A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. The prostate is a small, walnut-shaped gland in men that produces fluid that nourishes and transports sperm.
During a prostate biopsy in Iran a needle is used to collect a number of tissue samples from your prostate gland. The procedure is performed by a doctor who specializes in the urinary system and men's sex organs (urologist).
Your urologist may recommend a prostate biopsy if results from initial tests, such as a prostate-specific antigen (PSA) blood test or digital rectal exam, suggest you may have prostate cancer. Tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly it's likely to progress and to determine your best treatment options.
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A prostate biopsy is used to detect prostate cancer.
Your doctor may recommend a prostate biopsy if:
. A PSA test shows levels higher than normal for your age
. Your doctor finds lumps or other abnormalities during a digital rectal exam
. You've had a previous biopsy that was normal, but you still have elevated PSA levels
. A previous biopsy revealed prostate tissue cells that were abnormal but not cancerous.
Prostate biopsy samples can be collected in different ways. Your prostate biopsy may involve:
. Passing the needle through the wall of the rectum (transrectal biopsy). This is the most common way of performing a prostate biopsy.
. Inserting the needle through the area of skin between the anus and scrotum (transperineal biopsy). A small cut is made in the area of skin (perineum) between the anus and the scrotum. The biopsy needle is inserted through the cut and into the prostate to draw out a sample of tissue. An MRI or CT scan is generally used to guide this procedure.
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Your doctor should talk to you about the advantages and disadvantages of having a biopsy. If you have any concerns, discuss them with your doctor or specialist nurse before you decide whether to have a biopsy.
. It’s the only way to find out for certain if you have cancer inside your prostate.
. It can help find out how aggressive any cancer might be in other words, how likely it is to spread.
. It can pick up a faster growing cancer at an early stage, when treatment may prevent the cancer from spreading to other parts of the body.
. If you have prostate cancer, it can help your doctor or nurse decide which treatment options may be suitable for you.
. If you have prostate cancer, you’ll usually need to have had a biopsy if you want to join a clinical trial in the future. This is because the researchers may need to know what your cancer was like when it was first diagnosed.
. The biopsy can only show whether there was cancer in the samples taken, so it’s possible that cancer might be missed.
. It can pick up a slow growing or non-aggressive cancer that might not cause any symptoms or problems in your lifetime. You’d then have to decide whether to have treatment or whether to have your cancer monitored. Treatment can cause side effects that can be hard to live with. But having your cancer monitored rather than having treatment might make you worry about your cancer.
. A biopsy has side effects and risks, including the risk of getting a serious infection.
. If you take medicines to thin your blood, you may need to stop taking them for a while, as the biopsy can cause some bleeding for a couple of weeks.
Having a biopsy can cause side effects. These will affect each man differently, and you may not get all of the possible side effects.
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Some men feel pain or discomfort in their back passage (rectum) for a few days after a TRUS biopsy. Others feel a dull ache along the underside of their penis or lower abdomen (stomach area). If you have a transperineal biopsy, you may get some bruising and discomfort in the area where the needle went in for a few days afterwards.
If you receive anal sex, wait about two weeks, or until any pain or discomfort from your biopsy has settled, before having sex again. Ask your doctor or nurse at the hospital for further advice.
Some men find the biopsy painful, but others have only slight discomfort. Your nurse or doctor may suggest taking mild pain-relieving drugs, such as paracetamol, to help with any pain.
If you have any pain or discomfort that doesn’t go away, talk to your nurse or doctor.
It’s normal to see a small amount of blood in your urine or bowel movements for about two weeks. You may also notice blood in your semen for a couple of months it might look red or dark brown. This is normal and should get better by itself. If it takes longer to clear up, or gets worse, you should see a doctor straight away.
A small number of men (less than 1 in 100) who have a TRUS biopsy may have more serious bleeding in their urine or from their back passage (rectum). This can also happen if you have a transperineal biopsy but it isn't very common. If you have severe bleeding or are passing lots of blood clots, this is not normal. Contact your doctor or nurse at the hospital straight away, or go to the accident and emergency (A&E) department at the hospital.
Some men get an infection after their biopsy. This is more likely after a TRUS biopsy than after a transperineal biopsy. It's very important to take any antibiotics you’re given, as prescribed, to help prevent this. But you might still get an infection even if you take antibiotics.
Symptoms of a urine infection may include:
. Pain or a burning feeling when you urinate
. Dark or cloudy urine with a strong smell
. Needing to urinate more often than usual
. Pain in your lower abdomen (stomach area).
