Tuesday, November 29, 2022

What To Expect After Your Prostate Biopsy

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Day After The Prostate Biopsy

What you can expect after a prostate gland biopsy? (Robert Donnell, MD)

After your biopsy, you will have to drink many fluids so that you may provide us with two separate urine samples from two separate voids. The most common complication is blood in the urine after the biopsy. We would like to make sure that your urine is in the process of clearing before we send you home for the day. It is normal to see blood in the urine and bowel movements for 1-2 weeks after the procedure. It should progressively diminish over that time-period. If you find that, you cannot urinate or if you are passing a large number of blood clots, then report to the office or nearest emergency room for evaluation. A physician may have to insert a catheter into the bladder for a few days to allow you urine to be drained. You should continue to drink more than your usual intake of fluids to keep your urine diluted and to prevent formation of blood clots within the bladder.

You may also experience a dull ache in the perineum for many days after the biopsy. It is recommended that you halt sexual intercourse for 3-5 days after the biopsy to allow some initial healing. Do not be surprised if you see blood in your semen after ejaculation. This is normal and does not cause an infectious concern for your sexual partner. This may take months to resolve. In addition, you cannot pass along cancer to your partner via your semen either.

If you have fever or chills, please take your temperature with an oral thermometer and call your physician if it reads above 100.8 F.

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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.

Short-term bleeding

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.

Infection

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 .

Why Are There Marks On My Skin

Small marks resembling freckles will be made on your skin along the treatment area by the radiation therapist. These marks provide targets for the treatment and are a semi-permanent outline of your treatment area. Do not try to wash these marks off or retouch them if they fade. The therapist will re-mark the treatment area when necessary.

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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:

Psa Levels After Treatment

What to Expect After Your Prostate Biopsy?

A continuous rise in your PSA level can be the first sign that your cancer has come back. This should be picked up by your regular PSA tests.

The exact change in PSA level that suggests your cancer has come back will depend on which treatment you had. Speak to your doctor or nurse about your own situation.

Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery. This is because the prostate, which produces PSA, has been removed. A rise in your PSA level may suggest that you still have some prostate cancer cells.

After radiotherapy or brachytherapy, your PSA should drop to its lowest level after 18 months to two years. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA.

Your PSA level may actually rise after radiotherapy treatment, and then fall again. This is called PSA bounce. It could happen up to three years after treatment. It is normal, and doesnt mean that the cancer has come back.

If your PSA level rises by 2 ng/ml or more above its lowest level, this could be a sign that your cancer has come back. Your doctor will continue to check your PSA level and will talk to you about further tests and treatment options.

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Who Interprets The Results And How Do I Get Them

A pathologist examines the removed tissue specimens and makes a final diagnosis. The results usually are available to your physician within a few days of the procedure. The time it takes may vary based on the complexity of the examination, preparation time for the specimens, need for a second opinion and other factors.

Results Of A Prostate Biopsy

Results of a prostate biopsy are usually available within 10 days following the procedure. If cancer cells are present, a grade will be given, which your doctor will discuss with you. The Gleason score is considered a tool for predicting how aggressive the cancer is. Normal results from a biopsy will suggest that no cancer cells have been found in the prostate. While an abnormal result will indicate that cancer cells are present. Your pathology report may include:

  • A description of the biopsy sample
  • A description of the cells
  • Cancer grading

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Side Effects Of Prostate Surgery

The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.

Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:

  • Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
  • Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
  • Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
  • Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.

After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.

There are several options for treating erectile dysfunction:

Precancerous Cells And Pin

What to Expect from a Prostate Biopsy

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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Bowel And Bladder Problems

Radiation therapy for prostate cancer can irritate the bowel, the bladder, or both.

A person can develop:

Radiation proctitis: Symptoms include diarrhea and blood in the stool.

Radiation cystitis: Symptoms include a need to urinate more often, a burning sensation when urinating, and blood in the urine.

Bladder problems may improve after treatment, but they may not go away completely.

Is There An Alternative To A Prostate Biopsy

Prostate cancer enzyme tests A newer blood test is the 4Kscore test, which measures a persons risk of prostate cancer. This test does not completely replace the need for a biopsy, but it can help identify who should have one. As a result, it may help doctors reduce the number of people who have biopsies.

