Sunday, September 25, 2022

When Do You Need A Prostate Biopsy

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Scared Stiff Of Having A Prostate Biopsy

Prostate MRI: Do You Need a Random Biopsy? | Off The Cuff with Mark Moyad, MD

Although the DRE and PSA tests are useful, they are not enough to make a clear diagnosis of prostate cancer. When results are abnormal or questionable, the doctor may prescribe a transrectal ultrasound and a biopsy. These examinations usually provide enough information for a precise diagnosis.

Having to undergo prostate biopsies can be scary: fear of the intervention, the pain it can cause, the unknown … or knowing you have prostate cancer. But remember, if you have cancer, the sooner it is diagnosed, the greater your chances of a complete cure with treatment!

Why a biopsy

Abnormalities detected during a digital rectal exam and a high PSA level often lead to a prostate biopsy. This procedure consists of taking small tissue samples of your prostate in order for the pathologist to examine them under a microscope to determine if they are cancerous or not.

That prostate biopsies are indicated does not mean that you necessarily have prostate cancer. Indeed, the analysis of microscopic specimens makes it possible to differentiate a benign hypertrophy from a cancer of the prostate.

To this day, the actual diagnosis of prostate cancer can only be made with a prostate biopsy.

Prostate Biopsy In Clinical Practice

The decision to proceed with biopsy is complex, evolving, and should be made on an individualized basis. Traditionally, biopsy is performed for three general indications: abnormal digital rectal exam , increased prostatic-specific antigen , and clinical suspicion of prostate cancer.

Prior to the advent of PSA screening, prostate biopsy was performed solely for lesions palpable on DRE. Concerning findings on DRE include nodularity, asymmetry, or diffuse firmness. DRE has a poor positive predictive value for detecting cancer and is not recommended as a sole screening tool. However, detection of suspicious gross abnormality on DRE may be an indication for biopsy regardless of PSA depending on contextual patient factors.

PSA is an important biomarker that correlates with the risk of prostate cancer. Screening for prostate cancer using PSA has been shown to reduce prostate cancer mortality, but its utility is highly age dependent. The American Urological Association provides guidance on who should be screened using PSA. Their recommendations include avoiding screening altogether in men under the age of 40, average risk men age 4054, men age 70 or older and men with a life expectancy less than 1015years. They recommend that for men aged 5569, the decision to screen using PSA should be shared amongst the physician and patient and that a biennial interval may preserve the benefits of annual screening while reducing overdiagnosis.

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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What Are The Different Types Of A Prostatebiopsy Procedures

A prostate biopsy is one of the last steps down the road after measuring prostate-specific antigen in the blood, performing a digital rectal examination, and considering each patients risk factors and symptoms.

The main goal is to obtain a prostate sample, especially if there is a visible lesion or tumor. But there are several ways to get this biopsy sample. The most common types are as follows:

What To Watch For Afterward

Scared stiff of having a prostate biopsy?

Here are the most common complications of prostate biopsy:

  • Pain in the area between the anus and scrotum for a few days to a week.
  • Blood in your urine for a few days to several weeks.
  • Blood in the stool for a day or so. If it lasts longer, notify your physician.
  • Blood in the semen for three to six weeks, and possibly longer.

Make sure to notify your doctor if rectal or urinary bleeding get worse. Also, be on guard in the first 24 to 48 hours for signs of a serious infection in the urinary tract or prostate gland. “The alarm signs are fever or chills,” Dr. Garnick says. “If you experience this, get to a hospital immediately for intravenous antibiotics.” A runaway infection can be dangerous, so don’t ignore the signs.

Another uncommon but dangerous complication is urinary retentionthe inability to pass urine caused by an infection. Seek care immediately if you stop being able to urinate after a biopsy.

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What Will I Experience During And After The Biopsy

If you receive IV contrast for the MRI-guided procedure, you may feel coolness and a flushing sensation for a minute or two when the contrast material is injected. The intravenous needle may cause you some discomfort when it is inserted and you may experience some bruising once it is removed.

Rarely, patients may experience side effects from the MR contrast material, including nausea and local pain, hives, itchy eyes or other reactions. If you experience allergic symptoms, a radiologist or other physician will be available for immediate assistance.

When the ultrasound probe or endorectal coil is inserted into the rectum, you will feel pressure and may have some temporary discomfort.

You will hear a clicking noise when the biopsy needle samples the prostate, and you may feel a stinging or burning sensation in the area.

Some patients find it uncomfortable to remain still during MR imaging. Others experience a sense of being closed-in . Therefore, sedation can be arranged for those patients who anticipate anxiety.

If you feel heating on your skin at any time during MR imaging, the MR technician should be notified so that they can perform a closer examination of the area.

Some patients experience a small amount of bleeding from the rectum or perineum immediately after the biopsy procedure. If this occurs, it will cease with gentle pressure.

You may feel pain and discomfort in the area of the prostate for a day or two after the biopsy, particularly when you are seated.

