Biopsy: Things You Need To Know
The first thing you should know is that theres still plenty of room for confusion after a biopsy. The prostate in a young man is about the size of a walnut with age and BPH it can get bigger think of a lime, or a lemon, or even an orange. Now, imagine that you have about 14 tiny needles each needle has a hollow center, and when it is stuck into the prostate, it takes out a very small core of tissue. Theres a lot of potential to miss any cancer that might be hiding in there.
This is why many men end up getting multiple repeat biopsies, says NYU urologist Stacy Loeb, M.D. This means that you might have a PSA that is elevated. Your doctor orders a biopsy, and no cancer is found. But the PSA keeps on creeping up, so your doctor recommends another biopsy, and maybe even another. About a third of men in one study got another biopsy within five years of a negative biopsy, says Loeb. If the PSA is elevated, do we do another biopsy, or what do we do? This is where some of the second-line PSA tests, like the Prostate Health Index or 4K Score, can be helpful.
A urine test, called the PCA3 test, may also be helpful. Unlike the PSA test, which is prostate-specific but not cancer-specific , the PCA3 test targets genes produced by prostate cancer cells.
First, it can hurt. To get to the prostate, the doctor goes through your rectum. With needles. To minimize pain, your urologist may use conscious sedation or an anesthetic called a prostatic block .
Post Prostate Biopsy Symptoms
I couldn’t find an existing thread on this topic, but I wanted to share what I’m seeing so far, and compare with other’s results.
I’m 58 years old. After discovering a 5+ PSA result in a routine adult physical, I was scheduled for and received both a MRI, and a Transperineal biopsy. In my case, they took 16 samples. I do not yet have the pathology results.
I was not prepared for what happened though. Four days after the biopsy, and to my horror, I found my expectations were way underestimated. It was not “streaks or spots” of blood, nor was it red-tinted. It looked to be pure blood. The volume was probably double what I would have expected. Hoping that the next day would be more normal, I again tested the waters.. It was nearly as bad, however, the color seemed to be a cross between pure blood and fresh motor oil.
I’ve got a message into my care team, and I’m awaiting a response while I also await pathology. I’m a bit nervous.
Has this been other’s experience? If it is common, why understate it in the publications I was provided?
I have not noticed blood in my urine, however, it tends to be dark-ish as I tend to under-hydrate.
Im Not Having Another Biopsy After The Last One
It will come as no particular surprise that men who have had complications after a prior biopsy tend to be less enthusiastic when it is suggested that they need another one. However,
A recent study designed to validate this hypothesis does provide us with some useful data about just how often such complications of biopsy can occur, and how such complications affect compliance with the need for later, repeat biopsies.
Logan et al. used data from the REDUCE trial to conduct a retrospective analysis of whether previous prostate biopsy-related complications and certain types of complication in particular were associated with repeat prostate biopsy compliance and lack of compliance in a clinical trial with study-mandated, systematic biopsies.
In particular, they looked at data on four specific type of biopsy complication hematuria , urinary tract infection , acute urinary retention , and hematospermia among the 4,939 participants in the REDUCE study. This study design specified that men should have biopsies at 2 and 4 years after starting treatment with dutasteride to see if it would lower risk for diagnosis of prostate cancer.
Here is what the authors found:
- 260/4,939 men had a prostate biopsy-related complication at their 2-year biopsy.
- 180/4,939 men had hematuria.
- 36/4,939 men had a UTI.
- 26/4,939 men had AUR.
- 102/4,939 men had hematospermia.
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Sexual Activity After A Prostate Biopsy
You may also want to wear condoms for a week or two to help prevent bacteria or other substances from irritating the areas around your rectum, perineum, or urethra.
Here are some ways you can help reduce your recovery time before and after your prostate biopsy:
- Stop taking blood thinners like aspirin or warfarin to help promote blood clotting during healing.
- Take any antibiotics a doctor instructs you to take before and after the biopsy.
- Use any enemas that a doctor instructs you to take to clean out your rectum and reduce your risk of infection.
- Consider giving a urine sample before the biopsy so that the doctor can ensure you dont have a urinary tract infection.
- Rest for a few days after the biopsy and try to stay off your feet to prevent irritation at the biopsy site.
- Consider taking a few days off work or other activities to reduce stress and movement.
- Reduce stress or anxiety to keep your body calm and promote your immune system function.
- Drink about 64 ounces of water a day to hydrate and promote healing.
- Avoid caffeine and alcohol, which can thin your blood, interfere with antibiotics, and make you pee more frequently.
