What Are The Different Types Of A Prostate Biopsy Procedure
The surgeon can choose any of the three different ways of performing a prostate biopsy. These are as follows:
- Transrectal method: This is the most common method of performing a prostate biopsy. In this, the surgical instruments are inserted through the rectum .
- Perineal method: This is done through the area lying between the scrotum and rectum.
- Transurethral method: A cystoscope is inserted through the urethra .
When Is Prostate Biopsy Needed
The urologist recommends prostate biopsy when the previous test results of digital rectal exam or prostate specific antigen blood test are abnormal or indicative of prostate cancer. Youre likely to be recommended the test under following circumstances:
- If your serum prostate specific antigen levels are significantly higher than the normal range for your respective age.
- If your doctor came across any lump or other related abnormalities while performing a digital rectal exam.
- If your previous biopsy was normal however your prostate surface antigen levels are still high.
- If your previous biopsy test result confirmed the cells to be abnormal but not cancerous.
As part of the biopsy, the samples obtained from the procedure are examined carefully under the microscope to look for abnormal cells that are suggestive of prostate cancer. If the samples do exhibit abnormalities in the morphology, configuration and other characteristics, then further evaluation is performed to ascertain cancer prognosis . Then the best treatment options are considered according to the patients condition.
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 youre 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 patients 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 doesnt 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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Biopsy: What The Diagnosis Means
The pathologist has just looked under the microscope at 12 tissue samples from your prostate. Whats in there? First, there are normal cells. Pathologists can tell that theyre normal, because they are round and uniform, with well-defined edges and clear centers. As cancer progresses, the cells become more oblong then more irregular. The edges get blurred, and eventually, the outside shapes start to get weird so do the insides. What once looked like pebbles drawn with a fine-tip pen, as the cancer gets more aggressive, ends up looking like ragged clumps of algae drawn with a fat crayon.
But wait theres more! A sample of prostate cells might also include atypical cells, which are a big question mark. Theyre not normal, but the pathologist cant definitely report that theyre cancerous, either. Theyre just suspicious.
Note: This is one reason why you may want to get a second opinion on your biopsy slides from a pathologist who is an expert in prostate cancer. Having your slides sent to another pathologist is a lot cheaper than having a repeat biopsy just to get more conclusive information.
Gleasons original system had more than 25 different possible combinations. That has just been simplified into a new system, called grade groups, by Jonathan Epstein at Johns Hopkins. The World Health Organization has accepted Epsteins new system, and your hospital may already be using it. Heres what you need to know:
Prostate Biopsy Side Effects Are Common
Complications from prostate biopsies are common but usually not severe, a study in Urology reveals. Participants in the study had biopsies to look for cancer after an abnormal rectal exam or prostate-specific antigen blood test. In a biopsy, a fine needle punches quickly through the rectal wall to remove a tiny sample of prostate tissue for examination under a microscope. Doctors took 12, 18, or 24 samples per participant. Typical problems from biopsy include pain, soreness, and infections. A more serious complication, which may lead to hospital admission, is acute urinary retention, in which a man is temporarily unable to drain his bladder.
Here is what the study found:
40% of the men experienced a complication.
The complication rate was as high as 57% in men with 24-sample biopsies.
Only 1.2% of the men required hospital admission.
9.1% ended up visiting an emergency room.
6.7% developed acute urinary retention.
Prostate needle biopsy is the only way to diagnose prostate cancer, regardless of PSA test results. The complication rate would vary with the general health of the men involved.
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Transrectal Ultrasound Guided Procedure
Also can be done under local or general anaesthetic.
A thumb sized ultrasound probe is inserted through the anus into the rectum. The probe measures the shape of the prostate and the images help guide the needle to the most likely infected places from which to take each biopsy. The rectum provides the easiest access to the prostate. However, you may be advised to clear out your colon with an enema to reduce the risk of infection from possible faecal matter in the rectum.
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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
A physician can recommend a number of treatments to address an enlarged prostate. An enlarged prostate will require surgery to relieve the symptoms. In most cases, surgical treatment for an enlargement of the penis is enough. Moreover, a doctor may recommend a course of treatment based on symptoms. A TURP procedure is not painful and requires less recovery time than open surgery. The recovery period will be shorter and less traumatic.
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Prostate Biopsy At Ucla: The Targeted Biopsy Process
Patients who are suspected of having a prostate cancer diagnosis receive a multi-parametric MRI of the prostate after consultation with their UCLA urologist. An expert in prostate MRI will review the scan and provide an overall score to determine cancer risk. Using software created at UCLA, a 3-D image of the patient’s prostate is then generated using the data and scores from the MRI prostate scans to clearly show the location of any suspicious areas.
