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.
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.
How Long Does It Take To Recover From A Prostate Biopsy
A patient may take about four to six weeks or even more recover after a prostate biopsy. The recovery process after biopsy usually depends on the patient’s health and age. Doctors may recommend only light activities for 24-48 hours after a prostate biopsy. The doctor prescribes painkillers, vitamins, and antibiotics for a few days to speed up the healing process.
After the biopsy, it is normal to experience the following sensations or symptoms:
- Burning urination: It may start within 24 hours after the biopsy and may continue until three to seven days. This burning sensation is a side effect of the procedure and usually considered normal.
- Frequent urination: It may gradually improve over the first 24-36 hours.
- Blood in the urine: It is considered normal to have slightly red-tinged urine or urine that resembles the color of a rose or red wine. This may last from 12 hours to 3 weeks after the biopsy.
- Blood in stool: A patient may notice red stains on the toilet tissue or see some bloody streaks in the stool. This may last for up to five days.
- Blood in the semen: This may persist for up to six weeks after the biopsy.
- Tiredness: A patient may feel tired for a month or two. It usually takes 30-45 days to regain full normal strength after the procedure hence, sufficient rest is usually advised by the doctor.
Post-biopsy restrictions and instructions:
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Set To Experience Biopsy
The little reproductive organs behind the prostate will be assessed and the area amongst it and the prostate will be infused one on every side with anesthesia, to numb it. The biopsy will be performed then, by taking specimens of your prostate tissues and putting these examples under the magnifying instrument to search for tumor cells.
How It Is Done
A prostate biopsy is done by a doctor who specializes in men’s genital and urinary problems . It can be done in the doctor’s office, a day surgery clinic, or a hospital operating room.
Some men have an MRI of the prostate before their biopsy. This helps to find the areas in the prostate to take biopsy samples. If you have an MRI, your doctor will use ultrasound and the MRI results to find the areas to biopsy.
Before your biopsy, you may be given antibiotics to prevent infection. You may be asked to take off all of your clothes and put on a hospital gown.
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Benefits Of Getting A Prostate Biopsy
A prostate biopsy is the only way to definitively determine whether you have prostate cancer and, if you do, how aggressive it is.
While prostate biopsies arent always conclusive, in general, a biopsy gives men the reassurance of knowing whether they have cancer or not. If you know you have prostate cancer, youre more likely to be appropriately treated.
Appropriate prostate cancer treatment options depend on several factors, including the stage of the cancer, your age, your general health and which risk category your cancer falls into.
Localized prostate cancer is categorized into six risk categories, which range from very low-risk to very high-risk. The risk group is determined by the stage of your cancer, your PSA levels and the Gleason score obtained from the biopsy pathology report.
The National Comprehensive Cancer Network guidelines outline appropriate treatment options based on risk categories and whether the cancer has already metastasized.
Patients whose cancer is confined to the prostate and falls into the very low-risk and low-risk categories tend to have slow-growing cancers. Treatment options for these patients often include active surveillance, radiation therapy or surgery. Similar treatment options may be recommended to patients in the low-risk and favorable intermediate prostate cancer risk categories.
The NCCN guidelines recommend immediate treatment for patients with high-risk disease or those patients whose cancer has metastasized.
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 you’re 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 patient’s 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 doesn’t 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.
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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.
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 PSA test 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.
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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.
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What Is An Mri
What makes an MRI different from other medical imaging techniques like X-rays and CT scans? X-rays take projection images of hard tissues like bones, while CT scans take images of both hard bony tissues and soft tissue. Both systems use ionizing radiation, which passes through the body to create images that are transferred to photographic film or to a video monitor.
An MRI works differently. Magnetic resonance imaging uses a magnetic field to create sound waves that are received, digitized, and displayed in real-time. When tissue is abnormal, its composition changes, so the images reflect damaged areas.
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Choosing Between A Prostate Mri Vs Biopsy
Whats worse than a false-positive PSA? A false-negative biopsy.
Research shows that 35% of biopsy results are false negatives. This means despite the invasive sampling of tissues, cancer can go undetected and continue to grow while symptoms persist.
Thats why having a prostate MRI before a biopsy is preferable. It shows the location of potential cancer, which helps direct the biopsy sampling.
Before you decide to get a prostate MRI vs. biopsy, here are a few things to know.
What Happens In A Prostate Biopsy
You will need to lie down on your side. Then you will be asked to bring your knees up to your chest. Next, the doctor will apply gel and gently insert a thin probe into your rectum.
