The prostate biopsy is a procedure that is performed because an elevated PSA or abnormal area has been identified in your prostate gland. It is impossible to determine the nature of such irregularities without obtaining a small amount of tissue with a needle biopsy for examination under a microscope. Our goal is to determine whether these abnormalities are the signs of an early or late stage prostate cancer. You will receive at the minimum 6 -12 biopsies and possibly more during this procedure. It may need to be repeated in 3 – 6 months if negative since there is a 20-40% reported second positive biopsy rate if the first is negative for cancer (but the PSA level is still higher than the normal range).
Protate ultrasound biopsy uses a probe which is inserted into the rectum the same way a finger is used to examine the prostate. The ultrsound probe uses sound waves to take a detailed picture of the size and shape of the prostate. Men lay on their left side during the procedure with the knees curled up toward the ches. There may be a small amount of discomfort when the probe is inserted, but usually not much more than with a finger exam. A numbing jelly is placed into the rectum prior to the procedure to decrease any pain. Ultrasound pictures of the prostate are taken to determine the size and shape of the prostate and to look for any areas that are suspicious for prostate cancer. The ultrasound is then use to guide the prostate biopsies to the correct place in the prostate
Prostate biopsy is performed with a small needle which is placed in a spring-loaded "gun" which shoots the needle through the ultrasound probe into the prostate. The needle cuts out a small thread of prostate tissue which can be examined for prostate cancer. Most men feel a sharp pinch in the rectum when the biopsies are taken, but the sharp sensation lasts for only a fraction of a second. Usually 5-6 biopsies are taken from each side of the prostate. When the biopsies are finished many men will have a feeling that they need to urinate, but the feeling will usually subside before men are dressed and ready to go home.
You do need to stop aspirin 10 days before prostate biopsy, and you also need to stop Coumadin for 4-5 days before a biopsy. The anesthetist will discuss this with you before the procedure. You will be given an enema to take in the evening one day before the biopsy to clean your lower colon. You will also be given antibiotic tablets to take 1 day before the biopsy and for 2 days after the biopsy.
The procedure cound be done with local anesthesia or with general anesthesia. You will choice and let your doctor know.
A transrectal ultrasound probe will be placed in the rectum and the prostate will be imaged and sized. This sensation is bothersome but is usually well tolerated by patients. The urologist will then obtain the multiple tiny prostate samples (5 - 12 or more). The biopsy device makes a little bit loud noise and can startle patients; we will let you hear this before beginning. The urologist will let you know when he places the needle in the prostate and again when he plans to fire the device. The tissue will be sent to a pathology lab for evaluation which takes 5-10 working days
After the procedure
After your biopsy, you will have to drink many fluids so that you may provide us with two separate urine samples from two separate voids. The most common complication is blood in the urine after the biopsy. We would like to make sure that your urine is in the process of clearing before we send you home for the same day. It is normal to see blood in the urine and bowel movements for 1-2 weeks after the procedure. It should progressively diminish over that time-period. If you find that, you cannot urinate or if you are passing a large number of blood clots, then report to the office or nearest emergency room for evaluation. A physician may have to insert a catheter into the bladder for a few days to allow you urine to be drained. You should continue to drink more than your usual intake of fluids to keep your urine diluted and to prevent formation of blood clots within the bladder.
You may also experience a dull ache in the perineum for many days after the biopsy. It is recommended that you halt sexual intercourse for 3-5 days after the biopsy to allow some initial healing. Do not be surprised if you see blood in your semen (bight red to dark brown discoloration) after ejaculation. This is normal and does not cause an infectious concern for your sexual partner. This may take months to resolve. In addition, you cannot pass along cancer to your partner via your semen either.
If you have fever or chills, please take your temperature with an oral thermometer and call your physician if it reads above 38 degree Cencius
Risk of the procedure
All men have a small amount of bleeding from the rectum that they will see on the toilet paper for several days after the biopsy. Some men will also see a small amount of blood at the beginning of urination, and this will stop within one week. All men will have blood in the semen for 4-6 ejaculations after prostate biopsy. Climax and ejaculation should not feel any different than before the biopsy and no special precautions are necessary unless patients have a condition which could be spread by blood contact, such as hepatitis or AIDS.
The more serious risks after prostate biopsy are rare. Approximately 1% of men will have severe difficulty urinating or be unable to urinate after prostate biopsy. This is caused by temporary swelling in the prostate. Roughly 1 out of 1000 men will have a prostate infection or significant bleeding after prostate biopsy.