A transrectal biopsy is a common medical procedure used to investigate concerns related to prostate health. It serves as a diagnostic tool, allowing healthcare providers to collect small tissue samples from the prostate gland. These samples are then analyzed in a laboratory to identify any abnormalities or diseases affecting the prostate.
Understanding a Transrectal Biopsy
A transrectal biopsy is a procedure designed to collect small tissue samples from the prostate gland for microscopic examination. This method allows for a detailed analysis of the cells to detect conditions that may not be apparent through other diagnostic tests.
One common indication for a transrectal biopsy is an elevated prostate-specific antigen (PSA) blood test result. PSA is a protein produced by the prostate, and higher-than-normal levels can sometimes indicate prostate cancer, although other non-cancerous conditions can also cause an elevation. Another reason is an abnormal finding during a digital rectal exam (DRE), where a doctor manually checks the prostate for unusual lumps, hardness, or asymmetry. Both an elevated PSA and an abnormal DRE can raise suspicion and warrant a biopsy to determine the underlying cause.
The Biopsy Procedure
Before a transrectal biopsy, patients often receive specific instructions to prepare for the procedure. This typically includes adjusting certain medications, particularly blood thinners like aspirin or ibuprofen, which may need to be stopped several days beforehand to reduce bleeding risk. Patients are usually advised to take antibiotics, starting either the night before or a few hours prior to the biopsy, and continuing for a short period afterward, to help prevent infection.
During the biopsy, the patient typically lies on their side with their knees drawn towards their chest to allow access to the rectum. A local anesthetic is administered around the prostate to minimize discomfort. A transrectal ultrasound (TRUS) probe is then inserted into the rectum, providing real-time images of the prostate gland. This ultrasound guidance allows the doctor to accurately identify areas of concern and precisely guide a thin, spring-loaded biopsy needle through the rectal wall into the prostate to collect tissue samples.
Multiple tissue samples, often between 6 to 12 cores, are collected from various areas of the prostate to ensure a representative sampling. The entire procedure is quick, lasting approximately 15 to 30 minutes. While the process is well-tolerated with local anesthesia, some patients may experience mild discomfort or pressure during the biopsy.
After the Biopsy
It is typical to experience mild discomfort or tenderness in the rectal area for several days. Many individuals notice blood in their urine (hematuria), which can range from a light discoloration to frank blood, and usually resolves within a week, though it can persist for up to six weeks. Blood in the stool (hematochezia) may also occur for a few days, and blood in semen (hematospermia) is a very common side effect, potentially lasting for several weeks or even months after ejaculation as the blood clears from the prostate.
Patients should be aware of less common complications, such as infection. Symptoms like a fever above 100.5°F (38.0°C), chills, or severe pain require immediate medical attention. Significant or persistent bleeding, particularly if passing large blood clots in urine or stool, or an inability to urinate, also warrants contacting a doctor or seeking emergency care.
General post-procedure care instructions include resting for a day or two and avoiding strenuous activities, such as heavy lifting, jogging, or cycling, for at least 2 to 5 days to reduce irritation and promote healing. Staying well-hydrated by drinking plenty of fluids is recommended to help flush the urinary tract and minimize blood clot formation. Avoiding constipation by eating fiber-rich foods or using stool softeners can also help prevent straining during bowel movements, which might exacerbate rectal bleeding.
Interpreting Your Biopsy Results
After the tissue samples are collected during the biopsy, they are sent to a pathology laboratory for thorough microscopic examination by a pathologist, a doctor specializing in diagnosing diseases through tissue analysis. This process typically takes about a week for the results to become available. The pathologist’s report will provide a detailed analysis of the cells found in the prostate tissue.
The biopsy results can fall into several categories. A “benign” result indicates that no cancerous cells were found, meaning the prostate tissue appears normal. Sometimes, the report may show “atypical cells” or prostatic intraepithelial neoplasia (PIN), which means there are some cellular changes that are suspicious but not definitively cancerous. High-grade PIN, in particular, suggests an increased risk of developing prostate cancer in the future and may warrant further monitoring or a repeat biopsy.
If prostate cancer is detected, the pathology report will confirm the presence of cancer cells and often include a Gleason score. The Gleason score is a grading system that describes how aggressive the cancer appears under the microscope, based on the patterns of the cancer cells. This score, typically ranging from 6 to 10, is derived by adding two numbers that represent the most common and second most common cell patterns observed. A lower score generally indicates a less aggressive cancer, while a higher score suggests a more aggressive form. Your doctor will review these results with you, discuss the implications of the findings, and outline the next steps, which could include active surveillance (close monitoring), additional diagnostic tests, or various treatment options depending on the nature and aggressiveness of the cancer.