A Few Important Points
You should inform the doctor if you are taking any anti-coagulants as these should be stopped before the procedure. Read about Preparing for Surgery.
It is possible small tumours can be missed by the biopsy pattern.
Prostate MRI prior to biopsy would seem to decrease this chance on present evidence.
The doctor will discuss the risk of infection with you and the importance of taking the prescribed antibiotics.
You should inform the doctor if you have been travelling in Asia in the previous 3 months. The choice of antibiotic cover may need to be varied if so.
Understanding Prostate Changes: A Health Guide For Men
Understanding Prostate Changes is a health guide for men. It has information about prostate cancer symptoms, risk factors, and the PSA screening test. Other prostate conditions, such as BPH and prostatitis, are also discussed.
This health guide answers questions you may have about prostate-related conditions:
- What are signs and symptoms of prostate-related conditions and changes?
- What causes these signs and symptoms?
- What lifestyle changes may help men feel better?
- What are risk factors for prostate cancer?
- What do we know about preventing prostate cancer?
- What is the PSA test? What causes PSA levels to rise or fall?
- What medical tests and procedures are used to diagnose and treat prostate conditions?
Also included are tips to help you prepare for your doctors visit, questions to ask your doctor, medical images, and a list of prostate-related organizations and resources.
The information in this booklet was last updated in August 2011.
Prostate cancer is the most common cancer in men in the United States, after skin cancer. It is the second leading cause of death from cancer in men. Prostate cancer occurs more often in African-American men than in white men. African-American men with prostate cancer are more likely to die from the disease than white men with prostate cancer.
Diseases and Conditions Prostate Cancer
Scared Stiff Of Having A Prostate Biopsy
Although the DRE and PSA tests are useful, they are not enough to make a clear diagnosis of prostate cancer. When results are abnormal or questionable, the doctor may prescribe a transrectal ultrasound and a biopsy. These examinations usually provide enough information for a precise diagnosis.
Having to undergo prostate biopsies can be scary: fear of the intervention, the pain it can cause, the unknown … or knowing you have prostate cancer. But remember, if you have cancer, the sooner it is diagnosed, the greater your chances of a complete cure with treatment!
Why a biopsy
Abnormalities detected during a digital rectal exam and a high PSA level often lead to a prostate biopsy. This procedure consists of taking small tissue samples of your prostate in order for the pathologist to examine them under a microscope to determine if they are cancerous or not.
That prostate biopsies are indicated does not mean that you necessarily have prostate cancer. Indeed, the analysis of microscopic specimens makes it possible to differentiate a benign hypertrophy from a cancer of the prostate.
To this day, the actual diagnosis of prostate cancer can only be made with a prostate biopsy.
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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.
Image: Wavebreakmedia Ltd/Getty Images
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 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.
What Is A Trus
Ultrasound scans use high frequency sound waves to create a picture of a part of the body. A prostate ultrasound scan can show changes in your prostate, including abnormal growths.
The ultrasound scanner has a microphone that gives off sound waves. The sound waves bounce off the organs inside your body, and the microphone picks them up. The microphone links to a computer. This turns the sound waves into a picture on the screen.
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Needle Biopsy For Diagnosing Prostate Cancer
A biopsy is recommended if prostate cancer is suspected. A prostate needle biopsy is a surgical procedure in which a small sample of tissue is removed from the prostate gland and examined under the microscope by a pathologist, a doctor specializing in identifying disease through the study of cells, tissue, and organs.
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.
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.
The Prostate Biopsy Process
The procedure takes about 15 minutes and is usually performed with a local anesthetic in the urologist’s office in conjunction with transrectal ultrasound , a procedure that uses sound waves to create a video image of the prostate gland. With the help of TRUS, a doctor guides a biopsy gun a hand-held device with a spring-loaded, slender needle through the wall of the rectum into the area of the prostate gland that appears abnormal.
The rectal wall is thin, so it is possible to place the needle more accurately and with less injury to other tissues. When activated, the needle can remove a slender cylinder of tissue , called a core, in a fraction of a second. Biopsy needles are tiny only 1.2 millimeters in diameter and less than 1/2″ long and very precise. A sliding sheath opens once the needle enters the prostate, closes onto a sample of tissue and the needle is withdrawn.
A sextant biopsy is the most common prostate biopsy procedure. An average of six cores are taken from the prostate to get a representative sample of the prostate gland and determine the extent of any cancer.
The results of the biopsy are not available immediately following the procedure. The tissue samples must examined by a pathologist, who then generates a report of the findings.
How To Prepare For A Prostate Biopsy
A patient may be asked to self-administer an enema before the procedure in order to clean out the rectum and decrease risk of infection. He may also be prescribed antibiotics as an additional precaution against infection these should be taken an hour before the procedure and for two to three days following it.
Additionally, certain drugs can increase the risk of bleeding. A patient shouldn’t change medications unless instructed by his doctor, but should inform his physician if he is taking any of the following:
- Aspirin or other pain medications, such as ibuprofen and other NSAIDS
- Blood thinning medications, such as warfarin or heparin
- Herbal medicines, some of which can also act as blood thinners
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.
