How Do They Do A Biopsy On Your Prostate

Temporary Effects On Your Bowel Movements Urine And Semen

How is a Prostate Biopsy Performed?

You might see blood in your bowel movements. You might also have a small amount of bleeding from your rectum. These can happen right after your procedure or for the next few days when you have a bowel movement.
You might see blood in your urine for 7 to 14 days after your procedure. This bleeding might come and go.
Your semen might look rust-colored for up to 12 weeks after the biopsy. This is because small amounts of blood might be in it.

What Does A Digital Rectal Exam Do

In a digital rectal exam , the doctor inserts a gloved finger into your rectum to feel for irregularities of the prostate. Its a common part of a mans routine physical examination.

Your doctor might perform a DRE alone or with a PSA test for routine screening. Its a quick and simple test. Although a DRE can signal a problem, such as an enlarged prostate, it cannot determine if its due to prostate cancer.

Prostate cancer is diagnosed 15 to 25 percent of the time when abnormal findings on a DRE lead to biopsy.

Alternatives To A Prostatebiopsy

When you need a prostate biopsy to complete the diagnosis and the Gleason score, no other diagnostic tool has the same value. However, there is a gray zone, in which doctors are not sure if the patient has prostate cancer or not. Many patients in this gray zone undergo a prostate biopsy that could be avoided by considering other options.

Depending on your case, one of these alternatives could rule out the suspicion of prostate cancer and disregard the need for a prostate biopsy:

Advanced PSA test measures such as PSA density or PSA velocity, especially in patients with known benign prostatic hyperplasia
A prostate MRI scan to see a more detailed picture of the prostate
Additional prostate markers such as PCA3, T2:ERG, and the MIPS prostate score
Watchful waiting, which is recommended for some patients in the gray zone

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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 Happens After A Biopsy

A negative biopsy indicates that none of the biopsy samples found any evidence of prostate cancer. This is usually good newshowever, this does not necessarily mean that there is no prostate cancer present. Your doctor may want to continue to monitor your PSA levels or do a repeat biopsy at some point in the future.

A positive biopsy indicates that there is evidence of prostate cancer. This would be considered a diagnosis of prostate cancer. At this point, you should also have some idea of the approximate location, size, and aggressiveness of the cancer. What happens next is a decision between you and your doctor. There are some additional tests you can take to give you a better idea of your diagnosis. For example, genomic tests can help provide information on how likely your cancer is to spread, or how aggressive it is likely to be.

In addition, there are additional new tests that can be performed with a biopsy to help make diagnosis and determine the aggressiveness of the cancer:

ERG Protein Marker
A marker used on prostate tissue after a biopsy, which measures ERG protein assays. This helps doctors identify patients who have the disease or have pre-cancerous lesions that indicate a patient is more likely to develop prostate cancer over time.

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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.

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 The Studies Say

In a Finnish survey about prostate biopsies and the need for rebiopsy, 18% of men said they would not accept a new biopsy, and the leading cause was pain. This symptom is sometimes as severe as causing tension and anxiety in men. Many of them end up with an unfavorable attitude to the procedure. Others are adequately treated or maintain close contact with the doctor reporting their symptoms and adjusting the doses. When patients achieve relief, they are more likely to accept a new biopsy if needed in the future.

Pain measurement studies in prostate biopsy use different methods to assess pain. The most common is a scale from 0 to 10, known as the visual analog scale. Other instruments can simply measure the respiratory rate, serum cortisol levels, or blood pressure. According to these studies, when patients feel very anxious, their perception of pain increases. Thus, the more nervous the patient is, the higher the need for anesthesia.

However, most studies mentioned above evaluate pain during the procedure and shortly after. As noted above, feeling pain is natural after any surgical procedure and not an alarming sign at all. Pain should go away after a few days or one week, and it is easier to manage as the days go by. If you still have significant pain symptoms one or two weeks after a prostate biopsy, it will be a good idea to talk to your doctor. You might have a complication -usually an infection- that is not allowing for a complete recovery.

Transrectal Biopsy Of The Prostate

How Safe is Prostate Biopsy?

Today this procedure is usually carried out in the office of an experienced physician such as a urologist. However, it can also be carried out in a hospital or a day surgery center. It is commonly carried out with the accompanying use of a local anesthetic, but always ask the urologist if he or she is going to give you an anesthetic: prostate biopsy can quite often be painful without it.

The patient is asked to lie in one of several possible positions. The physician normally uses a special prostate biopsy gun to drive ultra-fine biopsy needles through the wall of the rectum and into the prostate. This gun is used in combination with a transrectal ultrasound probe, which enables the doctor to see where the biopsy needles are being placed into the prostate. Each hollow needle will remove a fine cylindrical core of prostate tissue in about a second.

This entire procedure, properly called transrectal ultrasound-guided prostate biopsy or TRUS-guided biopsy is usually completed in about 20 minutes, from start to finish.

