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Anesthesia For Prostate Biopsy

Let’s Talk Prostate Biopsy

Anesthesia reduces any discomfort during the procedure which is a common complaint among patients undergoing a prostate biopsy.

Local anesthesia is safe and effective. It can be done with topical lidocaine gel or periprostatic nerve block with injection of lidocaine or bupivacaine. The topical lidocaine is effective in reducing the discomfort during probe insertion while the periprostatic injection or nerve block is more effective in minimizing the pain during the biopsy itself.

General anesthesia is required in patients undergoing transperineal saturation biopsy. Intravenous sedation or general anesthesia may be required in certain transrectal or transurethral biopsy patients who are not adequately anesthetized with nerve block or if the patients are found to have anal or urethral strictures.

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.

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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.

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About Your Prostate Biopsy

Your prostate is a small, firm gland about the size of a walnut. Its in front of your rectum, below your bladder . Your prostate works with other glands in your body to make semen. It surrounds your urethra .

Figure 1. Your prostate and surrounding organs

A prostate biopsy is a procedure to collect small pieces of tissue from your prostate. An ultrasound is an imaging scan that uses sound waves to make pictures of the inside of your body. Your healthcare provider will use ultrasound imaging during your biopsy to help them take tissue from the right areas of your prostate.

After your biopsy, the pieces of tissue will be looked at under a microscope to check for abnormal cells.

Your prostate biopsy with ultrasound is scheduled for___________________ with

What Can You Not Do After A Prostate Biopsy

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Blood in the semen this may persist for up to 6 weeks after your biopsy. How should I care for myself after the biopsy? Drink plenty of fluids to prevent blood clots and infection in the bladder Avoid strenuous exercise such as jogging, heavy lifting, golfing, and bike riding for at least 7 days.

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Preparation For A Biopsy

  • A patient may be given antibiotics before the procedure to prevent any infection following the biopsy.
  • An enema will be done before the biopsy to empty the feces and gas from bowel, which may complicate the procedure.
  • The patient is also required to discontinue drugs like aspirin, one week before the procedure to reduce the chances of bleeding.
  • Patients who are biopsied under general anesthesia are required not to eat anything orally at least 6 hrs before the procedure and not to drink anything at least 4 hours prior to the procedure.

Prostate Biopsy Side Effects Are Common

Complications from prostate biopsies are common but usually not severe, a study in Urology reveals. Participants in the study had biopsies to look for cancer after an abnormal rectal exam or prostate-specific antigen blood test. In a biopsy, a fine needle punches quickly through the rectal wall to remove a tiny sample of prostate tissue for examination under a microscope. Doctors took 12, 18, or 24 samples per participant. Typical problems from biopsy include pain, soreness, and infections. A more serious complication, which may lead to hospital admission, is acute urinary retention, in which a man is temporarily unable to drain his bladder.

Here is what the study found:

  • 40% of the men experienced a complication.

  • The complication rate was as high as 57% in men with 24-sample biopsies.

  • Only 1.2% of the men required hospital admission.

  • 9.1% ended up visiting an emergency room.

  • 6.7% developed acute urinary retention.

Prostate needle biopsy is the only way to diagnose prostate cancer, regardless of PSA test results. The complication rate would vary with the general health of the men involved.

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Can Prostate Biopsy Cause Erectile Dysfunction

If are recommended by your doctor to undergo prostate biopsy procedure for the detection of cancer, you must have a lot of questions and reservations. One of the most common question that people usually have is, can prostate biopsy cause erectile dysfunction or alter the quality of sex life at all?

The answer is yes erectile dysfunction may occur after prostate biopsy in some susceptible individuals but it is usually transient and self-limiting.

Accorded to a study published in the Journal of Urology, men who undergo prostate biopsy are at risk of temporary erectile dysfunction due to anxiety or pain however, in most men, symptoms improve within a couple of weeks.

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Why And How Prostate Biopsy Is Done

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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.

