A prostate biopsy collects small tissue samples from the prostate gland. This walnut-shaped gland, located in males below the bladder and in front of the rectum, produces fluid that forms a significant part of semen. Its purpose is to check these samples for prostate cancer. The procedure is often recommended after initial screenings, such as an abnormal Prostate-Specific Antigen (PSA) blood test or a digital rectal exam (DRE), suggest a potential concern.
Preparing for the Procedure
Before a prostate biopsy, patients receive specific instructions. Discuss all current medications, especially blood thinners like aspirin, warfarin, ibuprofen, or certain herbal supplements, with the doctor. Patients are generally advised to stop taking these medications several days to a week before the biopsy to reduce bleeding risk.
Antibiotics are commonly prescribed to prevent infection, a potential risk following a prostate biopsy. Patients usually begin taking these antibiotics one to two days before the procedure. Bowel preparation, such as using an enema, may also be required to cleanse the rectum. While some procedures might not require fasting, patients may be advised to eat a light meal or consume only clear liquids beforehand. If sedation is used, arrange for transportation home, as patients will not be able to drive themselves.
The Biopsy Process
During a prostate biopsy, tissue samples are collected from the prostate gland. The procedure typically takes 15 to 30 minutes. The most common approach is the Transrectal Ultrasound-Guided (TRUS) biopsy. For this method, the patient lies on their side, often with knees pulled towards the chest, and a thin, lubricated ultrasound probe is gently inserted into the rectum. This probe uses sound waves to create real-time images of the prostate, allowing the doctor to guide the biopsy needle accurately.
A local anesthetic numbs the area around the prostate, minimizing discomfort. Once numb, a thin, spring-propelled needle is inserted, usually through the rectal wall, to collect small, cylindrical tissue samples. Patients might hear a clicking sound or feel a brief, sharp sensation each time a sample is taken, but significant pain is uncommon due to the anesthetic. Typically, 10 to 14 tissue samples are collected from different areas of the prostate for comprehensive evaluation.
An alternative method is the Transperineal Biopsy, where samples are taken through the skin between the scrotum and anus, known as the perineum. This approach often involves general or spinal anesthesia, though it can also be performed under local anesthesia. An ultrasound or MRI guides the needle through the skin and into the prostate, collecting tissue samples. This method may involve taking a larger number of samples and can be preferred in certain situations, such as a history of infection after a TRUS biopsy.
What to Expect Afterwards
After a prostate biopsy, patients can expect temporary side effects that usually resolve within a few days to weeks. Mild pain or discomfort in the biopsy area is common and can be managed with over-the-counter pain relievers like acetaminophen. Bruising in the perineal area is also possible, particularly after a transperineal biopsy.
Blood in urine (hematuria) is common for a few days, sometimes up to two weeks, and may appear light red or rust-colored. Blood in stool (hematochezia) can also occur for a few days. Blood in semen (hematospermia) is also a frequent side effect, making semen appear red or dark brown. This can persist for several weeks or even up to two to three months. These bleeding instances are generally normal and typically clear up on their own.
Patients are usually advised to limit strenuous activities, such as heavy lifting, vigorous exercise, or bicycle riding, for a few days to a week. Sexual activity may also be restricted for about a week. Staying well-hydrated by drinking plenty of fluids is recommended to help flush the urinary system and reduce infection risk.
Contact a doctor if warning signs appear, as these could indicate a complication. Signs include a fever of 101°F (38.3°C) or higher, chills, or shaking, which may signal an infection. Inability to urinate or significant difficulty passing urine, severe and persistent pain not relieved by medication, or heavy, bright red bleeding that does not subside or involves large blood clots in urine or stool require immediate medical attention.
Interpreting Your Results
After collection, prostate tissue samples are sent to a pathology laboratory for examination under a microscope. Results typically take a few days to a week, sometimes up to two to three weeks. A pathologist, a doctor specializing in diagnosing diseases, analyzes the samples to identify abnormal cells.
Three outcomes are possible from a prostate biopsy. Results may be “benign,” meaning no cancerous cells were found. Another outcome is “suspicious” or “atypical,” where cells show abnormalities but are not clearly cancerous. This may necessitate further monitoring or a repeat biopsy. Lastly, results could confirm “cancerous” cells, indicating prostate cancer.
If cancer is detected, the pathologist assigns a Gleason score, a grading system that helps determine the cancer’s aggressiveness. This score, ranging from 6 to 10, is derived by adding two grades based on how abnormal the cancer cells look. A higher Gleason score suggests a more aggressive cancer that is more likely to grow and spread quickly.
A follow-up appointment with the doctor is crucial after receiving the biopsy report. During this consultation, the doctor explains the results, discusses their implications, and outlines next steps. This might include active surveillance for slower-growing cancers, further diagnostic tests, or a discussion of treatment options tailored to the diagnosis.