A prostate biopsy is a test that involves removing small tissue samples from different zones of the prostate so they can be examined under a microscope for signs of cancerous cellular growth.
A prostate biopsy is reserved for men who have a high PSA level based on their age and other factors, or whose digital rectal examination (DRE) has demonstrated a lump or some other form of abnormality of the prostate gland.
To guide the placement of the needle during a prostate biopsy, clinicians use transrectal ultrasound, a form of GPS for the prostate. The needles are hollow and are about half an inch long and a sixteenth of an inch in diameter. Each needle extracts a core of prostate tissue in about one second.
Well-differentiated prostate cells are more normal in appearance while poorly differentiated cells are more abnormal in appearance. Generally speaking the more abnormal the cells appear the more aggressive the cancer. Some cells, although not cancerous, may be classified as high grade PIN, which may be an indicator of potential cancerous growth.
There are three types of prostate biopsy procedures, all of which can be completed as an outpatient procedure in a doctor’s office or outpatient department of a hospital. Use of a local anesthetic is typical, but general anesthesia may be used if a doctor and the patient decide it is preferable. Each of the procedures may cause you to feel dull pressure when the needle is initially inserted and a quick, sharp pain when the needle is inserted into the prostate gland.
In a transrectal biopsy, the physician uses a device, under ultrasound guidance, to drive the needles through the wall of the rectum and into the prostate to take between 6 and 12 samples from different zones of the prostate. The entire procedure takes about 20 to 30 minutes. This approach is by far the most common procedure done in the United States.
During a transurethral biopsy, a lighted scope (cystoscope) is inserted into your urethra to allow the doctor to see the prostate gland. He then will pass a cutting loop through the scope and remove small samples of tissue. This procedure takes 30 to 45 minutes.
The transperineal biopsy involves an incision in your perineum, through which the doctor inserts the needle and takes samples from the prostate gland. This type of procedure usually takes about 15 to 30 minutes.
Another approach—an image-guided biopsy technique that uses magnetic resonance imaging (MRI)–is still in the experimental stages. In the image-guided technique, physicians merge MRI data with real-time ultrasound imaging data, which they use to guide the biopsy. This new technique provides a more accurate biopsy capable of detecting cancer in areas hidden when using other standard techniques.
For all the approaches, your doctor may ask you to have an enema the night before the biopsy is done, and you may be given a prescription for a short course of antibiotics to prevent any possible infection. Immediately before the procedure, you may also be given a sedative to help you relax. Make sure to talk to your doctor about allergies you may have to medications before your procedure. Also make sure to ask your urologist if he or she has a financial interest in the biopsy lab. Studies have shown that urologists with a financial incentive are more likely to perform biopsies in equivocal cases rather than apply watchful waiting.
Results of the biopsy are sent to a laboratory for grading in order to determine the presence of any cancerous cellular growth. In some cases, clinicians may not find cancer but may find the presence of abnormal cellular growth known as PIN or “prostatic intraepithelial neoplasia”. This is a tiny lesion, or wound, in the prostate tissue that experts believe sets the stage for the development of prostate cancer within about ten years for some, but not all men.
About 800,000 men undergo a prostate biopsy each year and about 9% will be told they have PIN. Formerly called dysplasia or atypical hyperplasia, PIN is considered to be a premalignant lesion, but recent studies suggest the likelihood of finding cancer on a repeat biopsy is no greater in men with PIN than in men with normal biopsy findings. Therefore, the finding of PIN alone is usually not a reason to perform a repeat biopsy.
Some prostate biopsies, however, can reveal abnormal or atypical cells that suggest the possibility of cancer but which are not sufficient to make a cancer diagnosis. In such cases, a repeat biopsy is usually performed because there is a 50% chance of finding cancer on a repeat procedure. If the biopsy results indicate cancer, additional diagnostic tests will need to be conducted to determine the extent of the disease.
Once the procedure is over, you can expect different post-procedure events. If you had a transrectal biopsy, you may experience some bleeding from your rectum for 2 to 3 days after the biopsy. You may have a urinary catheter inserted for a few hours after a transurethral biopsy. If you had general anesthesia, you will spend some time in a recovery room after the procedure, and you should have someone drive you home. After any of the procedures, you should avoid strenuous activities for at least four hours. Your pelvic area may be mildly painful for a few days, and some men experience mild cramping. You may see blood in your urine and/or stool for up to five days, and some men notice that their semen is discolored with blood for up to one month after a biopsy.
Here are some tips on what to do and not do after a prostate biopsy.
- Avoid any strenuous exercise or physical activities, including lifting, for at least 4 hours after the biopsy, and preferably 24 hours.
- Limit yourself to mild to moderate exercise or physical activities thereafter for the next 3 to 4 days (but always check with your doctor for more specific instructions)
- Take supplements to help prostate biopsy recovery. Read Maury’s Story on how he managed his PSA levels after multiple biopsies
- Avoid activites that could traumatize the pelvic area, such as martial arts, or riding a bicycle, motorcycle, or horse for about a week
- Take Modified Citrus Pectin, which has been shown in numerous studies to cause apoptosis (self destruction) in cancer cells. When having a biopsy, cancerous cells can escape from the prostate and modified citrus pectin is recommended to assist in prostate biopsy recovery in order to assist your immune system to eradicate cancerous cells that enter the blood stream during biopsy. Read more on prostate biopsy and the potential to spread prostate cancer here and here
- Do not strain when going to the bathroom
- Don’t hold it! Holding back from urinating can irritate your bladder and lead to a urinary tract infection.
- Avoid constipation by eating foods high in fiber and staying hydrated. Straining to eliminate can worsen your symptoms as you heal.
- Avoid sexual activities for the first few days.
- Keep your penis and surrounding area clean to help avoid infection.
- Contact your doctor immediately if you experience any of the following symptoms: fever greater than 101 degrees, heavy bleeding, urinary urgency, abdominal pain, chills, trouble urinating, or any other new symptom.
- Avoid spicy foods, alcohol, and caffeine, as they can irritate the bladder
- Do not wear light-colored pants in case you experience bleeding
- Discuss the prostate biopsy procedure with your partner and explain the reason for any blood in your semen
- Do not worry about erectile dysfunction or infertility: a prostate biopsy does not cause either of these conditions
- Stay hydrated with pure water and green tea, which can help fight any possible infection, promote healing, and support prostate health
- Make the decision to switch to The Prostate Diet, which will help support and enhance your prostate health from this day forward