The term biopsy is used for any medical procedure in which a small sample of tissue is taken from an organ of a living being for microscopic evaluation in search of disease. Prostate biopsy is done by removing a small sample of the prostate for further evaluation in a microscope by a pathologist looking for tumor cells.
Usually, prostate biopsy is indicated when the urologist suspects the presence of prostate cancer after an initial clinical and laboratory evaluation. The main data that lead the urologist to indicate a biopsy are an increased PSA examination, a rectal examination that identifies lumps or irregularities of the prostate or an ultrasound that detects a suspicious lump.
The most common way to perform a prostate biopsy is by transrectal, ie, through the anus/rectum. Transrectal biopsy is a simple procedure, usually performed in the urologist's own office with the patient awake throughout the procedure and only with local anesthesia. The procedure is done with the patient lying on his side and with his knees and hips flexed.
The urologist inserts an ultrasound probe into the anus, similar to the probe used for transrectal ultrasonography of the prostate, except that a biopsy needle is attached (see accompanying text below). Do not be alarmed, as the needle remains "hidden" all the time, being externalized only when the tissue samples are obtained.
The examination when done with anesthesia is practically painless, however, it can still be a bit uncomfortable for more anxious people.
With ultrasound, the doctor can identify the prostate and the location of the suspicious nodule (s) by inserting the needle at the exact point for collection of material. In addition to the suspected sites identified by the ultrasound, the urologist also usually takes at least 6 more diffuse samples of prostatic tissue to increase the probability of obtaining a positive sample. The larger the prostate volume, the more samples can be obtained.
Usually, the procedure does not last more than 10 minutes and the patient can go home next. The result usually takes a week to get ready.
Eventually, the patient may have prostate cancer and the prostate can not be identified by biopsy. If the tumor is not very large, the needle may not pick up, and only samples of healthy prostate tissue are obtained.
If the clinical picture is very suggestive of cancer and the biopsy points to only healthy tissue, the urologist may choose to repeat it. When the biopsy is repeated, the doctor can decide for the so-called saturation biopsy, when between 12 and 24 prostate samples are obtained. In this way, the chance of getting an area affected by malignant cells becomes very large.
Prostate biopsy may also be done via the transurethral (through the urethra, penile canal) or transperineal (through the perineum, region between the anus and the scrotal sac). These two routes, however, are usually used in special cases only.
Prostate biopsy increases the risk of urinary tract infection, so it is common for the urologist to request a uroculture prior to biopsy not to do so if the patient has bacteria in the urine.
If the uroculture is positive, the patient should first be treated with antibiotics for 5 to 7 days to sterilize the urine. Even with negative uroculture, it is recommended to use at least one antibiotic tablet, usually 500 mg to 1000 mg ciprofloxacin, one hour before the procedure. It is also common to prescribe antibiotics for a few days after the biopsy.
Some urologists indicate bowel lavage with an enema to be performed on the day of the procedure at home, however, this conduct is not essential and not all doctors indicate it.
A fasting of at least 4 hours is indicated.
Biopsy is a bleeding procedure, patients should not be taking drugs that inhibit clotting. If you take medicines such as Clopidogrel, Ticlopidine, Aspirin, Anti-inflammatory or Warfarin alert your doctor of this fact, as most urologists prefer to discontinue these drugs days before the biopsy.
If the patient has a large prostate and difficulty urinating, the doctor usually passes a bladder catheter to prevent prostate edema after the biopsy completely blocks the passage of urine.
After the biopsy the patient can go home. It is suggested to avoid physical activities, including sexual activity until the next day. As some physicians opt for mild sedation before the biopsy, driving is not indicated after the procedure.
It is normal to have some pain in the pelvic region and a small loss of blood through the anus. The presence of small amounts of blood in urine and sperm is also common for a few days. Another non-worrisome finding is a change in the color of the sperm for a few weeks, which is usually clearer.
If the urinary or rectal bleeding is large or persists for more than three days, the doctor should be consulted.
Another sign of complication is urinary retention. If, after the biopsy, the patient feels like urinating but can not, the urologist should be contacted.
A pain that worsens instead of getting better over the course of days or the presence of fever is also a sign of possible complications.
