Definition and Overview

Prostate biopsy is a diagnostic exam that is commonly used to confirm the presence of prostate cancer. It involves obtaining tissue samples of the prostate glands for close examination.

The prostate gland is part of a male's urinary system. It sits close to the bladder and surrounds a portion of the urethra, which connects the bladder and the kidneys. It also belongs to the male's reproductive system since it supports semen reproduction.

The prostate undergoes changes and it can grow significantly as man ages. At 60 years old, a man's prostate can become so large that it can push itself against the urethra, blocking the flow of urine in the process. It also becomes prone to cancerous cells. If cancer is suspected, a tissue sample will be obtained through a biopsy that can confirm the presence of cancer.

Who should undergo and expected results

There are usually two major reasons why a urologist, a doctor who specializes in the urinary system and the male's reproductive system, request for a prostate biopsy.

One, the urologist suspects the symptoms point to cancer. These include difficulty in urination, blood in semen or urine, burning sensation during urination, pain in the thighs or the lower back, and erectile dysfunction. The biopsy may also be used to rule out other prostate-related diseases that have similar symptoms like prostatitis or inflammation of the prostate.

Second, the results of the prostate-specific antigen (PSA) test reveal certain abnormalities. PSA is a blood test that measures the amount of prostate proteins in the body and is sometimes taken as part of routine cancer screening among men, particularly those who are considered high-risk, such as those who are 60 and older, African-American, obese, and with a family history of the disease.

Abnormalities in the PSA reading don't always mean cancer. In some cases, for example, they indicate benign tumors. A biopsy is conducted to confirm if the tumors are benign or malignant before a treatment plan is designed for the patient.

How the procedure works

Prior to conducting the biopsy, the urologist will explain the procedure in detail to the patient who will have to sign a form signifying that he is consenting to the procedure. Details that will be covered include the benefits, risks, and possible complications of the biopsy.

The patient's vital signs will then be checked before he is ushered to the lab where he removes all his clothes and changes to a lab gown. He is then provided with a local or general anesthetic as well as antibiotics to minimize the risk of infection.

In a biopsy, a needle is used to collect tissue samples. There are three ways to do it: through the rectum (transrectal), through the skin in between the scrotum and anus, or through the penis passing through the urethra. In a transrectal biopsy, the patient will undergo an enema to clear the bowel and the procedure will be performed using an ultrasound for guidance. A biopsy needle is then inserted to collect at least 10 to 12 tissue samples.

The entire procedure takes just 15 minutes to complete and the results will be available within a week.

Possible risks and complications

After the biopsy, it's normal for the patient to feel slight discomfort and bleeding. However, if the latter continues for more than a day, the patient is advised to seek medical help right away. Also, although antibiotics are provided before the procedure, infection may still occur, especially if the patient has prostatitis.

There's also the possibility that the results are inconclusive, which means it's not clear whether the patient has cancer or not. This could be because there's not enough tissue samples collected to confirm it. In such case, the doctor may either request for another biopsy or wait for further symptoms to appear. The accuracy of the results can also be a potential risk as they could be false-positive, which could force the patient to undergo unnecessary tests and treatment, or false-negative, which may prevent the doctor from treating cancer promptly.

References:

  • Aliotta PJ, Fowler GC. Prostate and seminal vesicle ultrasonography and biopsy. In: Pfenninger JL, Fowler GC, eds. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011:chap 121.

  • American Cancer Society. How Is Prostate Cancer Diagnosed? Updated 3/12/21015. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-diagnosis. Accessed 9/1/2015.

  • Trabulsi EJ, Halpern EJ, Gomella LG. Ultrasonography and Biopsy of the prostate. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 97.

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