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What Is The Best Prostate Biopsy Procedure

What Can You Expect During A Prostate Ultrasound And Biopsy

Mayo Clinic Minute: Prostate biopsy technique reduces infection risk

The procedure is short and generally only takes about 10 minutes. Your urologist, a doctor specializing in mens genital and urinary problems, will perform the procedure.

  • Upon arrival in the examination room, you will be given antibiotics to prevent infection.
  • You will be asked to lie on your side and bring your knees to your chest.
  • The area being tested may be numbed to help reduce any discomfort.
  • A lubricated probe is inserted into the rectum to generate the ultrasound.
  • A small needle is inserted through the probe to take several tiny tissue samples from the prostate. Some men may feel mild pressure or discomfort during the procedure.
  • After tissue samples are taken, they are sent to a lab for an analysis.

Commonly Used Mri Fusion Platforms

UroNav is another fusion biopsy system and was developed in National Institute of Health in Bethesda, MD, USA, in collaboration with Philips Healthcare. UroNav utilizes electromagnetic guidance to target MR lesions.43 UroNav can be used for both transrectal and transperineal approaches to obtain biopsies. Using the UroNav system, Siddiqui et al. found a 30% increase in identification of high-risk cancers with targeted biopsy versus standard biopsy and 17% fewer low-risk cancers .37 In a follow up of previously nontarget prostate lesions, Chelluri et al. elucidated that only 16% of rebiopsied lesions were found to have prostate cancer, and only 1.5% of all lesions were shown to have clinically significant cancer.47 This demonstrates the low false-negative rate of using the UroNav system for fusion biopsy. Recently, the UroNav system was used to biopsy cancers using the transperineal technique. Overall prostate cancer detection was found at 81.3% with clinically significant cancer detection at 59.4%.48 The transperineal approach is becoming more popular, even with the need for general anesthesia, because there is no need for antibiotic prophylaxis and no pain.49 Furthermore, Calio et al. demonstrated an improvement over time in detecting clinically significant prostate cancer using UroNav with each of their successive cohorts between 2007 and 2016.34

Other devices include Hitachi/HI-RVS , BiopSee , Virtual Navigator , BioJet , Mona Lisa , and LOGIQ 9 .32,43

How Does The Procedure Work

Ultrasound procedure:

Ultrasound imaging uses the same principles as the sonar that bats, ships, and fishermen use. When a sound wave strikes an object, it bounces back or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as its size, shape, and consistency. This includes whether the object is solid or filled with fluid.

Doctors use ultrasound to detect changes in the appearance of organs, tissues, and vessels and to detect abnormal masses, such as tumors.

In an ultrasound exam, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it sends small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive receiver in the transducer records tiny changes in the sound’s pitch and direction. A computer instantly measures these signature waves and displays them as real-time pictures on a monitor. The technologist typically captures one or more frames of the moving pictures as still images. They may also save short video loops of the images.

MRI procedure:

A computer processes the signals and creates a series of images, each of which shows a thin slice of the body. The radiologist can study these images from different angles.

MRI is often able to tell the difference between diseased tissue and normal tissue better than x-ray, CT, and ultrasound.

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What Does A Digital Rectal Exam Do

In a digital rectal exam , the doctor inserts a gloved finger into your rectum to feel for irregularities of the prostate. Its a common part of a mans routine physical examination.

Your doctor might perform a DRE alone or with a PSA test for routine screening. Its a quick and simple test. Although a DRE can signal a problem, such as an enlarged prostate, it cannot determine if its due to prostate cancer.

Prostate cancer is diagnosed 15 to 25 percent of the time when abnormal findings on a DRE lead to biopsy.

Is A Prostatebiopsy Painful

Figure 6 from Mechanically assisted 3D ultrasound guided prostate ...

A prostate biopsy is a surgical procedure, and what people feel after is very similar to what people feel after surgery. After any surgical procedure and when the anesthesia wears off, people feel pain. They need to use anti-inflammatory drugs to manage their symptoms, and the intensity is variable. You have people who manage their pain efficiently and others who are significantly affected by the symptom. Something similar happens after a prostate biopsy.

Anesthesia is not always used in a transrectal ultrasonography-guided biopsy. So, it might be a good idea to ask your doctor if hes going to use anesthesia or not. Certain studies show that theres no significant difference in pain symptoms with and without anesthesia. Others mention that anesthesia reduces the sensation of pain significantly. Due to diverging studies, anesthesia use is not explicitly written in the protocol, and some doctors prefer not to use it. However, it is essential to achieve adequate pain management in this procedure in any way or another. Ask your doctor what will be the method he will use to manage pain .

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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.

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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What New Biopsy Techniques Are Out There

Research is developing on other biopsy techniques that use MRIs. In this technique, doctors combine real-time ultrasound imaging with MRI data to guide a biopsy. A recent study published in the Journal of the American Medical Association that concludes using MRI with ultrasound produces better biopsy results1. This method aims to give a more accurate biopsy result while minimizing side effects including infection, bleeding, and potential damage to the urethra or nerves causing temporary incontinence and/or erectile dysfunction.

For men who have had a negative biopsy, there is a new test called ProMark. This helps to predict whether the next biopsy will also be negative, potentially cutting down on the number of biopsies a man will have to go through.

Prostate Cancer Enzyme Tests

Prostate biopsy procedure explained by urologist

Some tests check for enzymes that prostate cancer produces to see if cancer is present and gauge whether it may be aggressive or fast growing. These tests use either blood or urine samples to determine a persons overall risk for prostate cancer.

