A prostate biopsy is a medical procedure performed to collect small tissue samples from the prostate gland. This procedure is used to detect the presence of prostate cancer, often after abnormal results from a prostate-specific antigen (PSA) blood test or a digital rectal examination. Pathologists examine the collected tissue under a microscope to identify cancerous cells and determine their characteristics.
Preparing for the Biopsy
Before undergoing a prostate biopsy, patients receive specific instructions. They must review all current medications with their doctor, especially blood thinners such as warfarin or aspirin. These may need to be temporarily stopped days before the biopsy to minimize bleeding risk.
Patients are also prescribed antibiotics to take before and sometimes after the biopsy. This helps prevent infection, as the procedure often involves passing a needle through the rectal wall. Additionally, patients might receive instructions for bowel preparation, such as a cleansing enema. This clears the rectum, improving ultrasound visibility and reducing contamination.
The Biopsy Procedure
The most common method for a prostate biopsy is the transrectal ultrasound (TRUS)-guided biopsy. The patient is positioned on their side with knees pulled towards the chest or on their stomach for comfortable rectal access.
A local anesthetic numbs the area around the prostate to reduce discomfort. A thin, finger-sized ultrasound probe is then gently inserted into the rectum. This probe uses sound waves to create real-time images of the prostate gland, allowing the doctor to visualize its size, shape, and any suspicious areas.
The ultrasound images guide the biopsy needle. A thin, hollow needle is inserted through the rectal wall and into the prostate to collect small tissue samples. Each time a sample is taken, there may be a brief, uncomfortable sensation or a clicking sound. About 10 to 18 tissue samples are collected from different prostate areas for comprehensive sampling. The entire TRUS-guided procedure usually takes 10 to 20 minutes.
While TRUS-guided biopsy is widely used, another method is the transperineal biopsy. This approach involves inserting the biopsy needle through the skin between the scrotum and the anus (the perineum). An ultrasound probe is still inserted into the rectum to guide the needle and visualize the prostate.
After the Biopsy
After a prostate biopsy, patients are briefly monitored before discharge. Mild discomfort, soreness, or a dull ache in the rectal or perineal area is normal and can be managed with over-the-counter pain relievers. It is also common to observe blood in urine, stool, or semen. Blood in the urine may appear for a few days to three weeks, while blood in the stool typically resolves within five days. Semen may have a reddish tint due to blood, which can persist for several weeks.
Patients should take it easy for 24 to 48 hours, avoiding strenuous activities or heavy lifting to minimize bleeding risk. Most individuals can resume light activities within a day or two. It is important to continue any prescribed antibiotics to prevent infection.
Contact a doctor for signs of infection, such as fever, chills, or worsening pain. Other concerning symptoms include heavy or prolonged bleeding from the rectum or penis, difficulty urinating, or inability to pass urine. These require immediate medical attention.
The collected tissue samples are sent to a pathology laboratory for microscopic examination. A pathologist analyzes the samples for cancerous cells. If cancer is detected, the pathologist assigns a Gleason score, a grading system describing how aggressive the cancer cells appear. This score indicates how quickly the cancer might grow and spread, typically ranging from 6 (less aggressive) to 10 (more aggressive). Results are usually available within a few days to a few weeks, and the doctor will discuss them at a follow-up appointment.