Definition

A prostate biopsy is the removal of a small amount of tissue from the prostate gland. The tissue is examined to determine whether there is cancer .

Prostate Cancer

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Parts of the Body Involved

This procedure involves:

  • Rectum
  • Prostate gland

It may also involve the perineum or the urethra.


Reasons for Procedure

A prostate biopsy is usually done as a result of an abnormal test. The most common tests are digital rectal exam (DRE), or an elevated prostate-specific antigen (PSA) blood test. The DRE and PSA are tests that monitor the prostate gland for the presence of cancer, inflammation, or other problems. A prostate biopsy is the only way to determine the presence of cancer cells.


Risk Factors for Complications During the Procedure

There are few risk factors for complications during the procedure. However, notify your doctor prior to the procedure of any of the following:

  • History of bleeding disorders or easy bruising
  • Use of any prescriptions, over-the-counter medications, or herbal supplements
  • Sensitivity or allergy to latex, medications, or anesthesia

What to Expect

Prior to Procedure

You may be asked to do the following:

  • Discontinue use of any blood-thinning medications, such as aspirin, ibuprofen, Ticlid, Aggrenox, or Coumadin for 4-7 days prior to the procedure.
  • Begin taking an antibiotic as prescribed by your doctor. You will continue taking the antibiotic after the procedure as well.
  • Self-administer a fleet enema several hours prior to the biopsy procedure.

Anesthesia

In general, a transrectal prostate biopsy does not require anesthesia. If your doctor obtains a biopsy through the urethra or perineum (see below), you may be given local or general anesthesia.

Description of the Procedure

Your doctor will use one of the following methods to perform the biopsy:

  • Transurethral biopsy—You will lie on your back and your doctor will insert a lighted cystoscope (flexible tube) through your penis into the urethra. The urethra is the tube that carries urine from the bladder. Your doctor will obtain the biopsy with a cutting loop passed through the cystoscope (rare).
  • Perineal biopsy—Lying on your side or back, your doctor will make a small incision in the perineum. The perineum is the area between the scrotum and the rectum. He or she will insert a small needle through the incision into the prostate gland to obtain the biopsy. This method is not as commonly used as other methods.
  • Transrectal biopsy—This is the most common type of prostate biopsy. You will lie on your left side on an exam table. Your doctor will insert a small lubricated cylindrical ultrasound device—called a transrectal ultrasound, or TRUS—into your rectum. This device will emit sound waves to produce an image of your prostate. These images will help guide placement of the biopsy needle. Your doctor will then insert the tiny biopsy needle through the wall of your rectum and into the prostate gland. Because tumors can occur anywhere in the prostate, your doctor may take several biopsies from different areas of the prostate.

After the Procedure

You may experience some mild discomfort and soreness in the area of the biopsy. You may also see blood in your urine, stool, or ejaculate for several days after the procedure.

How Long Will It Take?

In general, this procedure is usually completed within 30 minutes.

Will It Hurt?

You will feel pressure in the rectum as the ultrasound probe is guided into place. In addition, you will feel a brief, sharp pain as the needle is inserted into the prostate gland to obtain the biopsy.

Possible Complications

In general, there are few complications associated with this procedure. However, you may experience the following:

  • Infection
  • Bruising at the biopsy site
  • Prolonged bleeding at the biopsy site
  • Difficulty urinating

Average Hospital Stay

You will not be required to stay in the hospital.

Postoperative Care

Your doctor may recommend that you do the following after the procedure:

  • Avoid strenuous activity the day and evening of the procedure.
  • Do not take blood-thinning medication for at least two days after the procedure, and until any blood in the urine is clear.
  • Keep well-hydrated by drinking plenty of fluids for the next few days after the procedure.

Outcome

Your biopsy will be sent to a pathologist, who will analyze it for any evidence of cancer. If cancer is present, the pathologist will grade the severity of the cancer, and assign a Gleason score (ranging from a low score of two to a high score of 10), based on the characteristics of the cancer cells. If you have a high Gleason score, it is likely that your doctor will suggest an aggressive treatment program.


Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If you experience any of the following, call your doctor:

  • Heavy bleeding, or bleeding that continues for more than 2-3 days
  • Fever
  • Increased pain
  • Inability to urinate
  • Blood in the urine (hematuria) after 2-3 days