The information is then ready for use in the clinic during a real-time ultrasound prostate biopsy at a later time. During the prostate biopsy, the MRI images are loaded into a3-D prostate biopsy system that allows the stored MRI images to be electronically transferred and fused with the real-time ultrasound, providing a 3-D image similar to a roadmap to help guide the tiny biopsy needle into targeted areas.
The work flow of MRI-guided TRUS biopsy, from patient selection to final prostate cancer diagnosis, as currently practiced at UCLA, is shown here and in this video.
Work flow of targeted prostate biopsy in 59 y.o. male with PSA 7.4 ng/ml, no palpable prostate lesion, and prior negative biopsy
A presentation of the initial Artemis experience at UCLA, establishing the biopsy-tracking accuracy of the device.
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:
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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
Cancer Lethality Set Early
The study looked for changes in cancer aggressiveness in men diagnosed with prostate cancer from 1982 to 2004. All of the men had their prostates removed after diagnosis, and biopsy samples were taken from the glands. The Harvard team reexamined the samples and graded them using a tool called the Gleason score, which assigns a number from 2 to 10 based on how abnormal the cells look under a microscope. High-scoring or high-grade cancers tend to be the most lethal.
Over the study period, fewer and fewer men were diagnosed with advanced, late-stage prostate cancers that had spread beyond the prostate gland. This reflected the growing use of prostate-specific antigen testing to diagnose prostate cancers earlier and earlier. In contrast, the proportion of high-grade cancers, as measured by the Gleason score, remained relatively stable rather than gradually becoming more aggressive. Previous studies have seen a similar pattern.
Its a very interesting study that confirms what previous studies have found, says Dr. Marc B. Garnick, a prostate cancer specialist at Harvard-affiliated Beth Israel Deaconess Medical Center who was not involved in the study. There may be rare exceptions, but in the vast majority the cancer is born with a particular Gleason score.
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Who Should Have A Targeted Prostate Biopsy
UCLA Urologists currently recommend it for men who are suspected of having prostate cancer, but who may have inconclusive tests results and have experienced any of the following:
- Persistent, unexplained elevated PSA, or
- Prior negative biopsy, or
- Apparent low-risk prostate cancer interested in Active Surveillance .
- All targeted biopsies are performed in the Urology, Westwood Adult clinic on an outpatient basis.
Morphologic Similarities Of Hgpin And Cancer
Many studies have demonstrated a remarkable similarity between the nuclear characteristics of prostate cancer cells and HGPIN compared with those of normal and hyperplastic epithelium. These include nuclear area, deoxyribonucleic acid content, chromatin content, chromatin distribution, nuclear perimeter, nuclear diameter, and nuclear roundness.
Cancer cells and PIN also share nucleolar abnormalities. The results of these studies further support the concept that a morphologic continuum from normal to PIN to cancer exists.
What Is A Trus Biopsy
This is the most common type of biopsy in the UK. The doctor or nurse uses a thin needle to take small samples of tissue from the prostate.
Youll lie on your side on an examination table, with your knees brought up towards your chest. The doctor or nurse will put an ultrasound probe into your back passage , using a gel to make it more comfortable. The ultrasound probe scans the prostate and an image appears on a screen. The doctor or nurse uses this image to guide where they take the cells from. If youve had an MRI scan, the doctor or nurse may use the images to decide which areas of the prostate to take biopsy samples from.
You will have an injection of local anaesthetic to numb the area around your prostate and reduce any discomfort. The doctor or nurse then puts a needle next to the probe in your back passage and inserts it through the wall of the back passage into the prostate. They usually take 10 to 12 small pieces of tissue from different areas of the prostate. But, if the doctor is using the images from your MRI scan to guide the needle, they may take fewer samples.
The biopsy takes 5 to 10 minutes. After your biopsy, your doctor may ask you to wait until you’ve urinated before you go home. This is because the biopsy can cause the prostate to swell, so they’ll want to make sure you can urinate properly before you leave.
Dealing With Bph Since 2003
Based on the experience of 2003, I will never again have a prostate biopsy. Since having my left cancerous kidney removed in April of 2015, the condition of my prostate has been monitored by more PSA tests and semi-annual prostate sonograms. My new urologist has me on the drug Avodart containing dutasteride to help shrink the prostate and another, Harnal containing tamsulosin hydrochloride, which makes it easier for me to urinate during the night.
This content is accurate and true to the best of the authorâs knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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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.