The Number of Cores Removed

Many different theories exist as to the best way to sample the prostate so as to find any cancer that may be present. There are no absolute prostate biopsy guidelines. In general, however, an experienced physician will seek to take prostate biopsy specimens as follows:

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What Is A Prostate Ultrasound And Biopsy And Why Would You Need One

The prostate is the part of your body that makes fluid for semen, which is the fluid that carries sperm. The gland surrounds part of your urethra, which is the tube that carries urine and sperm outside of the body. The prostate has muscles that move the sperm out of the body.

If you are having problems with your prostate, you might be having difficulties related to pushing urine or sperm out of your urethra and penis. Your healthcare provider may ask you to have a prostate ultrasound and biopsy to check for prostate cancer.

A prostate ultrasound probe is inserted into the rectum and uses sound waves to produce images inside the rectum to help image the prostate and guide the doctor in taking a biopsy of the prostate gland. Prostate ultrasound and biopsy are used to diagnose prostate cancer or to find the reason for other problems. A doctor may require this test if a patient has high levels of prostate-specific antigen found in a blood test, or has an abnormal prostate exam both suggesting that the patient may have a high risk for prostate cancer.

Does The Prostate Swell After A Biopsy

This happens because the biopsy can cause the prostate to swell, making it difficult to urinate. Acute urine retention may be more likely if you have a template biopsy. This is because more samples are taken, so there may be more swelling. Your doctor will make sure you can urinate before you go home after your biopsy.

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Are There Any Problems To Expect After A Prostate Ultrasound And Biopsy

In some cases, men can develop a urinary tract infection or an infection in the prostate. These infections are rare and easy to treat with prescribed antibiotics.

Blood in the urine and/or stool is common for three to five days after the biopsy. It is also common to have blood in your semen for up to two to three months after the biopsy. This is not harmful to you or your partner and will eventually go away on its own. You should avoid heavy lifting for two to three days to help avoid bleeding issues.

Some men may also have trouble urinating after the procedure. Most problems are minor and go away on their own after a few days. If you arent able to urinate at all, call your healthcare provider or go to the emergency room. Make sure that you tell them that you just had the ultrasound and biopsy.

A fever of 100 degrees F or higher.
Shaking or chills.

Types Of Prostate Biopsy Method

Prostate biopsy tests can be gathered in various ways. Your prostate biopsy may include:

The needle going through the mass of the rectum . This is the most widely recognized method for performing a prostate biopsy.
Inserting the needle through the area of skin between the butt and scrotum . A little cut is made in the skin area between the butt and the scrotum. The biopsy needle is embedded through the cut and into the prostate to draw out a specimen of tissue. An MRI or CT output is for the most part used to guide this technique.

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What Happens After A Prostate Ultrasound And Biopsy

When the procedure is finished, you may resume your normal meals and daily activities, unless otherwise instructed. Some urologists may prescribe an antibiotic after the biopsy to prevent any infections, but given antibiotics only prior to the biopsy. Some men may have soreness for a few days after the procedure, which is normal. Your provider will contact you when your results are available

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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The Test Is Often Not Needed

Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:

An enlarged prostate gland.
Recent sexual activity.
A recent, long bike ride.

Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.

Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.

What Is Prostate Cancer Screening

When should You Have a Prostate Biopsy?

The diagnosis of prostate cancer usually follows a biopsy prompted by a significantly elevated initial PSA level, an increase in PSA levels over time, or an abnormal digital rectal examination. According to JAMA, patients with a prostate cancer history benefit from extended PSA monitoring. Elevated PSA levels may help determine when to go in for a prostate MRI and hopefully avoid unnecessary or repeat prostate biopsies.

The American Journal of Mens Health reports that prostate cancer diagnosis occurs most often in men older than 50. Other factors influencing the rate of prostate cancer are ethnicity and family history. Screening is vital because localized prostate cancer sometimes causes no symptoms or warning signs.

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What Is A Mi

The MiPS score helps to evaluate your risk of prostate cancer and aggressive prostate cancer. Its usually performed after you have abnormal results from a PSA test and DRE.

This test involves a DRE, after which youll provide a urine sample. The Mi-prostate score combines three markers:

serum PSA
PCA3
TMPRSS2:ERG

PCA3 and T2:ERG are genes found in the urine. Its rare for men without prostate cancer to have high amounts of these markers in their urine. The higher your levels, the more likely it is that you have prostate cancer.

A MiPS provides more information than a PSA test alone. Its a valuable risk assessment tool and may be helpful in deciding whether or not to go ahead with a biopsy. Like other tests, a MiPS test alone cannot confirm prostate cancer.

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.

Prepare For The Immediate Complications

A prostate biopsy usually has the primary complication of bleeding. You can see blood in the urine, in the stool, or in your semen. Also, you may feel pain in your pelvic floor for up to one week. You need to understand before the procedure why this happens. That way, you will be able to tell when the bleeding is too much. Be sure to ask your doctor what to expect in your case.

Biopsy During Surgery To Treat Prostate Cancer

If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .

The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.