A prostate biopsy is a medical procedure used to confirm the presence of cancer in the prostate gland, which is a small organ located beneath the bladder in males. The procedure involves the removal of small, cylindrical pieces of prostate tissue using a hollow needle. These tissue samples are then sent to a laboratory for microscopic examination by a pathologist to determine if cancer cells are present and, if so, to assess how aggressive they are. This diagnostic step is a necessary follow-up when initial screening tests suggest a potential problem with the prostate.
When a Biopsy Is Recommended
A physician typically recommends a prostate biopsy when initial screening results suggest an increased risk of prostate cancer. The most common triggers for this recommendation are an abnormal result from a Digital Rectal Exam (DRE) and/or persistently elevated or rapidly rising Prostate-Specific Antigen (PSA) levels. PSA is a protein produced by both cancerous and non-cancerous cells in the prostate, and a high level in the blood can indicate a health issue.
An abnormal DRE involves the doctor feeling the prostate for any suspicious findings. While an elevated PSA level alone does not confirm cancer, an abnormal DRE suggests a physical change in the gland that warrants further investigation, even if PSA levels are within a seemingly normal range.
Preparing for the Biopsy and the Procedure Steps
Preparation for a prostate biopsy focuses on minimizing the risk of bleeding and infection, which involves specific instructions from the doctor. Patients are typically required to temporarily stop taking blood-thinning medications for several days before the procedure. To prevent infection, a course of antibiotics is commonly prescribed to be taken before and sometimes after the biopsy.
The procedure itself is generally an outpatient process that utilizes ultrasound guidance and local anesthesia to numb the area around the prostate. One common method is the Transrectal Ultrasound-Guided (TRUS) biopsy, where an ultrasound probe is inserted into the rectum to visualize the prostate. The biopsy needle is then passed through the rectal wall and into the prostate to collect tissue samples, a process that typically takes less than 10 minutes.
Another method, increasingly used to reduce the risk of infection, is the Transperineal biopsy. In this approach, the needle is inserted through the skin area between the scrotum and the anus, known as the perineum, to reach the prostate. For both methods, a spring-loaded device is used to quickly collect multiple tissue cores from various regions of the prostate.
What to Expect During Recovery
Recovery from a prostate biopsy is usually short, with most individuals returning to light activities within 24 to 48 hours. It is normal to experience some temporary side effects related to the procedure, most commonly minor discomfort or soreness at the biopsy site. Bleeding is also a frequent occurrence, often presenting as blood in the urine (hematuria) or stool for a few days.
A common temporary side effect is the presence of blood in the semen, known as hematospermia. This may persist for several weeks or even a couple of months following the procedure. Patients are often advised to avoid strenuous activity or heavy lifting for a few days to reduce the risk of bleeding.
Potential complications require immediate medical attention. The most concerning complication is a serious infection, which can occur despite taking prophylactic antibiotics. Patients should immediately contact their doctor if they develop a fever, chills, severe difficulty urinating, or prolonged and heavy bleeding. Acute urinary retention is another uncommon but serious side effect.
Understanding the Biopsy Results
The tissue samples collected during the biopsy are examined by a pathologist, who determines if cancer is present and assesses its characteristics. The results are communicated through a pathology report, which includes a diagnosis and, if cancer is found, a grading of its aggressiveness. The standard system for this grading is the Gleason Score, which ranges from 6 to 10 and is based on the microscopic appearance of the cancer cells.
The pathologist assigns a grade from 3 to 5 to the two most common patterns of cancer cells observed, and these two numbers are added together to create the final Gleason Score. A score of 6 is considered low-grade cancer, a score of 7 is intermediate-grade, and scores between 8 and 10 indicate high-grade, more aggressive cancer. A newer system, the Grade Group system, simplifies this by using a scale of 1 to 5.
If the biopsy is negative, it means no cancer was found in the tissue samples examined. If the result is positive, the Gleason Score and Grade Group are used alongside other factors, such as the number of positive cores and the clinical stage, to determine the most appropriate next steps. A positive diagnosis leads to a consultation with the physician to discuss treatment options or surveillance strategies based on the cancer’s aggressiveness.