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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:

Why Do I Need A Prostate Biopsy

A prostate biopsy is the only reliable method to detect prostate cancer. If your PSA is elevated and/or if your prostate exam is abnormal then a prostate biopsy is required to assess whether you have a prostate cancer. There are urine tests and imaging studies such as MRI that can aid in screening for prostate cancer, but these are not diagnostic.

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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.

What Are Some Common Uses Of The Procedure

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A prostate biopsy is currently the only way to definitively diagnose prostate cancer. It also helps differentiate cancer from benign prostatic hyperplasia or nodular enlargement of the prostate, a very common condition in middle-aged and older men that requires a different treatment approach than that of cancer.

A prostate biopsy may be ordered if the physician detects a nodule or other abnormality on the prostate during a digital rectal examination , a common prostate cancer screening test.

A biopsy also may be ordered when a blood test reveals elevated levels of prostate-specific antigen. While there are several reasons for an elevated PSA level, higher PSA levels are sometimes associated with cancer. PSA trends over time may trigger your physician to order a biopsy.

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 due to rising PSA demonstrates a very small abnormality that may not be easily targeted by ultrasound. MRI is also useful in patients who have previously undergone a biopsy and want to improve the sensitivity of the procedure and the precision of the biopsy.

A biopsy not only detects cancer it also provides information on the aggressiveness of the cancer and helps to guide treatment decisions.

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Sex After Prostate Surgery And Achieving Orgasm

Sex after prostatectomy is an important concern for most men. The total removal of the cancerous tissues is the primary goal, but the quality of life after prostate surgery is also important. Worrying about ED makes men be nervous and anxious when thinking about undergoing radical prostatectomy.

However, whilst most patients focus on erectile dysfunction, orgasm is somehow under-considered. But is it possible to achieve orgasm after prostatectomy? Erections and orgasm are equally important for a healthy sex life.

The good news is that sex after prostate surgery is very possible and enjoyable for most men. This is due to the newest robotic technologies that are nerve-sparing and preserve the sexual function.

Dr. Samadis robotic prostate surgery, SMART Surgery, was explicitly designed to spare the tiny nerve bundles surrounding the prostate in order to preserve sexual potency.

Men who undergo Dr. Samadis robotic prostate surgery have a reasonable chance of regaining complete erectile function for sex after prostate surgery.

What Happens During An Mri

These are done in the outpatient procedure area. Antibiotics will be given to reduce the risk of infection from the biopsy. Your doctor will be using the MRI and ultrasound images to watch where the biopsy needles are going. You may feel some discomfort or mild pain when the ultrasound probe is inserted into the rectum. Local anesthesia is used to ease the discomfort.

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Is There An Alternative To A Prostate Biopsy

Prostate cancer enzyme tests 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 reduce the number of people who have biopsies.

Getting The Results Of The Biopsy

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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

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Types Of Prostate Biopsy

Traditional prostate biopsies can be classified based on the approaches adopted in the procedure. There are 3 types namely :

  • Transrectalbiopsy performed using a probe passed through anus into the rectum
  • Transurethralbiopsy performed using a probe passed through the urethra)
  • Transperinealbiopsy done through the skin in front of the anus

Saturation biopsy is a modified type of transperineal prostate biopsy that has higher degree of accuracy.

What Are The Advantages And Disadvantages Of Having A Biopsy

Your doctor should talk to you about the advantages and disadvantages of having a biopsy. If you have any concerns, discuss them with your doctor or specialist nurse before you decide whether to have a biopsy.

Advantages

  • Its the only way to find out for certain if you have cancer inside your prostate.
  • It can help find out how aggressive any cancer might be in other words, how likely it is to spread.
  • It can pick up a faster growing cancer at an early stage, when treatment may prevent the cancer from spreading to other parts of the body.
  • If you have prostate cancer, it can help your doctor or nurse decide which treatment options may be suitable for you.
  • If you have prostate cancer, youll usually need to have had a biopsy if you want to join a clinical trial in the future. This is because the researchers may need to know what your cancer was like when it was first diagnosed.

Disadvantages

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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.

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