A prostate biopsy is a medical procedure used to obtain small tissue samples from the prostate gland. These samples are then examined under a microscope to detect the presence of cancer cells. The biopsy serves as a diagnostic tool, helping to determine if cancer is present and, if so, its characteristics.
Reasons for a Prostate Biopsy
A prostate biopsy is recommended when initial tests suggest a potential issue with the prostate. One common indicator is an elevated level of Prostate-Specific Antigen (PSA) in the blood. PSA is a protein produced by both cancerous and non-cancerous prostate tissue, and higher levels can signal the need for further investigation.
Another reason for a biopsy is an abnormal finding during a Digital Rectal Exam (DRE). During a DRE, a doctor manually checks the prostate for any unusual lumps, hardness, or irregularities. A strong family history of prostate cancer can also increase a person’s risk, prompting a doctor to consider a biopsy even with less pronounced changes in PSA or DRE results. These indicators guide the decision to perform a prostate biopsy, which remains the definitive method for diagnosing prostate cancer.
Before the Procedure
Patients are advised to stop taking certain medications that can increase bleeding, such as blood thinners like warfarin, aspirin, or ibuprofen, several days before the biopsy.
Bowel preparation is required, commonly involving a cleansing enema performed at home before the appointment to clear the rectum of stool. This step helps reduce the risk of infection, especially for transrectal approaches. Patients also receive prophylactic antibiotics, taken before and sometimes for a few days after the biopsy, to minimize the chance of infection.
The Biopsy Process
A prostate biopsy involves collecting tissue samples using a thin needle, guided by imaging. Local anesthesia is administered to numb the prostate and surrounding area, though some patients may receive light sedation. The procedure can be performed using two main approaches: transrectal ultrasound (TRUS)-guided biopsy or transperineal biopsy.
In a TRUS-guided biopsy, an ultrasound probe is inserted into the rectum to visualize the prostate. The biopsy needle then passes through the rectal wall into the prostate to collect samples. This method carries a higher risk of infection due to the needle passing through the rectum.
For a transperineal biopsy, a small cut may be made in the skin between the anus and scrotum (perineum), and the needle is inserted through this area into the prostate. This approach has a lower risk of infection because the needle does not pass through the rectal wall.
During either procedure, multiple tissue cores, often between 10 to 18, are collected from different areas of the prostate. Imaging, such as ultrasound or MRI fusion, guides the urologist to specific suspicious areas identified in pre-biopsy scans, improving the accuracy of sample collection. The procedure takes between 15 to 45 minutes, depending on the approach and the number of samples taken.
Recovery and Understanding Results
Mild discomfort or soreness in the pelvic area is common after a prostate biopsy. Light bleeding from the rectum, in urine, or in semen is also common. Blood in the urine usually resolves within a few days to weeks, while blood in semen can persist for several weeks or even months. Doctors advise avoiding strenuous activities for 24 to 48 hours and sexual activity for a few days to a week to aid healing.
The biopsy samples are sent to a pathology laboratory for analysis. A pathologist examines the tissue under a microscope to determine if cancer cells are present.
If cancer is detected, the pathologist assigns a Gleason score, which indicates how aggressive the cancer appears based on its cell patterns. The results clarify whether the findings are benign (non-cancerous) or malignant (cancerous), guiding subsequent discussions about treatment options. Biopsy results are available within a few days to two weeks.
Managing Potential Issues
Infection is a concern, with symptoms such as fever, chills, or persistent pain. Although antibiotics are given to reduce this risk, some infections, including severe ones like sepsis, can still occur, especially with antibiotic-resistant bacteria. Patients should contact their healthcare provider immediately if they develop a fever over 101°F or other signs of infection.
Bleeding is another common, usually temporary, side effect. While minor bleeding in urine, stool, or semen is expected, heavy or prolonged bleeding, or the presence of large blood clots, warrants medical evaluation. In rare instances, severe bleeding may require further intervention to stop it. Urinary retention, an inability to urinate, can also occur, though it is infrequent and may necessitate temporary catheterization.