What To Expect Before, During And After A Prostate Biopsy

A prostate biopsy is commonly used to diagnose prostate cancer in the event that a suspicious lump may be found.

A biopsy is a procedure which requires that a tissue sample be removed, generally via needle, from a conspicuous tissue of the body for thorough testing. A prostate biopsy is usually done to determine whether a lump found in the prostate is in fact cancerous. Usually, this procedure will be performed in response to indications of such a lump gathered by another test, such as a transrectal ultrasound, or a digital rectal exam (DRE). It may also be performed if high levels of Prostate-Specific Antigen (PSA) are found in the blood. PSA may be released in connection with unhealthy or cancerous inflammation of the gland.

Biopsies are generally not very invasive, as surgical procedures go, but the location of the prostate does not make for maximum patient comfort. Poking and prodding are inevitable, and depending upon your tolerance for such things, this is likely to be more mentally than physically stressful. Digital rectal exams are the standard method for detection of a lump, and it is not very unlikely that your physician may want to be very sure of a lump's presence before resorting to a biopsy. While the phrase may bring to mind other images, it should be made clear to those thus far left behind that "digital" in this instance refers to your physician's finger, and not his computer screen. A bowel movement or enema may be required to facilitate this procedure, if the colon is obstructed.

If your DRE results indicate a possible lump, a biopsy may be the next choice of action.

A prostate biopsy can be performed through one of three most common points of entry: the rectum, urethra, and perineum (the flat expanse of skin between the anus and scrotum). Because it is least invasive, transrectal prostate biopsies are the accepted method of choice, but individual physiologies or circumstances may negate preference for this possibility. Local anesthetic is required, at minimum, for a prostate biopsy, and depending upon the method of collection, general anesthetics may be preferable. Usually, you will have a choice in this matter. As you will be instructed, if choosing general anesthetic, avoid food or drink twelve hours before the procedure to prevent vomiting associated with the nausea experienced upon waking. Because the tissue of the prostate itself is not nervous, pain associated with the procedure usually results from the insertion of the needle or scope, and not the biopsy itself.

A transrectal biopsy is performed with a needle, usually guided with the aid of transrectal ultrasound. The needle may be spring-loaded, so that it can enter the prostate through the rectal wall and retrieve its sample quickly. There is also a method by which the doctor may help guide the needle with his finger, using a special needle guide, then twisting the needle quickly within the rectum to procure the sample. Transrectal biopsies can be performed from a kneeling, foetal (curled on side), or stirrup position. Antibiotic prescriptions may especially be associated with this procedure due to the bacterial conditions of the rectum, which will be punctured (albeit minimally) from the inside. Antibiotics should prevent any infection associable with the biopsy.

A transurethral biopsy involves the insertion of a device called a cystoscope, which is lighted and allows the physician to directly observe the prostate. A cutting loop is passed through the cytoscope to retrieve a small tissue sample, and is then pulled out. This procedure is performed in the stirrup position, and either requires localized numbing of the urethra or a general anesthetic.

Transperineal biopsy involves passing of the skin, and is so generally considered more invasive than transrectal or transurethral biopsies. While some prefer general anesthetic, once again localized numbing is all that is really necessary. The procedure requires first that a two to three millimeter incision be made in the perineum, so as to allow entry for the needle. Usually the physician must hold the prostate stationary by inserting a finger into the rectum while the procedure is performed. Once inside, the needle is, again, turned and removed, along with a tissue sample. A bandage is sufficient to stop the bleeding, and healing begins quickly.

Depending upon the specifics of the procedure, a prostate biopsy may take from fifteen minutes to an hour. As with any surgical procedure, be sure to consult a doctor before taking any anticoagulants prior to surgery, including aspirin and ibuprofen. Inform him or her of antibiotics or other drugs you may be taking, as well.

Recovery from the biopsy is quick and generally painless, save that some urethral irritation can be associated with transurethral biopsies, and some mild discomfort may be associated with the incision made for a transperineal procedure. Risks include infection, which is usually countered by antibiotics, rectal bleeding, which is noticed in the feces and is not serious so long as it ceases within two or three days, and bleeding into the bladder or the urethra. This can cause urinary discomfort or complications in urination. Contact your doctor if urinary symptoms are noticed in the days after the procedure.

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