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.
The Prostate Biopsy Procedure
The most common method for a prostate biopsy uses transrectal ultrasound to guide a hollow needle to the prostate.
The ultrasound wand, an instrument just a little larger than a pen, is inserted into the rectum and moved into place near the prostate, where it can transmit images of the prostate and surrounding tissues. A spring-loaded needle is then inserted into the rectum and guided to the prostate. Several small pieces of tissue are sampled from both sides of the prostate, then sent to a lab to be examined by a pathologista doctor trained in diagnosing disease based on tissue and other biological samples.
The prostate biopsy, which takes around 30 minutes, can be done under local anesthesia at a doctors office or an outpatient clinic. If necessary, a sedative can also be prescribed to help a patient relax before the procedure starts.
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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How Does Your Doctor Do Prostate Biopsies
So the time has come for a whole bunch of reasons for actual and potential prostate cancer patients to start asking their urologists about whether they are able to carry out transperineal as opposed to transrectal biopsies.
Once upon a time back in the 1970s before we had PSA tests to screen for risk of prostate cancer, and transrectal ultrasound equipment to help guide transrectal biopsies, and a relatively low risk for biopsy-related infections with antibiotic-resistant bacteria, older forms of transperineal biopsy were a very normal way to carry out prostate biopsies. But they werent very good and they werent easy to do.
So, to be clear, a transperineal prostate biopsy is carried out through the skin between the rectum and the testes . By comparison, transrectal biopsy is carried out through the skin inside the rectum and comes with a relatively high risk for prostatic infections, including serious infections like septicemia that can lead to hospitalization and even death.
This link to information on the Mayo Clinic web site provides a pretty straightforward introduction to the relative merits of transperineal as opposed to transrectal biopsies. It is worth noting, in particular, the following:
The reasons that most urologists here in the USA dont use the transperineal method for carrying out prostate biopsies are:
The bottom line here is that there is an increasingly credible amount of data suggesting that:
What Are Additional Tests For Detecting Prostate Problems
If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.
How To Prepare For A Prostate Biopsy
A patient may be asked to self-administer an enema before the procedure in order to clean out the rectum and decrease risk of infection. He may also be prescribed antibiotics as an additional precaution against infection these should be taken an hour before the procedure and for two to three days following it.
Additionally, certain drugs can increase the risk of bleeding. A patient shouldn’t change medications unless instructed by his doctor, but should inform his physician if he is taking any of the following:
- Aspirin or other pain medications, such as ibuprofen and other NSAIDS
- Blood thinning medications, such as warfarin or heparin
- Herbal medicines, some of which can also act as blood thinners
Prostate Biopsy Specimens: Ask For Meticulous Labeling
The way that prostate biopsy samples are handled varies among hospitals. The samples, or “cores,” are put onto glass slides to be examined under a microscope for signs of cancer. Find out if the physician doing the biopsy will place each core in a separate, labeled container. If cancer is discovered, its location in the prostate gland can affect decisions about further testing and possible treatment.
Individual labeling of biopsy cores is more expensive, and not all hospitals provide this level of service. “If all of the samples from the right and left side of the prostate gland are processed together, as opposed to individually, consider having the biopsy done elsewhere,” Dr. Garnick says.
How Should I Prepare
Prior to a prostate biopsy, you should provide your physician with a list of all the medications you are taking, including herbal supplements. Tell your doctor if you have any allergies, especially to anesthesia. Also, inform your physician about recent illnesses or other medical conditions.
You may be asked to stop or curtail the use of blood thinning medications for seven to 10 days before the procedure to prevent excessive bleeding during and after the biopsy. A blood test may be required to check your blood clotting on the day of the procedure. Consult your physician and the hospital radiology clinic or department for more information.
You may be advised to take antibiotic pills for a day or two before the biopsy, and on the morning of the procedure, to help prevent infection.
If you are undergoing an MRI-guided biopsy, you will be asked 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. Make sure to inform your technologist of prior surgeries or metal implants, such as pacemakers, aneurysm clips, or joint replacements.
For the MRI-guided procedure, you will receive intravenous contrast material called gadolinium. Because gadolinium does not contain iodine, it can be used safely in patients with contrast allergies.
If you are sedated for the procedure, you will want to have a relative or friend accompany you and drive you home afterward.
Precancerous Cells And Pin
Sometimes, the results will show that precancerous cells, or prostatic intraepithelial neoplasia , are present.
If these PIN are low grade, the doctor will not consider this a matter of concern. Many men have low grade PIN.
However, if the PIN are high grade, there is a chance that cancer may develop. In these cases, a doctor may suggest further tests.
Carcinoma in situ refers to cells that are not yet cancerous but could become so. They can occur almost anywhere in the body.
The outlook depends on the results of the biopsy and other tests.
If results show that cancer is present in or around the prostate gland only, there is an almost 100% chance of surviving at least another 5 years. This is because effective treatment is available, and because many types of prostate cancer are slow growing.
However, if cancer has spread to other organs, such as the liver or lungs, the chance of someone surviving another 5 years or more falls to 30%.
Factors that affect the outlook for a person with prostate cancer include:
- their age and overall health
- the type of cancer present
- how far cancer has spread
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How Do You Prepare For A Prostate Biopsy
Your doctor or nurse may instruct you to take an enema before the procedure. This helps to keep the bowels clean during the surgery.
