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:
Inflammation Of The Prostate
Some studies have suggested that prostatitis may be linked to an increased risk of prostate cancer, but other studies have not found such a link. Inflammation is often seen in samples of prostate tissue that also contain cancer. The link between the two is not yet clear, and this is an active area of research.
Eating Diet And Nutrition
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing prostatitis. During treatment of bacterial prostatitis, urologists may recommend increasing intake of liquids and avoiding or reducing intake of substances that irritate the bladder. Men should talk with a health care provider or dietitian about what diet is right for them.
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What Is Free Psa
The routine PSA test measures total PSA in your blood. But there are two types of PSA. Bound PSA is attached to a protein. Free PSA is not. The free PSA test breaks the results down and provides your doctor with a ratio. Men with prostate cancer tend to have lower levels of free PSA than men who dont have prostate cancer.
Its a simple blood test, but theres no consensus among doctors on the ideal ratio of free to bound PSA. The free PSA test is valuable in that it gathers more information, which can help in the biopsy decision.
On its own, the free PSA test cant confirm or rule out a prostate cancer diagnosis.
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
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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.
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.
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 .
Long Term Side Effects Of Rectal Prostate Biopsy
Hello does anyone know we what the long term effects of a prostate biopsy are. I have read that although rare they happen.
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Posted 3 years ago
Thank you for your reply. If you read my reply to Fred you will see my husbands history re. prostate. I do think that doctors generally should tell patients about risks short and long term when undertaking a procedure. I have found that when it comes to medication they often dont mention side effects. I suppose that they hope you wont get them but these days it is so easy to google medications side effects and interactions and make a choice based on their circumstance. I was given a steroid nasal spray for rhinitis which worked a treat but I did query whether I should use it as I was worried about it affecting my glaucoma as I have been told by the eye hospital that I am a steroid responder. I was assured it would be ok but when I had my routine eye check my eye pressures had gone up quite a bit and I decided with the knowledge of my gp to discontinue the spray. When I returned 6 weeks later the pressures and gone down to base level. Obviously I cant prove it but I am sure it was the spray. Sorry if I have digressed. As I mentioned in my reply to Fred I did not mention digestive problems as I was waiting to see if anyone might have experience of this. Thanks
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A Traditional Prostate Biopsy Which Is A Random Sampling Of The Prostate Can Miss Prostate Cancers Says Michael Herman Md Director Of Urologic Oncology At South Nassau Communities Hospital In Oceanside Ny
The miss rate, continues Dr. Herman, is up to 25 percent of the time. That is not reassuring.
Dr. Herman continues, This often led to patients requiring repeat biopsies because of a persistently elevated PSA.
Solution to Biopsies Missing Prostate Cancer
However, over the last few years, we have developed the use of MRI before biopsy to more accurately target areas in the prostate that are concerning, explains Dr. Herman.
These MRI-targeted biopsies are up to 30 percent more accurate than traditional biopsies.
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The Test Poses Some Risksand Often Isn’t Necessary
Each year more than 1 million men in the U.S. have a prostate biopsy, an invasive procedure to discover whether the prostate gland is cancerous. While most prostate biopsies turn out to be negative, the rate of cancer detection as a result of biopsies ranges from 17 to 44 percent in recent studies. But an alarming number of the men who undergo the procedure are also getting infections that are resistant to antibiotics. The problem is so serious that our medical consultants say men should be cautious about prostate-cancer screening.
A biopsy is the usual follow-up procedure if a mans prostate-specific antigen level is consistently elevated, as shown by a blood test. In a standard biopsy, a urologist uses an ultrasound probe to guide a needle through the wall of the rectum and into the prostate gland, taking multiple tissue samples to examine for cancerous cells. Since the rectum is full of bacteria, doctors should prescribe antibiotics before and after the procedure to thwart infection.
For more information read “Evaluating drugs used to treat enlarged prostate.”
In the last decade, some bacterial strains have become resistant to the class of antibiotics that were once highly effective: fluoroquinolones such as ciprofloxacin . Studies suggest that about one in five men undergoing biopsies harbor E. coli bacteria that are resistant to fluoroquinolones. They are more likely to develop infections of the urinary tract or bloodstream and land in a hospitals intensive-care unit.
