Prostate Biopsy And Drug Therapy
Prior to a prostate biopsy, patients should make sure that their urologist is advised of all medications that they are normally taking on a day-to-day basis. Patients who take such drugs as aspirin, warfarin, and clopidogrel or other so-called blood thinners are normally asked to stop taking such drugs for a period of time prior to a biopsy procedure, and should discuss the appropriate time to stop taking such drugs with their primary care physician or their cardiologist, as appropriate.
Content on this page last reviewed and updated August 2007, 2012.
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.
Additional Tests That May Aid Prostate Cancer Diagnosis
There are few other diagnostic tools or tests, which can be performed before you have a prostate biopsy, that may help your physician gather more information about your specific case. These procedures may help determine the likelihood of the presence of cancer and its aggressiveness and increase the accuracy of a biopsy when performed. Those tests include:
4Kscore blood test is a molecular test that helps predict the likelihood and risk of a patient having aggressive prostate cancer. If you’re a patient whose PSA values are borderline for a prostate biopsy or you have a condition that could be aggravated by a biopsy, your physician may use this test before to help determine whether you should get a biopsy or a repeat biopsy.
Urine sample testlooks for biomarkers that may indicate the presence of prostate cancer cells in a patient’s body. This test may also be helpful when trying to determine whether a patient should be rebiopsied or not.
The use of multiparametric MRI imaging of the prostate gland before a biopsy has been a game changer in prostate cancer diagnosis, increasing the accuracy of biopsies over standard biopsies. The mpMRI doesn’t replace the standard biopsy, but by improving its accuracy, it may help decrease the number of biopsies needed.
The mpMRI has a higher resolution than a standard prostate ultrasound. This increases the ability to see suspicious lesions in the prostate, providing additional targets for the biopsy to sample.
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Possible Complications And Considerations
There are rarely any severe after effects of a prostate biopsy. Men can usually go on about their normal activities, and we will discuss this with them at the time of the biopsy.
Occasionally, some men will experience mild discomfort at the biopsy site, but this can be managed by Tylenol or Advil. Some men may notice blood in their urine, which should only last a couple of days. Blood in a mans ejaculate can occur in decreasing amounts for up to a few weeks, or for several months in rare cases.
Serious rectal bleeding or infection are rare. Men who have had a prostate biopsy should call our offices if they experience elevated temperature, severe pain or bleeding, passage of blood clots or other unexpected symptoms. They should call us immediately if they experience:
Q: Am I Guaranteed To Have Gleason Score 4+3 If That Is What My Results Showed
A: No and there are two reasons. First, when a 12-needle biopsy is performed, only a tiny amount of prostate tissue is removed. Thus, a needle could hit a large area of tumor and show that you have a Gleason score of 4+3. However, it is possible that you could have a small area of Gleason 4+4=8 or more that was missed. We learned this from comparing biopsy Gleason scores to men who later had a Radical Prostatectomy in which the entire prostate is studied. Fortunately, this is uncommon with the 12-needle biopsy. As for the second reason, the Gleason score determination is made by the pathologist who looked at your biopsy material. The accuracy depends on his skill and experience. Thus, pathologists can sometimes make a mistake in the Gleason score. Because of this, we always have a mans biopsy material double checked by expert pathologists before we treat someone.
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How Long Does It Take To Recover From A Prostate Biopsy
A patient may take about four to six weeks or even more recover after a prostate biopsy. The recovery process after biopsy usually depends on the patient’s health and age. Doctors may recommend only light activities for 24-48 hours after a prostate biopsy. The doctor prescribes painkillers, vitamins, and antibiotics for a few days to speed up the healing process.
After the biopsy, it is normal to experience the following sensations or symptoms:
- Burning urination: It may start within 24 hours after the biopsy and may continue until three to seven days. This burning sensation is a side effect of the procedure and usually considered normal.
- Frequent urination: It may gradually improve over the first 24-36 hours.
- Blood in the urine: It is considered normal to have slightly red-tinged urine or urine that resembles the color of a rose or red wine. This may last from 12 hours to 3 weeks after the biopsy.
- Blood in stool: A patient may notice red stains on the toilet tissue or see some bloody streaks in the stool. This may last for up to five days.
- Blood in the semen: This may persist for up to six weeks after the biopsy.
- Tiredness: A patient may feel tired for a month or two. It usually takes 30-45 days to regain full normal strength after the procedure hence, sufficient rest is usually advised by the doctor.
Post-biopsy restrictions and instructions:
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.
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.
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.
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Controversies And Misconceptions Surrounding Prostate Biopsies
The PSA test measures the levels of PSA proteins in the body, and when it was first developed, it was quickly implemented by many physicians as a screening test for prostate cancer. The thought was that since PSA proteins are only produced by the prostate, elevated levels could be an indication of prostate cancer. As a result, most men with an abnormal PSA test underwent a prostate biopsy.
The increase in biopsies resulted in the number of advanced, untreatable prostate cancers decreasing significantly because more prostate cancers were caught earlier, when the disease is easier to treat. But the problem with many patients being diagnosed sooner was that some patients were being aggressively treated when they should have been monitored instead.
Though many in the field of urology believe it was flawed, a controversial study attempted to assess the benefits of the PSA test as a screening tool for prostate cancer, and its results led to the recommendation that most men shouldn’t get the test because it didnt appear to improve mortality rates from prostate cancer. This, combined with growing awareness that many cases of prostate cancer were being treated unnecessarily or prematurely, led to a reduction in prostate biopsies. This controversy led to a reduction in prostate cancer screening and an increase in the number of diagnoses of advanced prostate cancer.
How Serious Is My Cancer
If you have prostate cancer, the doctor will want to find out how far it has spread. This is called the stage of the cancer. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what types of treatment might be best for you.
The stage is based on the growth or spread of the cancer through the prostate, and if it has spread to other parts of your body. It also includes your blood PSA level and the grade of the cancer. The prostate cancer cells are given a grade, based on how they look under a microscope. Those that look very different from normal cells are given a higher grade and are likely to grow faster. The grade of your cancer might be given as a Gleason score or a Grade Group . Ask your doctor to explain the grade of your cancer. The grade also can helpdecide which treatments might be best for you.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the prostate.
If your cancer hasn’t spread to other parts of the body, it might also be given a risk group. The risk group is based on the extent of the cancer in the prostate, your PSA level, and the results of the prostate biopsy. The risk group can help tell if other tests should be done, and what the best treatment options might be.
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What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life, making healthy choices and feeling as good as you can.
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 bloodâs 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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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 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. âLocal anesthesia makes a world of difference between having a tolerable biopsy experience and an unpleasant one,â 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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How Is Prostate Removal Surgery Done
Surgery to remove your prostate gland
- The operation. The surgeon removes the prostate gland, surrounding tissues,
- Nerve sparing prostatectomy. This type of surgery is for early prostate cancer
- Removing lymph nodes. During your operation the surgeon examines the prostate and surrounding area.
- How your surgeon does your operation. Doctors rarely do
What To Expect In A Prostate Biopsy
Our urologists usually take around 10 minutes to complete the prostate biopsy. The man will remain awake during the procedure, and may receive a mild sedative to help him remain calm. We will also give him antibiotics to prevent possible infection. The man may experience some discomfort during the procedure.
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