Doctors usually recommend these tests for males who have high PSA scores or whose doctors find abnormalities during a digital prostate exam.

A newer blood test is the 4Kscore test, which measures a persons risk of prostate cancer.

This test does not completely replace the need for a biopsy, but it can help identify who should have one. As a result, it may help doctors

4Kscore test is also effective for testing African American and Afro Caribbean men for prostate cancer.

Enzyme tests cannot identify every case of prostate cancer, but neither do biopsies. Instead, blood and urine screenings can identify the most aggressive presentations of the disease.

Some forms of prostate cancer are slow growing rather than aggressive. Slow growing prostate cancer is unlikely to be fatal.

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Template Mapping Prostate Biopsy

Although TRUS-GB offered a reasonable way to sample the prostate gland, there was still a reported underdiagnosis of 2530% of clinically significant tumours . This could happen due to under-sampling of the lesions or missing the lesions completely which was proved on the repeated biopsy studies .

One of the solutions for that was to increase the numbers of cores and to shift to the perineal route to get better access to the anterior part of the prostate. As a standard protocol it was done under general anaesthesia which enables taking a large number of cores. In the CDR most of the studies supported the idea that there is an improved CDR in comparison to the TRUS-GB .

Although Jones and colleagues argued that such a saturated biopsy strategies did not yield improved CDRs in biopsy naïve men and increased their risk of post-biopsy complications . Other well-documented limitations were that such biopsy necessitated a general anaesthesia with all the inherent risks related to this. In addition, the risk of urinary retention was very high and a proportion of patients required a urethral catheter post-procedure . More importantly, overall improved cancer detection led to a rise in the non-significant disease .

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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What To Expect During A Prostate Biopsy

A prostate biopsy is generally performed in a hospital and can usually be completed in 15 to 45 minutes. The average timeframe is approximately 20 minutes.

Before the procedure, you will be given a local anesthetic to numb the area where the needle is inserted into your rectum so that you do not feel pain during the biopsy. Some physicians prefer general anesthetics.

You may also receive antibiotics to prevent infection before and after your biopsy.

Depending on the type of prostate biopsy you receive, your doctor may position your body on your side or your stomach. During a prostate biopsy, a urologist inserts a thin needle into your body and may use imaging technology to guide it into your prostate gland.

Once the correct location is reached, the doctor removes tissue from your prostate gland. Generally, the urologist will take several samples from various parts of your prostate. You might feel pressure and mild pain each time a sample is taken.

The tissue can then be examined under a microscope to determine whether cancer cells are present. In most cases, results from the biopsy will help doctors confirm or rule out a diagnosis of prostate cancer.

What Are The Limitations Of Ultrasound

Life Through My Eyes: The Ins And Outs Of A Prostate Biopsy....No Pun ...

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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Transperineal Vs Transrectal Mri

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government.Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
First Posted : March 25, 2021Last Update Posted : August 31, 2022

Approximately one million transrectal prostate biopsies are performed annually in the U.S., and the risk of post- biopsy infection is increasing due to greater antibiotic resistance of rectal flora. Preliminary data demonstrates that a transperineal MRI-targeted biopsy approach under local anesthesia compared to the standard practice transrectal MRI-targeted prostate biopsy has a much lower risk of infection, comparable pain/discomfort and may improve detection of prostate cancer.

This randomized controlled trial will be the first prospective study to evaluate in-office transperineal MRI targeted prostate biopsy.

The investigators hypothesize that a transperineal MRI-targeted biopsy approach under local anesthesia compared to the standard practice transrectal MRI-targeted prostate biopsy has a much lower risk of infection, comparable pain/discomfort and may improve detection of prostate cancer.

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.

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What Happens After A Biopsy

A negative biopsy indicates that none of the biopsy samples found any evidence of prostate cancer. This is usually good newshowever, this does not necessarily mean that there is no prostate cancer present. Your doctor may want to continue to monitor your PSA levels or do a repeat biopsy at some point in the future.

A positive biopsy indicates that there is evidence of prostate cancer. This would be considered a diagnosis of prostate cancer. At this point, you should also have some idea of the approximate location, size, and aggressiveness of the cancer. What happens next is a decision between you and your doctor. There are some additional tests you can take to give you a better idea of your diagnosis. For example, genomic tests can help provide information on how likely your cancer is to spread, or how aggressive it is likely to be.

In addition, there are additional new tests that can be performed with a biopsy to help make diagnosis and determine the aggressiveness of the cancer:

  • ERG Protein Marker
  • A marker used on prostate tissue after a biopsy, which measures ERG protein assays. This helps doctors identify patients who have the disease or have pre-cancerous lesions that indicate a patient is more likely to develop prostate cancer over time.

What To Watch For Afterward

Transperineal Prostate Biopsy Explained

Here are the most common complications of prostate biopsy:

  • Blood in your urine for a few days to several weeks.
  • Blood in the stool for a day or so. If it lasts longer, notify your physician.

Make sure to notify your doctor if rectal or urinary bleeding get worse. Also, be on guard in the first 24 to 48 hours for signs of a serious infection in the urinary tract or prostate gland. The alarm signs are fever or chills, Dr. Garnick says. If you experience this, get to a hospital immediately for intravenous antibiotics. A runaway infection can be dangerous, so dont ignore the signs.

Another uncommon but dangerous complication is urinary retentionthe inability to pass urine caused by an infection. Seek care immediately if you stop being able to urinate after a biopsy.

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