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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Risks Associated With Transperineal Prostate Biopsy
Common risks associated with transperineal prostate biopsies include:
- Bruising around the skin â this is usually minor and will disappear after 1-2 weeks
- Blood in the urine â it is normal to have a small amount of blood in the urine for up to one week
- Blood in the semen â because semen is produced by the prostate, it is common to notice red or rust colouring to the semen after a prostate biopsy. This is not a cause for concern, this will likely persist for several weeks after the biopsy.
- Difficulties in urinating â in some men with pre-existing enlarged prostates, prostate biopsy can cause difficulties passing urine due to prostatic swelling. This may last for about one week. Medications can be given to help urination, rarely, a temporary urinary catheter must be inserted if urination is not possible.
Prostate Cancer Risk Factors
A risk factor is anything that raises your risk of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a persons age or family history, cant be changed.
But having a risk factor, or even several, does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.
Researchers have found several factors that might affect a mans risk of getting prostate cancer.
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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.
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.
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How The Test Will Feel
During the procedure you may feel:
- Mild discomfort while the probe is inserted
- A brief sting when a sample is taken with the biopsy needle
After the procedure, you may have:
- Soreness in your rectum
- Small amounts of blood in your stools, urine, or semen, which may last for days to weeks
- Light bleeding from your rectum
To prevent infection after the biopsy, your provider may prescribe antibiotics to take for several days after the procedure. Be sure you take the full dose as directed.
Indications For A Prostate Biopsy
As prostate biopsy is employed for early detection of prostate cancer, it is recommended under the following circumstances:
- The prostate-specific antigen blood levels are higher than normal
- Abnormal findings are detected during digital rectal exam
- High prostate-specific antigen levels even after a normal biopsy
- Presence of non-cancerous abnormal cells in previous biopsy
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Isnt A Psa Test Enough
The prostate specific antigen test is a common screening test for prostate cancer. PSA is a protein that comes from the prostate gland. The test measures the amount of PSA in your blood. Its a simple blood test, and for some men, it turns out to be a lifesaver.
On the other hand, its value as a diagnostic tool is fairly limited. High PSA levels may be a sign of prostate cancer, but its not enough to diagnose the disease with certainty. Thats because there are other reasons your PSA levels could be high, including urinary tract infection and inflammation of the prostate.
Read more: PSA levels and prostate cancer staging »
Also, a single abnormally high PSA test result cant tell you if the high level is temporary or rising over time.
Low PSA levels cannot definitively rule out prostate cancer, either. The fact is that PSA tests can result in both false positives and false negatives.
PSA tests can be useful during and after treatment for prostate cancer. Rising PSA levels may signal that treatment is not effective or there is a recurrence of the cancer. If your PSA levels are decreasing, your current treatment is probably doing its job.
What Are The Different Types Of A Prostate Biopsy Procedure
The surgeon can choose any of the three different ways of performing a prostate biopsy. These are as follows:
- Transrectal method: This is the most common method of performing a prostate biopsy. In this, the surgical instruments are inserted through the rectum .
- Perineal method: This is done through the area lying between the scrotum and rectum.
- Transurethral method: A cystoscope is inserted through the urethra .
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Prostate Biopsy Alternatives And Cancer Treatment Options
My Personal Experience with Trans-Rectal Ultrasound MRI Fusion-Guided Prostate Biopsy: A Guide of what to expect after your prostate biopsy.
Since 10 years ago, there is a lot more information on what to expect after your trans-rectal ultrasound prostate biopsy. Back then, many websites omitted some key side effects, such as blood in your ejaculate. Even some very reputable health and medical websites buried things like the possibility of serious infection or sepsis as a small bullet point. It turns out, this is a very real, increasingly likely and possibly fatal complication. Urinary infection or inability to urinate are also possible complications. Urinary incontinence and erectile dysfunction are less common risks.
This new care sheet is pretty good based on my experiences. Here is another reasonable webpage more centered on the risks, except that you also may see traces of blood in your semen doesnt come remotely close to describing it for some men:
Im going to discuss my own, personal recovery experience following my second TRUS guided prostate biopsy, done under local anesthesia. It was pretty similar to my first one. If you are squeamish or dont like the TMI type of details, STOP READING NOW. The rest of this article is definitely Too Much Information unless you really want to know from first-hand experience.