How Is Benign Prostatic Hyperplasia Diagnosed
Your doctor will look at your medical history and give you a complete physical examination.
Your doctor will perform a digital rectal examination by inserting a gloved, lubricated finger into your rectum to feel the prostate, estimate its size and detect any hard areas that could be cancer.
Several studies may be performed to help diagnose your condition:
- A survey to evaluate how severe your symptoms are.
- A flow study may be conducted to measure how slow the urinary stream is compared with normal urine flow.
- A study to detect how much urine is left in the bladder after you finish urinating.
- A cystoscopy to look into the bladder.
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How Is The Biopsy Procedure Performed
Ultrasound-guided biopsy procedure:
The ultrasound-guided prostate biopsy is carried out by a radiologist or urologist, assisted by a sonographer and often a nurse who helps look after the patient.
You may have a small enema inserted into your rectum half an hour or so before the procedure to clean out your bowels and clear the rectum of feces so that the prostate may be seen more clearly with the ultrasound and to lower the risk of infection.
You may also be given antibiotics just before the procedure as an additional safeguard against infection. You also may receive medication for pain and anxiety. Sometimes an injection of local anesthetic or sedative will be given in the area of the rectum to minimize discomfort during the procedure.
The procedure is often carried out after you have been given a light general anesthetic, which means you will be asleep or sedated during the procedure. If the procedure is carried out using an anesthetic, an anesthesiologist will be present.
During the procedure, you will be asked to lie on your left side with your legs bent.
The physician will first carry out a DRE with a gloved finger.
An ultrasound probe will then be inserted into your rectum. The probe is sterilized, covered with condoms to ensure protection from any infection or contamination, and lubricated to help it glide easily into your rectum.
The entire ultrasound-guided biopsy procedure is usually completed within 45 minutes or less.
MRI-guided biopsy procedure:
Key Points To Remember
- Surgery can help if your enlarged prostate is causing serious problemssuch as kidney problems or repeated urinary tract infectionsor if medicines havent helped.
- The most important thing in deciding whether to have surgery is how much the symptoms bother you.
- Surgery works well for most men. But it can cause side effects, including ejaculation problems and erection problems.
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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 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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Getting The Results Of The Biopsy
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
Whats The Purpose Of A Transrectal Ultrasound
A transrectal ultrasound is a procedure that produces an image of the prostate. Its usually ordered after an abnormal PSA and DRE. For the test, a small probe is inserted into the rectum. The probe then uses sound waves to produce a picture on a computer screen.
The test is uncomfortable, but not painful. It can be done in your doctors office or on an outpatient basis in about 10 minutes. It can help estimate the size of the prostate and spot abnormalities that may indicate cancer. However, a TRUS cant confirm the diagnosis of prostate cancer.
A TRUS can also be used to guide a biopsy.
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Follow The Antibiotic Schedule
Your doctor will probably prescribe antibiotics before the procedure. They are meant to prepare your body to destroy any bacteria that comes through. Doses are essential here, and you need to take the antibiotics as instructed. Otherwise, it can be dangerous for you, and the risk of complications will be higher.
Further Testing For Advanced Cancer
If there’s a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
- an MRI scan, CT scan or PET scan these scans build a detailed picture of the inside of your body
- an isotope bone scan, which can tell if the cancer has spread to your bones a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities
What Else Do You Need To Make Your Decision
Check the facts
- Sorry, thats wrong. Most men can treat their symptoms at home or take medicines for their symptoms. Surgery can be helpful if an enlarged prostate is causing serious problems or if medicines arent working.
- Thats correct. Most men can treat their symptoms at home or take medicines for their symptoms. Surgery can be helpful if an enlarged prostate is causing serious problems or if medicines arent working.
- It may help to go back and read Get the Facts. Most men can treat their symptoms at home or take medicines for their symptoms.
- Thats right. Retrograde ejaculation, which means semen is ejaculated into the bladder instead of out through the penis, is a common side effect of surgery. That can make it difficult to father children.
- Sorry, youre wrong. Retrograde ejaculation, which means semen is ejaculated into the bladder instead of out through the penis, is a common side effect of surgery. That can make it difficult to father children.
- It may help to go back and read Get the Facts. Retrograde ejaculation is a common side effect that can make it difficult to father children.
1.How sure do you feel right now about your decision?
3.Use the following space to list questions, concerns, and next steps.
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Preparing For Your Biopsy
You have the biopsy under local or general anaesthetic.
Having the biopsy under local anaesthetic means you should be able to eat and drink normally before the test.
Having the biopsy under general anaesthetic means that you wont be able to eat or drink for a number of hours beforehand. You usually stop eating at least 6 hours before the biopsy and stop drinking at least 4 hours beforehand. Your team will give you instructions.
Take your usual medicines as normal, unless you have been told otherwise. If you take warfarin to thin your blood, you should stop this before your biopsy. Your doctor will tell you when to stop taking it.
You have antibiotics to stop infection developing after the biopsy. You have them before the biopsy and for a few days afterwards.
You might have a tube into your bladder to drain urine.
Your doctor will ask you to sign a consent form once you have all the information about the procedure.
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