biopsy is the taking of tissue samples
from the prostate
gland and examining them underneath a microscope
for cell differentiation. Cancerous cells are shaped
and arranged differently than healthy cells. The more
differentiated cancerous cells are from healthy cells,
the more aggressive the cancer. If the biopsy reveals
no cancerous cells, either you do not have prostate
cancer, or the prostate biopsy missed the tumor.
If the doctor believes the biopsy missed a tumor based
on other factors such as your family history, a particular
irregularity in the digital
rectal exam, or a rising PSA density,
you will receive a follow-up biopsy in six months. Seventy-five
percent of men have negative primary prostate biopsies.
Before the Prostate Biopsy
Before undergoing the biopsy, a patient may take antibiotics
to reduce the risk of infection after the prostate biopsy.
The patient also should stop anti-inflammatory
drugs, such as aspirin or ibuprofen,
that may increase the risk of bleeding after the biopsy.
Finally, the doctor may also order an enema before the
prostate biopsy to remove feces and gas that may complicate
the transrectal biopsy.
Types of Prostate Biopsies
There are three types of prostate biopsies: the transrectal,
the transurethral, and the transperineal. The transrectal
prostate biopsy is guided by the transrectal ultrasound
(TRUS) through the anus and into the rectum. The transurethral
biopsy is performed with a lighted cystoscope up through
the urethra so the doctor can look directly at the prostate
gland. The transperineal biopsy collects the tissue
through a small incision in the perineum.
The transrectal and transperineal prostate biopsies both use spring-loaded needles to collect their samples as quickly, efficiently, and painlessly as possible. The biopsy gun can collect between 6 and 13 samples, depending on how many a doctor believed is necessary to diagnose you correctly.
Transperineal Prostate Biopsy
Patients opting to undergo the transperineal biopsy
may also be put under general anesthesia if they wish
to be unconscious during the biopsy. Men who opt to
have the transperineal biopsy performed may experience
some tenderness as well as blood in the semen
for one to two months afterwards.
Transrectal Prostate Biopsy
In the transrectal biopsy, transrectal
ultrasound guides the doctor and the
biopsy gun to the proper place. Patients who opt for
this prostate biopsy may experience a small amount of
bleeding from the rectum
as well as blood and urine in the semen afterwards.
Transurethral Prostate Biopsy
The transurethral biopsy inserts the cystoscope into
the urethra. Local anesthesia is given to numb the area.
The doctor looks directly at the prostate through the
cytoscope and then inserts a cutting loop to extract
tissue. The cutting loop works by turning and extracting
a small amount of tissue with each turn.
Side Effects of Prostate Biopsy
Only minimal pain is associated with both procedures,
though, doctors are more commonly using local anesthesia
to numb the tested area. After having the prostate biopsy,
men may experience blood in their urine and their semen
for a few weeks or up to two months afterwards. Some
soreness or minimal bleeding (after the transperineal
biopsy) may also be experienced for a few days. Some
doctors recommend having someone drive the patient home
to avoid unpleasantness or soreness. Also, patients
who opt for local anesthesia may be groggy for a short
time after the prostate biopsy. Patients may return
to normal activities as soon as they feel able.
In all three procedures, the pathologist
needs multiple samples from different areas of the prostate
to make an accurate diagnosis. Remember, if a tumor
is small enough, it can be missed during the prostate
biopsy. A doctor will examine patient's circumstances
and determine whether he needs a follow-up biopsy. If
the pathologist does find prostate cancer, the next
step is to assign a Gleason