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Things To Know Before Getting A Prostate Biopsy

  • Youre not crazy for not wanting a prostate biopsy. Prostate biopsies are painful and uncomfortable weeks after the procedure. Despite that, you may still need one.
  • A prostate biopsy can cause erectile dysfunction in some cases. While I understand no man wants ED, a biopsy is the ONLY way to confirm if you have prostate cancer or not.
  • The idea that prostate biopsies cause spreading of cancer is theoretically probable but hard to prove.
  • There is only one gold-standard way of knowing if you have prostate cancer and that is through a prostate biopsy.
  • Beware of charlatans wanting to treat your prostate cancer without a biopsy. That is not possible.
  • There is blood in your pee and semen after a biopsy for up to two weeks.
  • Up to 25% of men can develop lower urinary tract symptoms after a prostate biopsy.
  • Despite taking antibiotics before and after a prostate biopsy, infections still can occur. If a fever occurs after a prostate biopsy, dont bother taking anything for the fever. Go to the emergency room immediately.
  • A prostate MRI may help determine if a biopsy is needed.
  • Other lab tests like the 4K Score, Select MDx, PSA density, PSA kinetics are all useful tools to determine if a prostate biopsy is necessary at all.
  • How To Prepare For A Prostate Biopsy

    Biopsy Procedure by Dr. K. Ramesh  Chennai Urology

    Your doctor will let you know how best to prepare for your prostate biopsy.

    Prostate biopsy preparation often includes:

    • Detailed Explanation Your doctor will explain the procedure, the benefits, the risks, and what to expect before, during, and after your biopsy.
    • Paperwork You will be asked to sign consent forms for the procedure and explore health insurance authorization.
    • Medical Review Your doctor will review your general health, medical history, and may perform a physical exam.
    • Medications Your doctor will review your current medication use and any history of medications. Inform your doctor of any medication you take, especially blood thinners, as they can affect the procedure. Your doctor may prescribe antibiotics to help prevent infection.
    • Enema Your doctor will usually recommend an enema the night before or the morning of your prostate biopsy to clear your body for the procedure.
    • Clear Fluids Your doctor might also recommend that you drink a lot of water a few hours before your biopsy. A full bladder makes it easier for your doctor to examine your prostate with imaging tools.
    • Outfit You will wear a hospital gown for the procedure. Your doctor may suggest that you bring loose-fitting clothing to wear after your procedure.
    • Drive Home Your doctor will generally ask you to organize a ride home from the hospital after the procedure.

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    How The Test Will Feel

    During the procedure you may feel:

    • Mild discomfort while the probe is inserted
    • A brief sting when a sample is taken with the biopsy needle

    After the procedure, you may have:

    • Soreness in your rectum
    • Small amounts of blood in your stools, urine, or semen, which may last for days to weeks
    • Light bleeding from your rectum

    To prevent infection after the biopsy, your provider may prescribe antibiotics to take for several days after the procedure. Be sure you take the full dose as directed.

    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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    Types Of Biopsy Procedures

    Your doctor may recommend one of several different types of prostate biopsy. The biopsies differ by site and method. Currently, there are five recognized types of prostate biopsy.

    Types of prostate biopsy:

    • Random 12-Core Biopsy In this biopsy, your doctor uses a needle to collect 12 tissue samples from all parts of the prostate gland using a random pattern approach. The randomized collection allows for a more accurate diagnosis of prostate cancer.
    • Imaging Guided Biopsies In this type of biopsy, your doctor uses special imaging, such as magnetic resonance imaging or ultrasound, to identify areas of abnormality. Your doctor then guides a needle into the prostate gland where tissue samples are collected.
    • Transrectal In a transrectal prostate biopsy, your doctor inserts a needle directly through the rectum to collect tissue samples from the prostate.
    • Transperineal During a transperineal prostate biopsy, your doctor inserts a needle between the scrotum and anus, to collect tissue samples from the prostate.
    • Transurethral In this type of biopsy, your doctor inserts a needle through the urinary opening to collect tissue samples from the prostate.

    Your doctor will decide which type of biopsy is best for you based on your symptoms, age, test results, and other personalized health factors.

    What Are Some Common Uses Of The Procedure

    After prostate biopsy exam, how long should one wait to have the surgery?

    A prostate biopsy is currently the only way to definitively diagnose prostate cancer. It also helps differentiate cancer from benign prostatic hyperplasia or nodular enlargement of the prostate, a very common condition in middle-aged and older men that requires a different treatment approach than that of cancer.

    A prostate biopsy may be ordered if the physician detects a nodule or other abnormality on the prostate during a digital rectal examination , a common prostate cancer screening test.

    A biopsy also may be ordered when a blood test reveals elevated levels of prostate-specific antigen. While there are several reasons for an elevated PSA level, higher PSA levels are sometimes associated with cancer. PSA trends over time may trigger your physician to order a biopsy.

    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 due to rising PSA demonstrates a very small abnormality that may not be easily targeted by ultrasound. MRI is also useful in patients who have previously undergone a biopsy and want to improve the sensitivity of the procedure and the precision of the biopsy.

    A biopsy not only detects cancer it also provides information on the aggressiveness of the cancer and helps to guide treatment decisions.

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