Prostate biopsy: What to expect
Early detection can help prevent prostate cancer from entering the more advanced stages. A prostate biopsy is the only effective means to diagnose prostate cancer.
This article addresses some of the questions a man may want to ask before having a prostate biopsy.
What happens in a prostate biopsy?
A doctor will use an ultrasound probe in order to see the prostate gland.
During the procedure, the doctor inserts an ultrasound probe into the rectum to create an image of the prostate gland. The prostate is located just on the other side of the rectal wall.
Using the ultrasound image as a guide, the doctor removes several samples from the prostate with a spring-loaded tool.
The device quickly punches a needle through the rectal wall into the prostate and removes minute cylindrical cores of cells. Typically, a biopsy removes around 10 to 12 core samples, usually five or six from each side of the prostate.
In some cases, a doctor may decide that a larger sample is needed. In these cases, the doctor performs a "saturation" biopsy, which collects 20 to 30 samples, sometimes more.
The entire procedure takes about 20 minutes. After the biopsy, doctors may suggest that men take an antibiotic to prevent infection.
Another procedure called a transperineal biopsy involves making a small cut between the anus and the scrotum. The biopsy needle is inserted through the cut and into the prostate and extracts a sample of tissue. The doctor will likely use an ultrasound scan to guide the procedure.
How to prepare
The anesthetic will numb the area during the procedure and ensure minimal discomfort.
Preparation will vary based on the doctor's recommendations.
Here are some general ways to prepare for the prostate biopsy:
- Stop taking any medication that increases the risk of bleeding. Medications, such as warfarin, ibuprofen, aspirin, and certain herbal supplements should be stopped several days before the procedure.
- Urine samples may be requested to test for a urinary tract infection. If an infection is present, the biopsy will be postponed until the infection clears up.
- A doctor may order an enema at home before the biopsy.
- Doctors may prescribe antibiotics that people should take before the biopsy to help prevent infections from the procedure.
Men should also prepare themselves to receive the results of the biopsy. People should find out as much as they can by reading about prostate cancer and asking questions about the next steps in case cancer is diagnosed.
Before the procedure, doctors usually provide a detailed list of instructions for men to follow. If an individual has any questions, it is also best to ask them before the biopsy takes place.
How does a prostate biopsy feel?
In most cases, a doctor will administer an anesthetic injection into the prostate gland before the procedure. Despite the numbness from the anesthetic, a man may still feel a pinch as the needle punctures the gland.
Most men report that they only feel mild to moderate discomfort during the procedure, but some men experience much greater pain.
Afterward, as with any invasive procedure, there may be lingering tenderness and discomfort as the puncture wounds heal.
Risks and complications
As with any invasive procedure, there are some risks involved. The most common risk factors include infection and bleeding. Other risks include blood in the semen or urine, discomfort in the area of surgery for a few days, and difficulty urinating.
To help prevent further complications after the biopsy, men should look out for these signs:
- prolonged or heavy bleeding
- difficulty urinating
- worsening pain
A man should contact his doctor if he experiences any of these symptoms, as an infection may be present.
Other tests for prostate cancer
A doctor is likely to perform screening tests before a biopsy to help determine whether a biopsy is even necessary.
Although the medical community does not fully agree on the benefits of screening all men, the general advice is that those over 50 get routine examinations to check for the presence of prostate cancer.
Screening tests include the following:
Digital rectal exam (DRE)
During a DRE, the doctor inserts a lubricated, gloved finger into the rectum to examine the prostate.
The doctor feels for abnormalities in texture, size, or shape. Any abnormalities may require additional tests to determine the presence of cancer.
Prostate-specific antigen (PSA) test
For the PSA, a doctor draws a blood sample from a vein in the man's arm.
PSA is a substance produced by the prostate. Low numbers of PSA are normal, but higher numbers may indicate an infection, inflammation, or possible cancer.
There are a number of factors, including the stage and Gleason score, which affect the treatment and outlook for men with prostate cancer.
After the biopsy, further tests and examinations carried out in the lab will help the doctor determine how fast any cancer is growing, how likely it is to spread, and the best course of treatment to pursue.
One of the most common ways to grade the type of cancer that may be present is by applying the Gleason score, which classifies cancer into one of five distinct categories.
To classify the biopsy, a doctor examines the tissue under a microscope and determines which two areas in the sample have the highest concentration of cancer cells. They then assign each of these samples a value of 1 - 5.
Adding the two values together gives the Gleason score. The lower the score, the less advanced the cancer is likely to be.
The outlook for a man depends on the results of the biopsy and other tests. Some major factors that affect the overall outlook for a man include:
- stage of the cancer
- whether the cancer has spread
- the Gleason score
- age of the man
- other health conditions
For stage 1 prostate cancer where the cancer has not spread outside the prostate, doctors usually recommend treatment that consists of active surveillance for both young and older men.
Younger men, however, may eventually choose to undergo more aggressive treatments. Older men may decide not to treat stage 1 prostate cancer as treatment may cause complications with other health conditions.
For prostate cancer in more advanced stages or that has spread beyond the prostate, men will likely undergo more aggressive treatment options upon diagnosis.
As with stage 1 cancers, a doctor can help make the decision of how to treat the cancer based on the age and overall health of the man.
If prostate cancer is diagnosed in the early stages, the chance of surviving at least another 5 years is almost 100 percent.