Prostate Biopsy

Prostate biopsy

Prostate biopsy is the definitive method to confirm prostate cancer. Only a biopsy can confirm the presence and type of prostate cancer.

Prostate biopsy may either be done through the rectum, known as transrectal prostate biopsy, or transperineally.

Do note that such biopsies are random biopsies, because early prostate cancers cannot be identified by imaging techniques.

Recently, studies have reported that multiparametric MRI (mpMRI) of the prostate may benefit in detecting the sites or areas to concentrate on during prostate biopsies. But the MRI itself cannot confirm prostate cancer, and one will still require to get a biopsy for confirmation. But do note that the current indications for mpMRI of the prostate is for individuals who had previous negative prostate biopsy reports and persistent elevated PSA test results.

It is best to discuss with the urologist on what is the best option for your when proceeding with prostate biopsy

Transrectal biopsy. An ultrasound probe is inserted into the rectum to show where the tumor is. Then a needle is inserted through the rectum into the prostate to remove tissue from the prostate.

Pic from National Cancer Institute NCI

You may be recommended prostate biopsy if:

  • A PSA test shows levels higher than normal for your age
  • When you have a rising PSA even if the PSA is below the normal threshold level for prostate biopsy
  • Your doctor finds lumps or other abnormalities during a digital rectal exam
  • You have had a previous biopsy that was normal, but you still have elevated PSA levels
  • A previous biopsy revealed prostate tissue cells that were abnormal but not cancerous

To prepare for your prostate biopsy, you may be advised the following:

  • Given laxatives at home before your biopsy appointment.
  • Given antibiotics to start at home before your biopsy appointment.
  • Inform your doctor regarding any medication that you are taking that can increase the risk of bleeding — such as warfarin (Coumadin), aspirin, plavix, ticlid, etc. Your doctor will advise you if there is a need to stop this for several days before the procedure.

During the procedure

You will be asked to lie on your side with your knees pulled up to your chest. After cleaning the area and applying gel, your doctor will gently insert a thin ultrasound probe into your rectum.

The ultrasound images are used to guide the prostate biopsy needle into place.

Then, your doctor will retrieve thin, cylindrical sections of tissue with a spring-propelled needle. The procedure typically causes a very brief uncomfortable sensation each time the spring-loaded needle takes a sample.

Your doctor may target a suspicious area to biopsy or may take samples from several places in your prostate. Generally, 10 to 12 tissue samples are taken. The entire procedure usually takes about 10 minutes.

After the procedure

Your doctor will recommend that you do only light activities for 24 to 48 hours after your prostate biopsy.

You will probably need to take an antibiotic for a few days. You might also:

  • Feel slight soreness and have some light bleeding from your rectum.
  • Have blood in your urine or stools for a few days.
  • Notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen. This can last for several weeks.

Call your doctor if you have:

  • Fever
  • Difficulty urinating
  • Prolonged or heavy bleeding
  • Pain that gets worse

You will be required to come back a week later to review the results of the biopsy.