosed sooner was that some patients were being aggressively treated when they should have been monitored instead.

    Though many in the field of urology believe it was flawed, a controversial study attempted to assess the benefits of the PSA test as a screening tool for prostate cancer, and its results led to the recommendation that most men shouldn’t get the test because it didnt appear to improve mortality rates from prostate cancer. This, combined with growing awareness that many cases of prostate cancer were being treated unnecessarily or prematurely, led to a reduction in prostate biopsies. This controversy led to a reduction in prostate cancer screening and an increase in the number of diagnoses of advanced prostate cancer.

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    How Should I Prepare

    Prior to a prostate biopsy, tell your doctor about all the medications you take, including herbal supplements. List any allergies , recent illnesses, and other medical conditions.

    You may need to stop taking blood thinners for seven to 10 days before the procedure. This will help prevent excessive bleeding during and after the biopsy. The doctor may check your blood clotting on the day of the procedure. Ask your doctor and the hospital radiology clinic or department for more information.

    You may need to take oral antibiotics a day before and the morning of the biopsy. This will help prevent infection.

    If you are having an MRI-guided biopsy, you will need to wear metal-free clothing and remove any metallic objects, such as jewelry, watches, and hearing aids.

    A technologist will walk through an MR imaging safety checklist with you. Tell your technologist about prior surgeries and metal implants, such as pacemakers, aneurysm clips, and joint replacements.

    An MRI-guided procedure may use an injection of gadolinium contrast material. Because gadolinium does not contain iodine, it can be used safely in patients with contrast allergies.

    Your MRI procedure may use an endorectal coil. This is a thin wire covered with a latex balloon. The doctor will lubricate this assembly and gently insert it into your rectum. Tell the doctor if you are allergic to latex so they may cover the coil with a latex-free balloon.

    Among Men With Previous Negative Biopsy

    What is a Prostate Cancer Biopsy?

    In patients with a prior negative biopsy, MRI targeted prostate biopsy can guide treatment decisions by helping overcome diagnostic uncertainty as imaging may assist in localizing an area of suspicion, such as the 30% of men with prostate cancer whose tumor originates in the anterior or transitional zone. Lawrentschuk and Fleshner analyzed combined data from 215 men across six prospective studies of MRI prior to repeat biopsy for rising PSA, and found that in those who had both standard and MRI-directed biopsies that 54% had prostate cancer detected only by MRI-directed cores. In a related study involving MR-US fusion biopsy on 105 patients with prior negative biopsy and elevated PSA, Sonn et al. found a cancer detection rate of 34% , with 72% of these 36 cancers being clinical significant. On multivariate analysis, a highly suspicious MRI lesion was the most significant predictor of significant cancer with an odds ratio of 33, with 12/14 patients found to have clinically significant cancer. Multiparametric MRI is now recommended according to National Comprehensive Cancer Network and the European Association of Urology guidelines for men with a rising PSA and suspicion of cancer despite multiple negative biopsies.

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    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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