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.
Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
Use In Men Already Diagnosed With Prostate Cancer
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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Number Of Prostate Biopsy Cores Involved
During the biopsy, the urologist will have taken several samples, or cores, from the prostate. This was done with a prostate specialized device that went through the ultrasound probe and removed a small sample of the prostate tissue. This tissue comes out looking like a silk worm. The number of these cores that are positive will play into your disease risk.
The more the number of cores involved, the more concerning.
Does A Prostate Biopsy Damage The Prostate
Many people want to know, does a prostate biopsy damage the prostate? During a prostate biopsy, doctors use needles to take a sample of tissues for examination and prostate cancer diagnosis. Though they take most precautions when taking biopsy samples, nonetheless the procedure is invasive.
Moreover, a needle is introduced through the bowel wall to the prostate. It means that the prostate is not only traumatized due to needles. In addition, there is always a risk of some pathogens entering the prostate gland.
Transrectal prostate biopsy does cause some damage to the prostate. Fortunately, this damage is relatively small.
Generally, there would be healing in a week after the procedure. It is rare to cause long-term issues.
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Further Testing For Advanced Cancer
If there’s a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
- an MRI scan, CT scan or PET scan these scans build a detailed picture of the inside of your body
- an isotope bone scan, which can tell if the cancer has spread to your bones a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities
Can The Gleason Score On My Biopsy Really Tell What The Cancer Grade Is In The Entire Prostate
Because prostate biopsies are tissue samples from different areas of the prostate, the Gleason score on biopsy usually reflects your cancers true grade. However, in about 1 out of 5 cases the biopsy grade is lower than the true grade because the biopsy misses a higher grade area of the cancer. It can work the other way, too, with the true grade of the tumor being lower than what is seen on the biopsy.
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Side Effects And Risks Of A Prostate Biopsy
Any invasive procedure carries risks and causes specific side effects.
One of the more common side effects post prostate biopsy is rectal bleeding. Rectal bleeding occurs since in most cases a transrectal prostate biopsy is used.
It means mild trauma of the rectum. This side effect would not occur in the case of transperineal prostate biopsy.
Blood in the semen is another complication of the issue which may continue for a few weeks in some cases.
Blood in urine and increased risk of urinary tract infection are rare but possible complications. If a urinary tract infection occurs, doctors will prescribe antibiotics. Urinary tract infection post prostate biopsy is uncommon.
Some may also find difficulty while urinating, and doctors may need to insert a urinary catheter.
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.
Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.
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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.
Indications For Prostate Biopsy
A detailed discussion of the controversy concerning screening asymptomatic men for prostate cancer is discussed elsewhere in this book. Before TRUS improvements and PSA testing became widespread, clinicians relied mainly on digital rectal examination to establish a suspicion of prostate cancer and performed digitally directed lesional biopsies.PSA-based screening of asymptomatic men has resulted in the adaptation of TRUS biopsy as the standard of care when prostate biopsy is used to identify prostate cancer . In general, the TRUS without a biopsy has little utility in the evaluation of a patient for prostate cancer. Overall it estimated that an initial prostate biopsy carries a 30% rate of detecting prostate cancer.Fine-needle aspiration biopsy is no longer considered state-of-the-art in the diagnosis of prostate cancer .
David G. Bostwick, Liang Cheng, in, 2020
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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.
Possible Harms From Treatment
The most common treatments for prostate cancer are surgery to remove the prostate and radiation therapy.
The most common harms from prostate cancer treatment are
- Urinary incontinence . About 1 out of every 5 men who have surgery to remove the prostate loses bladder control.
- Erectile dysfunction . About 2 out of every 3 men who have surgery to remove the prostate become impotent, and about half of men who receive radiation therapy become impotent.
- Bowel problems, including fecal incontinence and urgency . About 1 out of every 6 men who has radiation therapy has bowel problems.
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Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
Possible Harms From Diagnosis
Screening finds prostate cancer in some men who would never have had symptoms from their cancer in their lifetime. Treatment of men who would not have had symptoms or died from prostate cancer can cause them to have complications from treatment, but not benefit from treatment. This is called overdiagnosis.
Prostate cancer is diagnosed with a prostate biopsy. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells. Older men are more likely to have a complication after a prostate biopsy.
A prostate biopsy can cause
- Blood in the semen or ejaculate.
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What Happens If You Have A Likert Score Of 3 Or More
This result on its own doesnt mean that you definitely have prostate cancer. But its more likely that you do. Your doctor is likely to recommend for you to have a biopsy.
The MRI scan also helps doctors know where to take the biopsy from. You usually have tissue samples taken from the suspected area of cancer and also from the rest of the prostate. Doctors call these targeted biopsies and systematic biopsies. This is because not all cancers can be seen on an MRI scan.
What Does It Mean To Have A Gleason Score Of 6 7 8 Or 9
Because grades 1 and 2 are not often used for biopsies, the lowest Gleason score of a cancer found on a prostate biopsy is 6. These cancers may be called well differentiated or low-grade and are likely to be less aggressive that is, they tend to grow and spread slowly.
Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade. These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of 9-10 is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8.
Cancers with a Gleason score of 7 can either be Gleason score 3+4=7 or Gleason score 4+3=7:
- Gleason score 3+4=7 tumors still have a good prognosis , although not as good as a Gleason score 6 tumor.
- A Gleason score 4+3=7 tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor.
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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.
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.
Possible Harm From Screening
False positive test results: This occurs when a man has an abnormal PSA test but does not have prostate cancer. False positive test results often lead to unnecessary tests, like a biopsy of the prostate. They may cause men to worry about their health. Older men are more likely to have false positive test results.
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Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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Using Biomarkers To Guide Our Next Step
While MP-MRI has proven to be an effective tool in diagnosing prostate cancer, not every facility has the technology needed to perform itthe MRI machine and special biopsy platformor radiologists with the expertise to read a prostate MRI. In addition, the test can take up to an hour in an MRI machine, which can be uncomfortable for patients, particularly if he is claustrophobic.
In these cases, biomarkers can be useful to potentially avoid repeat biopsy. Biomarkers indicate whether a certain body process is normal or abnormal. These biomarkers can pinpoint men who actually need a repeat biopsy, as well as help us find more aggressive cancers.
Types of biomarkers we can use to detect prostate cancer include:
If a biomarker test suggests that the initial biopsy failed to diagnose prostate cancer, a repeat biopsy is recommended. Ideally, you would get an MP-MRI, but if you dont have access to that technology, you may get a traditional prostate biopsy. However, if a traditional biopsy still doesnt find high-grade prostate cancer despite biomarkers indicating it, you may want to travel to the nearest facility with MP-MRI.
A high PSA level and negative biopsy can certainly cause you and your doctor to feel nervous. But MP-MRI and biomarkers can provide reassurance that our next step is the right one.
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