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.
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.
What Is A Transperineal Biopsy
This is where the doctor inserts the biopsy needle into the prostate through the skin between the testicles and the back passage . In the past, hospitals would only offer a transperineal biopsy if other health problems meant you couldnt have a TRUS biopsy. But many hospitals have stopped doing TRUS biopsies and now only do transperineal biopsies.
A transperineal biopsy is normally done under general anaesthetic, so you will be asleep and wont feel anything. A general anaesthetic can cause side effects your doctor or nurse should explain these before you have your biopsy. Some hospitals now do transperineal biopsies using a local anaesthetic, which numbs the prostate and the area around it, or a spinal anaesthetic, where you cant feel anything in your lower body.
The doctor will put an ultrasound probe into your back passage, using a gel to make this easier. An image of the prostate will appear on a screen, which will help the doctor to guide the biopsy needle.
If youve had an MRI scan, the doctor may just take a few samples from the area of the prostate that looked unusual on the scan images. This is known as a targeted biopsy.
Why Are Biopsies Done
Biopsies are most often done to look for cancer. But biopsies can help identify many other conditions.
A biopsy might be recommended whenever there is an important medical question the biopsy could help answer. Here are just a few examples:
- A mammogram shows a lump or mass, indicating the possibility of breast cancer.
- A mole on the skin has changed shape recently and melanoma is possible.
- A person has chronic hepatitis and it’s important to know if cirrhosis is present.
In some cases, a biopsy of normal-appearing tissue may be done. This can help check for cancer spread or rejection of a transplanted organ.
In most cases, a biopsy is done to diagnose a problem or to help determine the best therapy option.
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Adverse Effects Of A Prostate Biopsy
The majority of men undergo prostate biopsy with few or no significant problems at all. However, some men do have problems, and a good physician will be sympathetic to these problems if they occur:
- While many men have little or no pain associated with a prostate biopsy, for some men there can be significant pain. It is possible that such pain is associated with the biopsy needle cutting into or through nerves that run through the prostate tissue.
- Minor bleeding may occur after a biopsy, and evidence of blood in the urine and the semen post-biopsy is very common. Rectal bleeding is also a possibility. The patient should be encouraged to avoid heavy work or exercise for 24 hours after a biopsy. If there is significant and continued bleeding, a patient should immediately contact the doctors office.
- Difficult with urination is also a possible complication. In this case also, the doctors office should be informed immediately.
- Infection associated with a prostate biopsy is a relatively rare but very possible complication. If the patient develops a high fever, and complains of chills or abdominal pain after the procedure, he should arrange to see the doctor right away.
How To Get The Best Results
Most men do not find prostate biopsy excessively painful or uncomfortable, and the complications are usually not seriousbut can be. Certain steps taken before, during, and after the procedure can improve the outcome:
Take antibiotics. Taking preventive antibioticsbefore and after the procedurecuts the risk of infection substantially. Most infections are not dangerous but could become so if they get out of control. The overall chance of being hospitalized with an infection after prostate biopsy is 1% to 3%.
Review medications. Before the biopsy, your doctor may advise you to stop taking daily low-dose aspirin or an anticoagulant such as warfarin , dabigatran , edoxaban , rivaroxaban , or apixaban . These drugs reduce the blood’s ability to clot. Your doctor will weigh the chance of bleeding against the need for anticoagulants to prevent heart problems or stroke.
Expect anesthesia. Get local anesthesia for the biopsy. This means an injection of a numbing drug into the prostate gland to reduce pain during the biopsy.
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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 feel pain or discomfort in their back passage for a few days after a TRUS biopsy. Others feel a dull ache along the underside of their penis or lower abdomen . If you have a transperineal biopsy, you may get some bruising and discomfort in the area where the needle went in for a few days afterwards.
If you receive anal sex, wait about two weeks, or until any pain or discomfort from your biopsy has settled, before having sex again. Ask your doctor or nurse at the hospital for further advice.
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.
Its normal to see a small amount of blood in your urine or bowel movements for about two weeks. You may also notice blood in your semen for a couple of months it might look red or dark brown. This is normal and should get better by itself. If it takes longer to clear up, or gets worse, you should see a doctor straight away.
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 often than usual
- pain in your lower abdomen .
What Is A Biopsy
A biopsy is a procedure that removes a sample of tissue or cells for study and are most commonly used to look for cancer.
Prostate biopsies are done with a biopsy needle that can be positioned with the assistance of ultrasound images to get samples for testing.
Your doctor might decide you need a prostate biopsy based on the results of a blood test that measures your level of PSA . A high PSA result might point to cancer, but there are other things such as non-cancerous enlargement or infection that cause PSA to rise. Tests that measure derivatives of PSA such as OPKO 4k and Prostate Health Index may be more accurate than PSA in assessing your risk for having a cancer that needs treatment.
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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.
Temporary Effects On Your Bowel Movements Urine And Semen
- 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.
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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 A Prostate Biopsy
- Do not take medications containing aspirin or ibuprofen for 10 days prior to the prostate biopsy. These brand name medications include Plavix, Advil, Motrin, Aleve and Naprosyn. Tylenol is allowed. Patients can continue their medications with aspirin and ibuprofen after the biopsy.
- Patients should stop taking Coumadin, Pradaxa, Effient, Eliquis or Xarelto 5 days before their prostate biopsy, unless otherwise directed by their urologist.
- Patients may need a consultation with their primary care provider, cardiologist or hematologist to consider bridge steps between stopping their blood thinner medications and the prostate biopsy. They will be counseled on how to start back on those medications after the biopsy.
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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.
What Does The Equipment Look Like
Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer or probe that is used to do the scanning. The transducer sends out inaudible high frequency sound waves into the body and then listens for the returning echoes. The principles are similar to sonar used by boats and submarines.
The ultrasound image is displayed on a video screen that looks like a computer or television monitor. The resulting image is based on the amplitude and frequency of the signal. The ultrasound image makes an image taking into account signal travel time, tissue composition, and type of body structure through which the sound travels.
The ultrasound probe used in prostate biopsies is about the size of a finger. Once the probe is placed in the rectum, the biopsy is performed with a spring-driven needle core biopsy device, or biopsy gun. The handheld device includes a long but very thin needle specially designed to open inside the prostate, take the sample and then close.
The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a table that slides into the center of the magnet.
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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.
How To Make Your Prostate Biopsy Go Better
Before a prostate biopsy, discuss all thesteps you or your doctor can take to makethe experience as comfortable, safe, andinformative as possible.
Here is what men need to know to minimize discomfort of a prostate biopsy and get the best results.
Many men choose to have prostate-specific antigen blood tests to check for hidden prostate cancer, despite the uncertain benefits. Having an abnormal PSA test result often leads to a prostate biopsythe only way to confirm the presence of cancer. Biopsies are invasive, but they have become routine.
To reduce discomfort and get the best results, discuss the procedure in detail with your doctor. Certain practices can improve the overall outcomefor example, make sure you get a shot of anesthetic into the prostate to numb pain during the procedure. “Local anesthesia makes a world of difference between having a tolerable biopsy experience and an unpleasant one,” says Dr. Marc B. Garnick, Gorman Brothers Professor of Medicine and a prostate cancer expert at Harvard-affiliated Beth Israel Deaconess Medical Center.
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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.
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.
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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:
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.
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