When A Biopsy May Be Needed
A biopsy can be used to investigate abnormalities, which can be:
- functional such as kidney or liver problems
- structural such as swelling in a particular organ
When the tissue sample is examined under the microscope, abnormal cells may be identified, which can help to diagnose a specific condition.
If a condition has already been diagnosed, a biopsy can also be used to assess its severity and grade .
This information can be very useful when deciding on the most appropriate treatment, and assessing how well a person responds to a particular type of treatment.
It can also be useful in helping to determine a person’s overall prognosis .
Examples of conditions where a biopsy may be helpful include:
- inflammation, such as in the liver or kidney
- infection, such as in lymph nodes for example, tuberculosis
- various skin conditions
It’s not usually possible to tell whether a lump or growth on your skin or inside your body is cancerous or non-cancerous by clinical examination alone, which is why a biopsy is often required.
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.
How Painful Is A Biopsy Of The Prostate
It is a common question, and the survey shows that it is not that painful. For example, in the case of transrectal prostate biopsy, most would describe experiencing mild discomfort.
That is why doctors do not use sedation or general anesthesia. Nevertheless, doctors may use some local anesthetic, which makes local tissues numb and is very safe.
Pain may be more pronounced in the case of transperineal biopsy, and that is why it is an uncommon way of the prostate biopsy procedure.
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Does The Prostate Swell After A Biopsy
When it comes to inflammatory responses, people differ. No matter how small, any trauma will cause local inflammation, and the prostate will swell a bit. However, in some individuals, this swelling may be more than in others.
This swelling of the prostate can make urinating difficult for individuals. Generally, this swelling would not last long. Nonetheless, your healthcare provider would recommend urinating before the procedure.
For most people, the swelling would last for a few hours. However, if it lasts longer, it may cause urinary retention or a problem peeing. In such instances, doctors may need to insert a catheter.
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.
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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:
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Biopsy: What The Diagnosis Means
The pathologist has just looked under the microscope at 12 tissue samples from your prostate. Whats in there? First, there are normal cells. Pathologists can tell that theyre normal, because they are round and uniform, with well-defined edges and clear centers. As cancer progresses, the cells become more oblong then more irregular. The edges get blurred, and eventually, the outside shapes start to get weird so do the insides. What once looked like pebbles drawn with a fine-tip pen, as the cancer gets more aggressive, ends up looking like ragged clumps of algae drawn with a fat crayon.
But wait theres more! A sample of prostate cells might also include atypical cells, which are a big question mark. Theyre not normal, but the pathologist cant definitely report that theyre cancerous, either. Theyre just suspicious.
Note: This is one reason why you may want to get a second opinion on your biopsy slides from a pathologist who is an expert in prostate cancer. Having your slides sent to another pathologist is a lot cheaper than having a repeat biopsy just to get more conclusive information.
Gleasons original system had more than 25 different possible combinations. This was simplified into a new system, called Grade Groups, originally proposed in 2013 by Jonathan Epstein at Johns Hopkins. The World Health Organization accepted Epsteins system in 2016. Heres what you need to know:
Grade Group 4: Gleason score 8, and Grade Group 5: Gleason scores 9-10.
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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.
What Kind Of Prostate Biopsy Are There
There are three types of prostate biopsies:
- Transrectal The most common biopsy procedure, the doctor with the guidance of an ultrasound device inserts needles through the wall of the rectum and into the prostate to take six to twelve samples from different zones of the prostate.
- Transurethral A lighted tiny lens is inserted into the urethra to allow the doctor to see the prostate and then uses a microscopic cutting loop to take samples of tissue.
- Transperineal The doctor makes an incision in the perineum and inserts a needle to take tissue cores of the prostate.
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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 Are The Risks
Infection: This can happen to one in 500 patients . We may give you antibiotics before or after your biopsy to reduce this risk but this is not always necessary. However, if you develop a fever, or have pain or a burning sensation passing urine, you might have an infection and should seek attention from your nearest A& E department.
Blood when you pass urine: This is not uncommon and can range from peachy coloured urine to rose or even claret coloured. It is rarely a sign of a serious problem. Increasing your fluid intake will usually help flush the system and clear any bleeding. However, if there is persistent or heavy bleeding every time you pass urine you should go to your nearest A& E department.
Difficulty passing urine: It is possible that the biopsy may cause an internal bruise or swelling that causes you difficulty passing urine. This can happen in less than 1 in every 200 cases and is more likely to happen in men who had difficulty passing urine before having the biopsy. Should you have difficulty passing urine, you may require a catheter and you will need to go to your nearest A& E department for assessment. A catheter is a hollow, flexible tube that drains urine from your bladder.
Allergic reaction: It is possible that you may have an allergic reaction to the medication we give you. Although the risk of this is low , you can reduce this risk by letting us know if you have had any previous allergic reactions to any medications or food.
