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Biopsy Of Prostate Gland Procedure

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What Happens During An Mri

Transrectal biopsy – Animated Atlas of BPH and OAB

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.

What Are The Advantages Of An Mri

Research has shown that using an MRI image to guide a biopsy improves detection of prostate tumors that require treatment, while finding fewer tumors that are called biologically insignificant. This means that they do not need any immediate treatment and are not likely to pose a threat to the patient. Because using an MRI image gives doctors better information and reduces the chance that a serious tumor will be missed, it should also mean that patients with blood-test results that suggest possible prostate cancer are less likely to need repeat biopsies because the first one may have produced a false negative.

What Happens Before During & After A Prostate Biopsy

Prior to having a prostate biopsy, patients are usually asked to provide a urine sample. This is done to look for signs of a urinary tract infection . If a UTI is present, the biopsy will likely be rescheduled. Men are also normally advised to stop taking certain medications that may increase bleeding risks, particularly blood thinners and certain NSAIDs and herbal supplements. Patients are sometimes advised to do a cleansing enema at home prior to arriving for their biopsy. Antibiotics may be given to a patient shortly before the test to reduce the risk of infection from the procedure.

There are different methods that may be used to perform a prostate biopsy. The most common option is what’s called a transrectal biopsy. It’s done by inserting a needle through the wall of the rectum to reach the prostate gland. Sound waves are used to produce an image of the gland so the needle can be accurately directed. Typically, several tissue samples are taken. There may be a brief unpleasant sensation each time the needle takes a sample, although the entire procedure is often completed in about 10 minutes.

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  • Blood tests will be done to check your PSA level. Your PSA level shows caregivers if you are still at risk for prostate cancer. You will need rectal exams to check the size and shape of your prostate gland. Ask your caregiver when, and how often, you need blood tests and rectal exams. You may need another prostate gland biopsy if you are at high risk for prostate cancer. If your biopsy showed cancer cells, you may need imaging tests to check if the cancer has spread. Imaging tests include bone scans, x-rays, computed tomography scans, or magnetic resonance imaging . Ask your caregiver for information about these and other tests you may need.

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 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.

Short-term bleeding

A small number of men who have a TRUS biopsy may have more serious bleeding in their urine or from their back passage . This can also happen if you have a transperineal biopsy but it isn’t very common. If you have severe bleeding or are passing lots of blood clots, this is not normal. Contact your doctor or nurse at the hospital straight away, or go to the accident and emergency department at the hospital.


Some men get an infection after their biopsy. This is more likely after a TRUS biopsy than after a transperineal biopsy. It’s very important to take any antibiotics youre given, as prescribed, to help prevent this. But you might still get an infection even if you take antibiotics.

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 urgently than usual
  • needing to urinate more often than usual during the day or night
  • a high or very low temperature
  • pain in your lower abdomen or back.

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How Often Do Prostate Biopsies Find Cancer

The likelihood that a prostate biopsy will detect cancer depends greatly on the pre-biopsy profile of the person undergoing the procedure. If you have a high PSA score and/or suspicious changes to your prostate, a biopsy is more likely to detect cancer than if you have no significant risk factors or indications that you may have cancer.

This is why its important to have a thorough conversation with your doctor about why they are recommending a biopsy. A small 2015 study found a positivity rate of 52%, which the researchers noted was higher than most published averages.

In recent years, the combination of an MRI-guided and TRUS-guided biopsy is becoming more popular.

The combination of these the two imaging technologies, known as a , allows the doctor to see combined images of the prostate that are more detailed than MRI or ultrasound alone.

According to a , prostate biopsy is the gold standard screening for prostate cancer, and the combination of MRI and TRUS has advantages over traditional biopsy procedures.

A separate 2020 review suggests that TRUS-guided biopsies without MRI tend to result in an excessive amount of findings associated with non-significant disease and that they under-detect clinically significant cancer findings.

Apart from biopsies, your doctor may turn to other tests to detect prostate cancer or the possibility of cancer. These other screenings include:

Transurethral Resection Of The Prostate

The Prostate Cancer pages of this website are part of the Comprehensive Prostate Cancer Awareness Program , a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.

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A Better Way To Biopsy In Prostate Cancer

Hashim Ahmed at Imperial College London researches biopsy methods for prostate cancer.Credit: Imperial College London

In principle, a prostate biopsy is a straightforward process. An ultrasound probe inserted into the rectum helps the clinician to locate the gland, and hollow needles are used to penetrate and collect tissue from a dozen sites across the prostate. The procedure is done with a local anaesthetic, and takes less than half an hour. More than one million such biopsies are performed every year in Europe and the United States. But a growing number of clinicians think this is too many.