If you have any of these symptoms, contact your doctor or nurse at the hospital straight away. If you can’t get in touch with them, call your GP.
Around 3 in 100 men (three per cent) who have a TRUS biopsy get a more serious infection that requires going to hospital. If the infection spreads into your blood, it can be very serious. This is called sepsis. Symptoms of sepsis may include:
. A high temperature (fever)
. Chills and shivering
. A fast heartbeat
. Fast breathing
. Confusion or changes in behaviour.
If you have symptoms of sepsis, go to your nearest hospital A&E department straight away.
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A small number of men find them suddenly and painfully can’t urinate after a biopsy this is called acute urine retention. This happens because the biopsy can cause the prostate to swell, making it difficult to urinate. Acute urine retention may be more likely if you have a template biopsy. This is because more samples are taken, so there may be more swelling.
Your doctor will make sure you can urinate before you go home after your biopsy. If you can’t urinate, you might need to have a catheter for a few days at home – this is a thin tube that’s passed into your bladder to drain urine out of the body.
If you develop acute urine retention at home, contact your doctor or nurse at the hospital straight away, or go to your nearest A&E department. You might need a catheter for a few days.
You can masturbate and have sex after a biopsy. If you have blood in your semen, you might want to use a condom until the bleeding stops.
A small number of men have problems getting or keeping an erection (erectile dysfunction) after having a biopsy. This may happen if the nerves that control erections are damaged during the biopsy. It isn’t very common and it should get better over time, usually within two months. Speak to your doctor or nurse if you’re worried about this.
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To prepare for your prostate biopsy, your urologist may have you:
. Provide a urine sample to analyze for a urinary tract infection. If you have a urinary tract infection, your prostate biopsy will likely be postponed while you take antibiotics to clear the infection.
. Stop taking medication that can increase the risk of bleeding such as warfarin (Coumadin), aspirin, ibuprofen (Advil, Motrin IB, others), and certain herbal supplements for several days before the procedure.
. Do a cleansing enema at home before your biopsy appointment.
. Take antibiotics 30 to 60 minutes before your prostate biopsy to help prevent infection from the procedure.
During the procedure, the doctor inserts an ultrasound probe into the rectum to create an image of the prostate gland. The prostate is located just on the other side of the rectal wall.
Using the ultrasound image as a guide, the doctor removes several samples from the prostate with a spring-loaded tool.
The device quickly punches a needle through the rectal wall into the prostate and removes minute cylindrical cores of cells. Typically, a biopsy removes around 10 to 12 core samples, usually five or six from each side of the prostate.
In some cases, a doctor may decide that a larger sample is needed. In these cases, the doctor performs a "saturation" biopsy, which collects 20 to 30 samples, sometimes more.
The entire procedure takes about 20 minutes. After the biopsy, doctors may suggest that men take an antibiotic to prevent infection.
Another procedure called a transperineal biopsy involves making a small cut between the anus and the scrotum. The biopsy needle is inserted through the cut and into the prostate and extracts a sample of tissue. The doctor will likely use an ultrasound scan to guide the procedure.
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Your doctor will likely recommend that you do only light activities for 24 to 48 hours after your prostate biopsy.
You'll probably need to take an antibiotic for a few days. You might also:
. Feel slight soreness and have some light bleeding from your rectum.
. Have blood in your urine or stools for a few days.
. Notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen. This can last for several weeks.
Call your doctor if you have:
. Difficulty urinating
. Prolonged or heavy bleeding
. Pain that gets worse
A doctor who specializes in diagnosing cancer and other tissue abnormalities (pathologist) will evaluate the prostate biopsy samples. The pathologist can tell if the tissue removed is cancerous and, if cancer is present, estimate how aggressive it is. Your doctor will explain the pathologist's findings to you.
Your pathology report may include:
. A description of the biopsy sample. Sometimes called the gross description, this section of the report might evaluate the color and consistency of the prostate tissue.
. A description of the cells. Your pathology report will describe the way the cells appear under the microscope. Prostate cancer cells may be referred to as adenocarcinoma. Sometimes the pathologist finds cells that appear abnormal but aren't cancerous. Words used to describe these noncancerous conditions include "prostatic intraepithelial neoplasia" and "atypical small acinar proliferation."
. Cancer grading. If the pathologist finds cancer, it's graded on a scale of 2 to 10 called the Gleason score. Cancers with a high Gleason score are the most abnormal and are more likely to grow and spread quickly.