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How To Get The Best Results
Most men do not find prostate biopsy excessively painful or uncomfortable, and the complications are usually not seriousbut can be. Certain steps taken before, during, and after the procedure can improve the outcome:
Take antibiotics. Taking preventive antibioticsbefore and after the procedurecuts the risk of infection substantially. Most infections are not dangerous but could become so if they get out of control. The overall chance of being hospitalized with an infection after prostate biopsy is 1% to 3%.
Review medications. Before the biopsy, your doctor may advise you to stop taking daily low-dose aspirin or an anticoagulant such as warfarin , dabigatran , edoxaban , rivaroxaban , or apixaban . These drugs reduce the blood’s ability to clot. Your doctor will weigh the chance of bleeding against the need for anticoagulants to prevent heart problems or stroke.
Expect anesthesia. Get local anesthesia for the biopsy. This means an injection of a numbing drug into the prostate gland to reduce pain during the biopsy.
Does Prostate Biopsy Increase Psa
Although prostate biopsy is used to determine the presence of prostate cancer, the procedure itself causes various risks, and increased PSA is one of them.
Evidence shows both prostate biopsy and transurethral resection of the prostate cause an instant elevation of serum PSA level.
It may take up to three weeks for PSA to stabilize and return to baseline concentration. However, in one study, PSA remained increased in participants even four weeks after prostate biopsy.
For that reason, a prostate biopsy is even riskier than we are led to believe. Even though some doctors may say PSA will return to normal soon, that doesnt always happen. So, if you have another test a few weeks or months later, the results may not be accurate.
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How Long Does It Take For The Prostate Gland To Heal After A Biopsy
The recovery process after biopsy depends on factors such as a patients age and overall health. While doctors keep saying prostate biopsy is easy, the recovery process isnt that simple.
It may take four to six weeks to recover. For some men, it can take longer than that, even when they adhere to all the instructions.
Prostate Biopsy: How It Works
The instrument used to perform most prostate biopsies today is a spring-loaded device that pokes a hollow needle through the rectal wall to collect small samples of prostate tissue, guided by an ultrasound or MRI.
The samples are quite smalljust several times the diameter of the lead in a mechanical pencil. Later, a pathologist checks the samples under a microscope for signs of cancer.
Prostate biopsy comes with certain risks. For example, when the biopsy needle passes through the rectal wall to reach the prostate, it can spread a bacterial infection to the prostate gland or bloodstream.
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How Do I Prepare For A Prostate Biopsy
As with TRUS, the patient may be instructed to have an enema prior to the procedure to remove feces and gas from the rectum, which might impede the progress of the rectal probe. In addition, patients may take oral antibiotics beginning the night before the biopsy and for 24 to 48 hours afterwards, to protect against possible infection. To limit the risks of bleeding, patients are advised to stop taking aspirin seven to 10 days before the biopsy and to stop taking anti-inflammatory medications such as ibuprofen, Advil, or Motrin, three days before the biopsy.
What Happens After A Prostate Biopsy
Your recovery process will vary depending on the type of anesthesia that isused. If you were given general anesthesia, you will be taken to a recoveryroom for observation. Once your blood pressure, pulse, and breathing arestable and you are alert, you will be taken to your hospital room ordischarged to your home.
If local anesthetic was used, you may go back to your normal activities anddiet unless otherwise instructed. You may feel the urge to urinate or havea bowel movement after the biopsy. This feeling should pass after a fewhours.
There may be blood in your urine or stool for a few days after the biopsy.This is common. Blood, either red or reddish brown, may also be in yourejaculate for a few weeks after the biopsy. This, too, is normal.
The biopsy site may be tender or sore for several days after the biopsy.Take a pain reliever for soreness as recommended by your healthcareprovider. Aspirin or certain other pain medicines may increase the chanceof bleeding, so be sure to take only recommended medicines.
Increase in the amount of blood in your urine or stool
Belly or pelvic pain
Changes in the way your urine looks or smells or burning with urination
Fever and/or chills
Your healthcare provider may give you other instruction, depending on yoursituation.
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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 males 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.
If a person already has prostate cancer, the grade of the PIN does not matter, as it does not affect the severity or the Gleason score of the cancer.
Carcinoma in situ refers to cells that have the potential to become cancerous. They can occur almost anywhere in the body.
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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
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Eating And Drinking And Medicines
You usually have a TRUS biopsy under local anaesthetic, so you can eat and drink normally beforehand and afterwards.
Take your usual medicines as normal, unless your doctor tells you otherwise. You need to stop taking drugs that thin your blood such as warfarin for a few days before your biopsy. Your doctor will tell you when you need to stop taking them. This is usually for 5 days before.
Tell your doctor if you also take drugs that stop cells in the blood called platelets from sticking together and forming a clot. These are antiplatelets. You need to stop taking these drugs for a few days before your biopsy.