What Is A Prostate Biopsy
At present, the most reliable way to diagnose cancer remains the examination of tissues under the microscope. However, it means that healthcare providers also need to extract those tissues.
In the case of prostate biopsy, doctors tend to recommend it if they expect that a person may have prostate cancer. In most cases, it means a positive PSA test and increased prostate size during the examination. Prostate cancer screening is an annual event for men older than 50 years and living with prostatitis.
Prostate biopsy is done through the transrectal route. Generally, doctors would use transrectal ultrasound to guide them.
In the procedure, they insert multiple needles. Generally, doctors would not use local anesthetic as the needles are very fine and should not cause significant pain.
Generally, doctors would insert multiple needles to get enough tissues for multiple examinations. During the procedure, doctors extract a tissue sample.
Once the tissue has been extracted, it is sent for further microscopic or histological examination. After examining under the microscope, doctors can say if these are cancer cells or normal cells. If they find cancer cells, they diagnose prostate cancer.
Doctors would also insert an ultrasound probe transrectally during the examination, which may cause mild discomfort but does not cause any trauma.
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Alternatives To A Prostate Biopsy
There are many tests that can help diagnose prostate cancer. The prostate biopsy is the only way to confirm if prostate cancer cells are present, other tests can suggest risk or probability.
Imaging methods like transrectal ultrasound can help learn more about the prostate size and probability of cancer. Nevertheless, the test cannot diagnose the condition.
Another commonly used test is the Mi-prostate score . It combines results of PSA with PCA3 and T2:ERG genes found in urine and thus helps predict prostate cancer risk with considerable accuracy.
Are There Alternatives To A Prostate Biopsy
A prostate biopsy is the most accurate tool a doctor can use to confirm a diagnosis of prostate cancer.
But you may not always need a prostate biopsy. Here are a few other tests that a doctor might recommend during a regular prostate cancer screening to rule out cancer without doing a biopsy:
- Digital rectal exam : During a DRE, a doctor will insert a gloved finger into your rectum to feel your prostate.
- Prostate-specific antigen test: A PSA test analyzes your blood for levels of the PSA protein. High levels could indicate prostate cancer.
- Transrectal ultrasound : A doctor may use TRUS to look at the prostate gland through your rectum, using an ultrasound machine to check for tumors or other abnormalities.
- Urine test: A urine test can detect other signs of prostate cancer in your pee, such as genetic markers that may indicate your risk.
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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.
What Happens After A Prostate Biopsy
Your recovery process will vary depending on the type of anesthesia that isused. If you were given general anesthesia, you will be taken to a recoveryroom for observation. Once your blood pressure, pulse, and breathing arestable and you are alert, you will be taken to your hospital room ordischarged to your home.
If local anesthetic was used, you may go back to your normal activities anddiet unless otherwise instructed. You may feel the urge to urinate or havea bowel movement after the biopsy. This feeling should pass after a fewhours.
There may be blood in your urine or stool for a few days after the biopsy.This is common. Blood, either red or reddish brown, may also be in yourejaculate for a few weeks after the biopsy. This, too, is normal.
The biopsy site may be tender or sore for several days after the biopsy.Take a pain reliever for soreness as recommended by your healthcareprovider. Aspirin or certain other pain medicines may increase the chanceof bleeding, so be sure to take only recommended medicines.
Increase in the amount of blood in your urine or stool
Belly or pelvic pain
Changes in the way your urine looks or smells or burning with urination
Fever and/or chills
Your healthcare provider may give you other instruction, depending on yoursituation.
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Day Before Prostate Biopsy
You will be given a prescription for an antibiotic that should be the day before and the morning of your biopsy. Enough antibiotics have been given for you to continue taking them for two more days after the biopsy. You will also have to purchase two fleets enemas at your local pharmacy. Follow the instructions in the box and take one the evening before and one two hours before your biopsy. You should also not eat any solid foods after dinner the night before your biopsy. You may drink any type of liquid that you choose right up to the point of your biopsy. It helps to have some fluid in the bladder during the biopsy.
To 7 Days Before Your Procedure
You may need to stop taking some of your usual medications before your surgery. Examples include anticoagulants, aspirin, medications that contain aspirin, and vitamin E. Follow your healthcare providers instructions.
You can read about medications that contain aspirin and vitamin E in the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.