How Does The Procedure Work

Ultrasound procedure:

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object’s size, shape and consistency. This includes whether the object is solid or filled with fluid.

In medicine, ultrasound is used to detect changes in the appearance of organs, tissues, and vessels and to detect abnormal masses, such as tumors.

In an ultrasound exam, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it sends small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive receiver in the transducer records tiny changes in the sound’s pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. Short video loops of the images may also be saved.

MRI procedure:

A computer processes the signals and creates a series of images, each of which shows a thin slice of the body. These images can be studied from different angles by the radiologist.

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Prostate Biopsy At A Glance

  • A prostate biopsy is the removal of tissue samples from the male prostate gland so a laboratory can examine the tissue for the presence of prostate cancer.
  • A biopsy is generally recommended when a prostate-specific antigen screening, a digital rectal exam or an imaging test indicate a suspicious area that requires further examination.
  • We will discuss our findings with the patient and the prospect of conducting a prostate biopsy to learn more.
  • Urologists perform the removal of the tissue in our offices using transrectal ultrasound and a small needle to obtain cell samples from the prostate for a biopsy.
  • The biopsies are sent to the pathology lab where they are stained and reviewed by a pathologist, with results typically available within one week of the biopsy.
  • Prostate biopsy is the only method of definitively diagnosing prostate cancer.

Prostate Cancer No Biopsy In Case Of A Normal Mri Summary:

When should You Have a Prostate Biopsy?

Sigrid V. Carlsson, MD, PhD, MPH, and Gerald L. Andriole, Jr., MD, discuss the pros and cons of omitting biopsy in patients with abnormal PSA levels and a negative MRI. While avoiding standard biopsy can mitigate serious complications, the data may not support full confidence in MRIs detection quality.

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What Are The Symptoms Of Prostate Dysfunction

Not all prostate cancer patients experience prostate symptoms. However, according to the National Institute on Aging, the most common symptoms of prostate problems include:

  • Increased frequency of urination
  • Sexual dysfunction
  • Painful back, hips, pelvis, or rectum

If you are experiencing these symptoms, please seek medical care as soon as possible. They may indicate inflammatory conditions like BPH , prostatitis , an infection of the prostate, bladder, or other organs, or other diseases like STDs and cancer.

Biopsy: Things You Need To Know

The first thing you should know is that theres still plenty of room for confusion after a biopsy. The prostate in a young man is about the size of a walnut with age and BPH it can get bigger think of a lime, or a lemon, or even an orange. Now, imagine that you have about 14 tiny needles each needle has a hollow center, and when it is stuck into the prostate, it takes out a very small core of tissue. Theres a lot of potential to miss any cancer that might be hiding in there.

This is why many men end up getting multiple repeat biopsies, says NYU urologist Stacy Loeb, M.D. This means that you might have a PSA that is elevated. Your doctor orders a biopsy, and no cancer is found. But the PSA keeps on creeping up, so your doctor recommends another biopsy, and maybe even another. About a third of men in one study got another biopsy within five years of a negative biopsy, says Loeb. If the PSA is elevated, do we do another biopsy, or what do we do? This is where some of the second-line PSA tests, like the Prostate Health Index or 4K Score, can be helpful.

A urine test, called the PCA3 test, may also be helpful. Unlike the PSA test, which is prostate-specific but not cancer-specific , the PCA3 test targets genes produced by prostate cancer cells.

First, it can hurt. To get to the prostate, the doctor goes through your rectum. With needles. To minimize pain, your urologist may use conscious sedation or an anesthetic called a prostatic block .

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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.

What The Studies Say

Scared stiff of having a prostate biopsy?

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.

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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.

Prostate Biopsy: How It Works

The instrument used to perform most prostate biopsies today is a spring-loaded device that pokes a hollow needle through the rectal wall to collect small samples of prostate tissue, guided by an ultrasound or MRI.

The samples are quite smalljust several times the diameter of the lead in a mechanical pencil. Later, a pathologist checks the samples under a microscope for signs of cancer.

Prostate biopsy comes with certain risks. For example, when the biopsy needle passes through the rectal wall to reach the prostate, it can spread a bacterial infection to the prostate gland or bloodstream.

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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:

  • Fever.

Prostate Cancer Enzyme Tests

Determining the Need for Prostate Biopsies

Some tests check for enzymes that prostate cancer produces to see if cancer is present and gauge whether it may be aggressive or fast growing. These tests use either blood or urine samples to determine a persons overall risk for prostate cancer.

Doctors usually recommend these tests for males who have high PSA scores or whose doctors find abnormalities during a digital prostate exam.

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

4Kscore test is also effective for testing African American and Afro Caribbean men for prostate cancer.

Enzyme tests cannot identify every case of prostate cancer, but neither do biopsies. Instead, blood and urine screenings can identify the most aggressive presentations of the disease.

Some forms of prostate cancer are slow growing rather than aggressive. Slow growing prostate cancer is unlikely to be fatal.

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