Transrectal ultrasonography uses sound waves to take pictures of your prostate. Your doctor will use these pictures to know where they need to give you an injection, which will make it less painful when they take the tissue sample. They also use images to guide the needle into place.
Once the area is numbed, there will be a device. There are lots of needles on it. The doctor will put them in your skin. It can make you feel uncomfortable for a second, but it is over quickly.
Your doctor might take a sample from your prostate to see what it is. Then, they will use an instrument called a biopsy gun to take the samples. It should only take about 20 minutes.
After a prostate biopsy, your doctor will tell you only to do light activities for 24 to 48 hours. After that, your doctor might recommend taking antibiotics for a few days.
- Worsening pain
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The Transperineal Prostate Needle Biopsy
Requires a general anaesthetic, so you need to book out the day or even overnight. Remember, as noted above, your perineum is the part of the body between the anus and the scrotum. An incision is made in order to access the prostate for biopsy collection.
Now you know what type of prostate biopsy you might have, what about those seven questions I mentioned before? to see if they have been answered?
Preparing For The Prostate Biopsy
In order to prepare for the biopsy, the urologist is likely to ask you to do the following:
- Avoid taking medications that can put you at risk of bleeding, for example warfarin, aspirin, ibuprofen and some herbal supplements for a few days prior to the prostate biopsy.
- Perform a cleansing enema at home prior to the procedure appointment.
- Take specific antibiotics 30-60 minutes prior to the procedure as a precaution to avoid the occurrence of any infection.
Like any invasive diagnostic procedure, prostate biopsy is also associated with some risks but since early detection of prostate cancer can greatly improve the prognosis, it is highly recommended to opt for biopsy.
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Why You Should Not Have A Prostate Biopsy
Prostate biopsy risks There are risks associated with prostate biopsies, but physicians can take steps to reduce those risks. Risks and ways to manage them include: Infection: The most serious risk of a prostate biopsy is the risk of infection, including urinary tract infections and, less commonly, sepsis.
What To Think About
- If the test results show cancer, other tests may be needed to see the spread of the cancer. These tests may include a blood test , bone scan, lymph node biopsy, or CT scan.
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Risks Of The Prostate Biopsy Procedureor The Prostate Cancer Biopsy
The idea behind cancer testing is to increase the life span of the patient. Here is why biopsies do not make sense for diagnosing prostate cancer…
Most prostate cancers are slow growing and show up later in life. It’s so slow that most men will die of other causes before exhibiting symptoms of prostate cancer. Or another way to look at it, cancer “survivors” would have enjoyed the same lifespan with or without treatment .
Not only can a prostate biopsy procedure be very harmful to the prostate, it can lead to painful, long-lasting infections that are difficult to treat. It can easily add bacteria from the bowel into the prostate . If cancer is present, watch out!
The biopsy needles can spread the cancer to other parts of the prostate, release cancerous cells into the bloodstream, and may spread the cancer to other organs or glands nearby, making a relatively benign form of cancer highly fatal. Metastasis is the term used to describe the spreading of the cancer outside the prostate. Metastasic prostate cancer often results in prostate cancer death but not from inside the prostate capsule itself!
The prostate biopsy can lead to surgeries that are not needed. The prostate needle biopsy can also increase urination difficulties and erectile dysfunction.
If high levels of PSA are found in the test, a snowball effect ensues, usually leading to biopsies. There are many possible negative consequences of biopsies:
- urinary incontinence
- erectile dysfunction
Painful Prostate Biopsy Heres What You Need To Know
A standout amongst the most famous symptomatic tests performed to recognize Prostate Cancer is Biopsy. If you are experiencing pee issues, erectile brokenness, or any prostate-related indications and would look for medical counsel from a medical expert, the standard suggestion would either be for you to experience the PSA test first then Prostate Biopsy or the last quickly.
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Mri/ultrasound Fusion Biopsy Of The Prostate
The MRI/Ultrasound fusion biopsy begins with an MRI of the prostate performed in the Department of Radiology. This initial exam will be done a few days or weeks prior to the scheduled prostate biopsy. Both appointments will be made through the Department of Urology. A specially trained Radiologist will analyze the images and identify areas that appear suspicious for prostate cancer.
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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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Why And How Prostate Biopsy Is Done
It is important to know how the prostate biopsy is done, especially if you are a man over 50 who has an elevated risk for prostate cancer.
Your doctor may recommend a prostate biopsy if they suspect that you have cancerous cells in your prostatic tissue.
If left untreated, these cells can lead to problems with bladder control and sexual function.
Prostate biopsies are typically performed outpatient under sedation or general anesthesia with the patient awake throughout the procedure.