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Additional Tests That May Aid Prostate Cancer Diagnosis
There are few other diagnostic tools or tests, which can be performed before you have a prostate biopsy, that may help your physician gather more information about your specific case. These procedures may help determine the likelihood of the presence of cancer and its aggressiveness and increase the accuracy of a biopsy when performed. Those tests include:
4Kscore blood test is a molecular test that helps predict the likelihood and risk of a patient having aggressive prostate cancer. If youre a patient whose PSA values are borderline for a prostate biopsy or you have a condition that could be aggravated by a biopsy, your physician may use this test before to help determine whether you should get a biopsy or a repeat biopsy.
Urine sample testlooks for biomarkers that may indicate the presence of prostate cancer cells in a patients body. This test may also be helpful when trying to determine whether a patient should be rebiopsied or not.
The use of multiparametric MRI imaging of the prostate gland before a biopsy has been a game changer in prostate cancer diagnosis, increasing the accuracy of biopsies over standard biopsies. The mpMRI doesnt replace the standard biopsy, but by improving its accuracy, it may help decrease the number of biopsies needed.
The mpMRI has a higher resolution than a standard prostate ultrasound. This increases the ability to see suspicious lesions in the prostate, providing additional targets for the biopsy to sample.
So Based On This What Is My Stage
For prostate cancer, I will actually use a different terminology: very low, low, intermediate and high risk. This really helps us to determine what treatment options are available. See below for how the risk groups are organized by NCCN Guidelines.
Very Low risk
- Normal prostate exam
- Gleason Score 6
- PSA < 10
- Fewer than 3 biopsy cores positive
- Less than 50% cancer in a core
- PSA density < 0.15
- Normal prostate exam or a small nodule felt
- Gleason Score 6
- PSA < 10
- Prostate exam will feel a nodule
- Gleason Score 3+4=7 or 4+3=7
- PSA 10-20
- Cancer felt to be just outside the prostate
- Gleason Score 8 or Gleason 9-10
- PSA > 20
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What Else Should I Look Out For
If you experience a fever, shivering or develop symptoms of cystitis , you should contact your GP. If there is a lot of bleeding in the urine, especially with clots of blood, you should contact the Urology Department. If you develop a fever outside your surgery opening hours, you must telephone the emergency number at your GP surgery so that a doctor can assess you.
Alternatives To A Prostate Biopsy
There are many tests that can help diagnose prostate cancer. The prostate biopsy is the only way to confirm if prostate cancer cells are present, other tests can suggest risk or probability.
Imaging methods like transrectal ultrasound can help learn more about the prostate size and probability of cancer. Nevertheless, the test cannot diagnose the condition.
Another commonly used test is the Mi-prostate score . It combines results of PSA with PCA3 and T2:ERG genes found in urine and thus helps predict prostate cancer risk with considerable accuracy.
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Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
What Is A Trus Biopsy
This is the most common type of biopsy in the UK. The doctor or nurse uses a thin needle to take small samples of tissue from the prostate.
Youll lie on your side on an examination table, with your knees brought up towards your chest. The doctor or nurse will put an ultrasound probe into your back passage , using a gel to make it more comfortable. The ultrasound probe scans the prostate and an image appears on a screen. The doctor or nurse uses this image to guide where they take the cells from. If youve had an MRI scan, the doctor or nurse may use the images to decide which areas of the prostate to take biopsy samples from.
You will have an injection of local anaesthetic to numb the area around your prostate and reduce any discomfort. The doctor or nurse then puts a needle next to the probe in your back passage and inserts it through the wall of the back passage into the prostate. They usually take 10 to 12 small pieces of tissue from different areas of the prostate. But, if the doctor is using the images from your MRI scan to guide the needle, they may take fewer samples.
The biopsy takes 5 to 10 minutes. After your biopsy, your doctor may ask you to wait until you’ve urinated before you go home. This is because the biopsy can cause the prostate to swell, so they’ll want to make sure you can urinate properly before you leave.
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What Does My Prostate Do
The prostate is beneath the bladder and in front of the rectum. Itâs a walnut-shaped gland that surrounds part of the urethra. . Hereâs what it does:
- It produces fluid for semen, which includes sperm produced in the testicles.
- It prevents urine from being included during ejaculation.
If it gets too big, your prostate can block pee from passing through the urethra and out the penis.
What Are Some Common Uses Of The Procedure
A prostate biopsy is currently the only way to definitively diagnose prostate cancer. It also helps differentiate cancer from benign prostatic hyperplasia or nodular enlargement of the prostate, a very common condition in middle-aged and older men that requires a different treatment approach than that of cancer.
A prostate biopsy may be ordered if the physician detects a nodule or other abnormality on the prostate during a digital rectal examination , a common prostate cancer screening test.
A biopsy also may be ordered when a blood test reveals elevated levels of prostate-specific antigen. While there are several reasons for an elevated PSA level, higher PSA levels are sometimes associated with cancer. PSA trends over time may trigger your physician to order a biopsy.
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 due to rising PSA demonstrates a very small abnormality that may not be easily targeted by ultrasound. MRI is also useful in patients who have previously undergone a biopsy and want to improve the sensitivity of the procedure and the precision of the biopsy.
A biopsy not only detects cancer it also provides information on the aggressiveness of the cancer and helps to guide treatment decisions.
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