A prostate biopsy is a medical procedure involving the removal of small tissue samples from the prostate gland. This is done using a thin needle, and the collected tissue is then examined under a microscope to detect cancer cells. The primary purpose of this diagnostic tool is to identify prostate cancer and assess its characteristics, such as how likely it is to spread beyond the gland.
Why a Prostate Biopsy is Performed
A prostate biopsy is typically recommended when other initial tests suggest a potential issue with the prostate gland. One common indication is an elevated Prostate-Specific Antigen (PSA) level detected during a blood test. PSA is a protein produced by the prostate, and higher levels can sometimes indicate prostate cancer, though other non-cancerous conditions can also cause an increase.
Another reason for a biopsy is an abnormal finding during a Digital Rectal Exam (DRE), where a doctor manually feels the prostate for lumps or irregularities. Additionally, suspicious results from imaging tests, such as a prostate MRI, can prompt a biopsy to further investigate areas of concern. These preliminary tests help guide the biopsy, which remains the most definitive method for diagnosing prostate cancer.
The Prostate Biopsy Procedure
The prostate biopsy procedure involves collecting tissue samples using a biopsy needle, often guided by an ultrasound probe. Patients typically lie on their side with knees pulled towards the chest. A local anesthetic is administered to numb the area, which may cause a brief stinging sensation before the region becomes numb.
The most common approach is the transrectal ultrasound (TRUS) guided biopsy. In this method, an ultrasound probe, lubricated with gel, is inserted into the rectum to visualize the prostate on a screen. The doctor uses this real-time image to guide a biopsy needle through the rectal wall and into different parts of the prostate, typically collecting between 10 to 12 tissue samples. The entire TRUS procedure generally takes about 15 to 30 minutes.
Alternatively, a transperineal biopsy involves inserting the needle through the skin between the scrotum and the anus, an area known as the perineum. This approach can be performed under local or general anesthetic. An ultrasound probe guides the needle, and sometimes an MRI scan is used to further pinpoint suspicious areas for targeted biopsies. This method may involve taking 10 to 30 samples and can offer a different angle for sampling the prostate, potentially reducing infection risk. Patients may feel mild pressure or a brief flicking sensation as each sample is taken.
Preparing For and Recovering From a Prostate Biopsy
Preparation for a prostate biopsy typically involves several steps. Patients are usually advised to stop taking blood-thinning medications, such as aspirin, ibuprofen, or warfarin, for about 5 to 10 days before the biopsy, after consulting with their doctor. This reduces the risk of excessive bleeding during and after the procedure.
Antibiotics are commonly prescribed, starting one to two days before the biopsy and continuing for a few days afterward, to prevent infection. Patients may also be instructed to use an enema at home prior to the appointment to cleanse the rectum.
After the biopsy, it is common to experience mild soreness or discomfort at the biopsy site for several days. Light bleeding in urine, stool, or semen is also expected; blood in semen can persist for several weeks. Patients are generally advised to avoid strenuous activity, including exercise and sexual activity, for a few days to a week.
Potential Risks and Complications
A prostate biopsy carries potential risks and complications. Bleeding is a common side effect, often appearing as blood in the urine, stool, or semen. Rectal bleeding is usually minor and resolves on its own, but heavy bleeding or blood clots warrant immediate medical attention.
Infection is another concern, despite preventative antibiotics. This can manifest as a urinary tract infection or, less commonly, a more serious blood infection called sepsis. Symptoms of infection include fever, chills, increased pain, or difficulty urinating, and medical attention should be sought promptly if these occur.
Temporary difficulty with urination after the procedure due to prostate swelling is possible, which in rare cases might require a temporary urinary catheter. Pain or discomfort at the biopsy site is also possible.