Prostate biopsy procedure: what you need to know

If your doctor suspects you have prostate cancer, they may advise you to have a prostate biopsy. A biopsy is a standard cancer screening test that involves the careful removal of small samples of tissue, which are then examined in the laboratory to determine whether they contain cancer cells or other abnormal cells.

Here’s what you need to know about a prostate biopsy, including when you might need this procedure and how often it can lead to a diagnosis of cancer.

A prostate biopsy is an invasive procedure in which a healthcare professional uses a needle to remove several small pieces of prostate tissue.

A pathologist — a doctor who specializes in the diagnosis of cancer and other diseases — analyzes all the samples. If the pathologist finds cancer cells, they may also be able to tell how aggressive the cancer is, which will help determine what you should do next.

A prostate biopsy procedure should only be performed if there are other indications that cancer may be present.

For example, a prostate biopsy may be appropriate if a prostate-specific antigen (PSA) test has revealed that your levels of this prostate-produced protein are higher than expected for your age. A doctor would likely order a second PSA test to confirm elevated levels before considering a biopsy.

If you’ve already had a prostate biopsy that found no cancerous cells, but your PSA level is high, your doctor may advise you to have another biopsy. A second biopsy may also be appropriate if a previous biopsy found abnormal cells that were not cancerous.

Additionally, your doctor may recommend a biopsy if a digital rectal exam revealed lumps or other changes in your prostate.

There are several steps to a prostate biopsy procedure.

Preparation before the procedure

At least one week before your prostate biopsy procedure, you should discuss your medications with your doctor. You may need to temporarily stop using blood thinners or nonsteroidal anti-inflammatory drugs, as these types of medications can increase the risk of bleeding complications during the procedure.

You may need to do an enema the day before your biopsy and possibly a second enema an hour or two before the procedure.

During prostate biopsy

Depending on the type of procedure you are having, a doctor may ask you to lie on your side with your knees drawn up toward your chest, or lie on your stomach. They will then apply a special gel to the area they are examining.

In order for the doctor to obtain tissue from only the suspicious parts of your prostate, imaging is needed to help guide the biopsy needle to the correct places.

A commonly used imaging technique is transrectal ultrasound (TRUS), which involves placing a thin ultrasound probe into the rectum. TRUS uses sound waves to create images of the prostate.

Your doctor may also use magnetic resonance imaging (MRI), which involves magnetic fields and special radio waves that create detailed images of the prostate.

Once your doctor locates the areas to biopsy, they will insert a central needle into your prostate to remove a small cylinder of tissue. In a typical prostate biopsy, they will take 10 to 12 samples.

A prostate biopsy procedure usually takes about 10 minutes. You will likely feel pain and discomfort for a few days afterwards. During this time, you should refrain from heavy lifting and other strenuous activities.

After the procedure

It will take up to a week to get the result of your biopsy, which is called a pathology report.

This report will indicate whether the biopsy found cancerous cells or non-cancerous but abnormal cells. Alternatively, the report may reveal that no cancerous or abnormal cells were found.

Before removing any tissue samples, your doctor will numb the area to be biopsied, which should reduce pain. Once this medicine wears off, you may feel some pain for the next few days

You may also have very minor bleeding from the rectum and you may see blood or a red tint in your urine, semen, and stool for a few days or weeks.

Although a prostate biopsy procedure is uncomfortable, you will remain awake throughout the process. You may be able to drive home, but your doctor’s office may suggest someone drive you.

The likelihood of a prostate biopsy detecting cancer depends greatly on the pre-biopsy profile of the person undergoing the procedure. If you have a high PSA score and/or suspicious changes in your prostate, a biopsy is more likely to find cancer than if you have no significant risk factors or indications that you might have cancer.

That’s why it’s important to have a thorough conversation with your doctor about why he recommends a biopsy. A small study from 2015 found a positivity rate of 52%, which the researchers said was higher than most published averages.

In recent years, the combination of MRI-guided and TRUS-guided biopsy has become more popular.

The combination of these two imaging technologies, known as fusion biopsyallows the doctor to see combined images of the prostate that are more detailed than MRI or ultrasound alone.

According to a 2019 reviewprostate biopsy is the “gold standard” screening for prostate cancer, and the combination of MRI and TRUS has advantages over traditional biopsy procedures.

A separate 2020 review suggests that TRUS-guided biopsies without MRI tend to result in an excessive amount of findings associated with insignificant disease and underdetect clinically significant cancer findings.

Besides biopsies, your doctor may use other tests to detect prostate cancer or the possibility of cancer. These other projections include:

  • a digital rectal exam, which cannot confirm the presence of cancer, but can help determine which part of the prostate is affected and whether the cancer may have spread to nearby tissues
  • a PSA blood test, which is not a perfect screening method because low levels of PSA can be detected in people with cancer, while high levels can exist in the absence of cancer
  • urine tests, which are relatively new additions to the set of diagnostic tools doctors can use – a 2019 report in the journal Prostate cancer and prostate diseases suggests that some urine tests may be 90% accurate for clinically significant tumors

A prostate biopsy procedure is the most definitive way to diagnose prostate cancer, although new tests and technologies are emerging that may make this invasive screening unnecessary for many people.

If your doctor suggests you have a biopsy, be sure to ask why he is recommending the procedure and what the risks and benefits of the biopsy may be.

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