Prostate biopsy
A transrectal ultrasound guided biopsy of prostate gland is a diagnostic test that entails insertion of a thin needle through the rectum to retrieve small samples of prostate tissue to be examined under a microscope for cancer cells.
Why It Is Done
It is done when a blood test shows a high level of prostate-specific antigen (PSA) or if a digital rectal examination (DRE) finds an abnormal prostate hardness or nodule. This helps rule out prostate cancer.
How To Prepare
You must tell your doctor if you:
- Past history of bleeding problems.
- History of any Allergy
- Medications that you are taking presently.
- Are taking any blood-thinners like clopidogrel, aspirin, warfarin , heparin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).
You will be given an enema before the biopsy.
How It Is Done
This biopsy is done by a doctor who specializes in men’s genital and urinary problems (urologist). It can be done in the doctor’s office, a daycare clinic, or a hospital operating room.
Before your prostate biopsy, you will be given antibiotics to prevent infection. You will be asked to change into a hospital gown.
Through the rectum (transrectal biopsy)
You may be asked to lie on your side with upper leg flexed at the hip joint & knee touching the abdomen. A lignocaine jelly is injected in the rectum prior to the procedure to anesthetise the area. One continues to have a sensation of touch ; however there is no pain. The physician will first image the prostate using ultrasound noting the prostate gland’s size and shape and whether or not any other abnormalities exist. Using the spring-loaded biopsy device attached to the ultrasound probe, the physician performs multiple biopsies of the prostate gland. Generally, 12 cores (or more, depending upon the size of the prostate gland and the prior PSA and biopsy history of the patient) biopsies will be performed.
Transrectal ultrasound (TRUS) guides the needle to the correct biopsy location. A spring-loaded needle quickly enters the prostate gland and removes a tissue sample. Each biopsy removes a cylinder of prostate tissue approximately 3/4 inch in length and 1/16 inch in width. Dr Manav has done approximately 600 biopsies till date & a transrectal biopsy takes about 3-5 minutes in our hands.
How It Feels
For a transrectal biopsy, you may feel pressure in the rectum while the ultrasound probe is placed. You also may feel a dull pressure as the biopsy needle is inserted into the prostate gland. Usually twelve cores are collected. A Saturation biopsy may entail taking 20 – 24 samples.
Sometimes patients experience mild discomfort in the biopsy area for 24-48 hours.
Risks
A prostate biopsy has a slight risk of causing problems such as:
- Infection. This is more common in men who have undiagnosed prostatitis. Usually, taking antibiotic medication before the biopsy prevents an infection from developing. In case a patient has fever > 100°F with chills & rigors occuring post biopsy, he willneed to get admitted for intravenous antibiotics & supportive therapy to treat sepsis (or spread of infection in blood) in such patients.
- Bleeding into the urethra or bladder. This can cause a clot in the bladder rarely leading to an inability to urinate, or a need to urinate often. Bleeding in urine may last 5 – 7 days.
Bleeding (Grades & significance)
(1) Light pink – Do not bother
(2) Rooh Afza like color & consistency – Drink more water.
(3) Thick clots and or difficulty in passing urine – Contact Urology Helpline (+91-9560398928). Patient may need to get readmitted for Cystoscopy & clot evacuation.
Bleeding from the rectum. If you have had a transrectal biopsy, you may experience a small amount of bleeding from your rectum for 2 to 3 days after the biopsy.
An allergic reaction to the local anesthesia used during the biopsy.
Sometimes one may have some discoloration of his semen for up to one month after the biopsy.
In case you have large untreated piles or fissures or fistulas in ano in acute painful state, please inform us so that they can be taken care of and are not a cause of pain or trouble for you at the time of biopsy.
Rarely this procedure is done under general anesthesia where you will be in a recovery room for a few hours after the biopsy. You will need someone to drive you home when you are released. When you get home, your muscles may ache and you may feel tired for the rest of the daybut this becomes normal in a day or two.
Anticipated problems at home?
Some people experience a mild burning sensation on passing urine after their surgery. This usually settles after a few days. Drink more water, if it still does not settle contact Urofort (+91-9910103545) for appointment to rule out urinary tract infection.
Inform us & contact our Hospital Emergency/ Casualty/ Urology Helpline (+91-9560398928) if you:
_ develop a temperature, have pain and persistent burning when you pass urine;
_ do not pass urine for eight hours (unless you are asleep);
_ pass large clots of blood; or
_ if you have persistent bleeding.
Results
A prostate gland biopsy results are usually available within 5 days.
Prostate biopsy – The results shall be discussed face to face when we sit with you across the table. Please take an appointment with Dr Manav Suryavanshi at Urofort(+81-9910103545) or at our hospital with our Urology Coordinator (+91-9560398967). We discourage discussion of such an important report on phone as this can lead to miscommunications & unwanted confusions. The results can be either normal or abnormal ( cancer/ noncancerous enlargement BPH/ infection)
If cancer cells are present, a Gleason Grade will be given, which Dr Manav will discuss with you. The grade indicates the tumor’s degree of aggressiveness—how quickly it is likely to grow and spread. The Gleason grading system is the most widely used system. In this system, the majority tumor pattern is assigned a score from 1 to 5 and the minority pattern is similarly assigned a score, using the same scale. The majority and minority scores are added together to give a Gleason sum ranging between 2 and 10. Scores of up to 6 indicate mild, 7 – moderate and scores of 8 to 10 highly aggressive disease.
What Affects the Test
Factors that can interfere with your test or the accuracy of the results include:
• The biopsy may not contain enough tissue to make a diagnosis.
• A chance that a cancer may be missed since the biopsy takes a small amount of tissue.
What To Think About
• Normal prostate biopsy results do not rule out cancer.
• A prostate gland biopsy does not cause problems with erections and will not make a man infertile.
The treatment to be taken after the biopsy is done will be given to you in a written discharge slip.
In case of any doubts please don’t hesitate to put forth your queries to Dr Manav Suryavanshi.
For More Information
Meet us at
Medanta Kidney & Urology Institute
Medanta – The Medicity
Sector 38, Gurgaon, Haryana – 122001, India
For appointment Call+91-9910103545
Email – info@urofort.com
Web address – www.manavsuryavanshi.com