One of their main concerns is that it is left to chance whether tumours in the prostate are caught by a needle unlike biopsies in other tissues, which target abnormalities already spotted on imaging. Although the random approach is a good way to find hidden tumours, it can also miss the clinically meaningful disease, providing a misleading view of actively growing tumours and thereby resulting in delayed diagnosis of aggressive cancer. Moreover, a sizable fraction of the tumours that are detected might best be left hidden. One-third of men above the age of 50 have indolent disease, says Hashim Ahmed, a surgeon at Imperial College London. These biopsies are picking up that pool of indolent disease.

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What Is The Procedure

Prostate Cancer Screening and Biopsy with Urologist Dr. Scott Davidson

Despite what some patients might think , a biopsy is very well tolerated, provided it is done in the appropriate conditions.

At least 12 fragments must be collected for analysis during the biopsy: at least 6 from each lobe , in previously defined and standardised regions, in accordance with well-defined and thorough protocols.

In most cases today, 12 or 14 fragments are removed in this type of biopsy.

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Use In Men Who Might Have Prostate Cancer

The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.

PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.

  • Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
  • Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
  • If the PSA is more than 10, the chance of having prostate cancer is over 50%.

If your PSA level is high, you might need further tests to look for prostate cancer.

To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.

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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When Is A Prostate Biopsy Done

Physicians may order a prostate biopsy in a few situations:

  • Abnormalities in a rectal examination: General practicioners perform these physical prostate exams–during which they use a gloved, lubricated finger inserted into the rectum to look for unusual tissue growth–as part of a man’s annual check-up. When doctor feel a lump or something else abnormal during a rectal exam, they typically order a prostate biopsy.
  • Elevated blood levels of prostate-specific antigen : PSA is a protein produced by the prostate. Historically, physicians believed that high PSA levels may indicate the presence of prostate cancer and ordered it as a routine screening test. However, a growing body of research has shown that high levels of PSA may be associated with other conditions, such as prostatitis. If elevated PSA is accompanied by other symptoms, a biopsy can determine whether prostate cancer is present.

What Does A Prostate Biopsy Involve

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

If you decide to have a biopsy, youll either be given an appointment to come back to the hospital at a later date or offered the biopsy straight away.

Before the biopsy you should tell your doctor or nurse if youre taking any medicines, particularly antibiotics or medicines that thin the blood such as warfarin or aspirin.

You may be given some antibiotics to take before your biopsy, either as tablets or an injection, to help prevent infection. You might also be given some antibiotic tablets to take at home after your biopsy. Its important to take them all so that they work properly.

A doctor or nurse will do the biopsy. There are two main types of biopsy:

  • a trans-rectal ultrasound guided biopsy, where the needle goes through the wall of the back passage
  • a transperineal biopsy, where the needle goes through the skin between the testicles and the back passage .

The type of biopsy you will have depends on your hospital.

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How Should I Prepare

Prior to a prostate biopsy, tell your doctor about all the medications you take, including herbal supplements. List any allergies , recent illnesses, and other medical conditions.

You may need to stop taking blood thinners for seven to 10 days before the procedure. This will help prevent excessive bleeding during and after the biopsy. The doctor may check your blood clotting on the day of the procedure. Ask your doctor and the hospital radiology clinic or department for more information.

You may need to take oral antibiotics a day before and the morning of the biopsy. This will help prevent infection.

If you are having an MRI-guided biopsy, you will need to wear metal-free clothing and remove any metallic objects, such as jewelry, watches, and hearing aids.

A technologist will walk through an MR imaging safety checklist with you. Tell your technologist about prior surgeries and metal implants, such as pacemakers, aneurysm clips, and joint replacements.

An MRI-guided procedure may use an injection of gadolinium contrast material. Because gadolinium does not contain iodine, it can be used safely in patients with contrast allergies.

Your MRI procedure may use an endorectal coil. This is a thin wire covered with a latex balloon. The doctor will lubricate this assembly and gently insert it into your rectum. Tell the doctor if you are allergic to latex so they may cover the coil with a latex-free balloon.

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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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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What Is An Mri

MRI fusion biopsy for prostate cancer

MRI stands for magnetic resonance imaging, a test that creates a detailed image of an area inside the body. An MRI provides a more detailed image than the ultrasound procedure, and allows doctors to spot parts of the prostate that dont look healthy and should be examined with a biopsy needle.

Doctors have started using ultrasound and MRI images together in what is known as a fusion-guided biopsy. An MRI is taken and the image is examined to identify areas that look suspicious. Later, the doctor who performs the biopsy uses an ultrasound probe along with special software to fuse the MRI and ultrasound images into one image that makes it easier to spot targets for the biopsy needles.

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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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