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Day After The Prostate Biopsy
After your biopsy, you will have to drink many fluids so that you may provide us with two separate urine samples from two separate voids. The most common complication is blood in the urine after the biopsy. We would like to make sure that your urine is in the process of clearing before we send you home for the day. It is normal to see blood in the urine and bowel movements for 1-2 weeks after the procedure. It should progressively diminish over that time-period. If you find that, you cannot urinate or if you are passing a large number of blood clots, then report to the office or nearest emergency room for evaluation. A physician may have to insert a catheter into the bladder for a few days to allow you urine to be drained. You should continue to drink more than your usual intake of fluids to keep your urine diluted and to prevent formation of blood clots within the bladder.
If you have fever or chills, please take your temperature with an oral thermometer and call your physician if it reads above 100.8 F.
Follow-up Your results will usually take 5-10 working days. If you have not heard from your physician after 14 days please call the office at 558-9091.
Figure : Transrectal Ultrasound
During a transrectal ultrasound, an ultrasound probe is inserted into the rectum. The probe emits sound waves that bounce back off surrounding tissues. Depending on the strength, pitch, and direction of the reflected sound waves, a computer can create pictures of the internal anatomy.
Based on the strength, pitch, and direction of the reflected waves, a computer creates pictures of the internal anatomy . Several studies have shown that TRUS effectively pinpoints usually benign abnormalities that can lead to hematospermia in 74% to 95% of patients. Among the findings: enlarged seminal vesicles stones in the seminal vesicles, prostate, or ejaculatory duct cysts and BPH. Interestingly, no cancers were detected in these studies. Because it is so effective and minimally invasive, TRUS is the first type of imaging that should be performed.
Depending on what information TRUS yields, your doctor may recommend two other procedures: magnetic resonance imaging and cystoscopy. Unlike TRUS, MRI can reveal bleeding in the seminal vesicles or prostate. Cystoscopy allows your doctor to examine the inside of the bladder and urethra, areas that may not show up well on MRI and TRUS, with a thin, lighted instrument called a cystoscope.
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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 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.
When To See A Doctor
Men who have warning signs should see a doctor. Timing is not critical, and a delay of a week or so is not harmful. Men who do not have warning signs and are younger than age 35 do not need to see a doctor unless they have other symptoms, such as pain in the scrotum Scrotal Pain Pain in the scrotum can occur in males of any age, from newborns to older men. The testes are very sensitive, so even minor injuries may cause… read more or groin or pain during urination Pain or Burning With Urination Burning or pain during urination may be felt at the opening of the urethra or, less often, over the bladder . Burning… read more . Men who do not have warning signs and are over 35 should see a doctor within a few weeks.
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Does The Prostate Swell After A Biopsy
When it comes to inflammatory responses, people differ. No matter how small, any trauma will cause local inflammation, and the prostate will swell a bit. However, in some individuals, this swelling may be more than in others.
This swelling of the prostate can make urinating difficult for individuals. Generally, this swelling would not last long. Nonetheless, your healthcare provider would recommend urinating before the procedure.
For most people, the swelling would last for a few hours. However, if it lasts longer, it may cause urinary retention or a problem peeing. In such instances, doctors may need to insert a catheter.
How Painful Is A Biopsy Of The Prostate
It is a common question, and the survey shows that it is not that painful. For example, in the case of transrectal prostate biopsy, most would describe experiencing mild discomfort.
That is why doctors do not use sedation or general anesthesia. Nevertheless, doctors may use some local anesthetic, which makes local tissues numb and is very safe.
Pain may be more pronounced in the case of transperineal biopsy, and that is why it is an uncommon way of the prostate biopsy procedure.
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What Happens During A Prostate Biopsy
Some of the effects you experience after a biopsy may depend on the type of biopsy you have. So, first, lets look at the different types of prostate biopsies.
There are three types of prostate biopsies doctors use to remove tissue samples from your prostate for lab analysis:
- transrectal biopsy
- transperineal biopsy
- transurethral biopsy
The surgeon will use an ultrasound tool to view the area around your prostate. Theyll also use a local anesthetic around the area to reduce pain. Guided by the ultrasound, the surgeon will use a needle to remove multiple tissue samples from your prostate gland.
In a transurethral biopsy, the surgeon uses a scope instead of an ultrasound. The scope goes through your urethra and has a tool to help the surgeon remove the tissue samples.
A prostate biopsy is a relatively low risk procedure. But there is some risk of adverse effects. These side effects are usually short-term and involve bleeding due to the needle or tools perforating the area around your prostate.
You may notice blood in your:
- rectum the first few days after your biopsy, and it may be difficult to stop the bleeding
- pee or poop for a few days, but this bleeding may extend up to a week or two
You may also have trouble peeing for a few days, especially after a transurethral biopsy. In some cases, the surgeon may insert a catheter to help you pee in the early stages of recovery.