. The pathologist's diagnosis. This section of the pathology report lists the pathologist's diagnosis. It may also include comments, such as whether other tests are recommended.
It can take up to two weeks to get the results of the biopsy. Ask your doctor or nurse when you're likely to get the results. You might be sent a copy of the pathology report. And you can ask to see copies of letters between the hospital and your GP. If you have trouble understanding any of the information, ask your doctor to explain it or speak to our Specialist Nurses.
If cancer is found
If cancer is found, this is likely to be a big shock, and you might not remember everything your doctor or nurse tells you. It can help to take a family member, partner or friend with you for support when you get the results. You could also ask them to make some notes during the appointment.
It could help to ask your doctor if you can record the appointment using your phone or another recording device. You have a right to record your appointment if you would like to because it’s your personal data. But let your doctor or nurse know if and why you are recording them as not everyone is comfortable being recorded.
Your biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.
When cells are seen under the microscope, they have different patterns, depending on how quickly they’re likely to grow. The pattern is given a grade from 1 to 5 – this is called the Gleason grade. Grades 1 and 2 are not included on pathology reports as they are similar to normal cells. If you have prostate cancer, you will have Gleason grades of 3, 4 and 5. The higher the grade, the more likely the cancer is to spread outside the prostate.
There may be more than one grade of cancer in the biopsy samples. An overall Gleason score is worked out by adding together two Gleason grades.
The first is the most common grade in all the samples. The second is the highest grade of what’s left. When these two grades are added together, the total is called the Gleason score.
Gleason score = the most common grade + the highest other grade in the samples
Your doctor might also talk about your "grade group". This is a new system for showing how aggressive your prostate cancer is likely to be. Your grade group will be a number between 1 and 5.
The higher your Gleason score or grade group, the more aggressive the cancer and the more likely it is to grow and spread. We've explained the different Gleason scores and grade groups that can be given after a prostate biopsy below. This is just a guide. Your doctor or nurse will talk you through what your results mean.
Gleason score 6 (3 + 3) All of the cancer cells found in the biopsy look likely to grow very slowly, if at all (grade group 1).
Gleason score 7 (3 + 4) Most of the cancer cells found in the biopsy look likely to grow very slowly, if at all. There are some cancer cells that look likely to grow at a moderate rate (grade group 2).
Gleason score 7 (4 + 3) Most of the cancer cells found in the biopsy look likely to grow at a moderate rate. There are some cancer cells that look likely to grow slowly (grade group 3).
Gleason score 8 (3 + 5) Most of the cancer cells found in the biopsy look likely to grow slowly. There are some cancer cells that look likely to grow quickly (grade group 4).
Gleason score 8 (4 + 4) All of the cancer cells found in the biopsy look likely to grow at a moderate rate (grade group 4).
Gleason score 8 (5 + 3) Most of the cancer cells found in the biopsy look likely to grow quickly. There are some cancer cells that look likely to grow slowly (grade group 4).
Gleason score 9 (4 + 5) Most of the cancer cells found in the biopsy look likely to grow at a moderate rate. There are some cancer cells that are likely to grow quickly (grade group 5).
Gleason score 9 (5 + 4) Most of the cancer cells found in the biopsy look likely to grow quickly. There are some cancer cells that look likely to grow at a moderate rate (grade group 5).
Gleason score 10 (5 + 5) All of the cancer cells found in the biopsy look likely to grow quickly (grade group 5).
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Your doctor will look at your biopsy results to see what type of prostate cancer you have.
For most men who are diagnosed, the type of prostate cancer is called adenocarcinoma or acinar adenocarcinoma – you might see this written on your biopsy report. There are other types of prostate cancer that are very rare.
If no cancer is found this is likely to be reassuring. However, this means ‘no cancer has been found’ rather than ‘there is no cancer’. Sometimes, there could be some cancer that was missed by the biopsy needle.
What happens next?
Your doctor or nurse will talk you through what your results mean. You might need scans to find out whether the cancer has spread outside the prostate and where it has spread to.
Your doctor will look at all of your test results with a team of health professionals. You might hear this called your multi-disciplinary team (MDT). Based on your results, you and your doctor will talk about the next best step for you.
Your doctor will look at your other test results and your risk of prostate cancer so that you can discuss what to do next.
If your doctor thinks you may have prostate cancer that hasn’t been found, they might suggest having another biopsy or an MRI scan.
If your doctor thinks you probably don’t have prostate cancer, they may offer to monitor your prostate with regular PSA tests to see if there are any changes in the future.
You will feel some pressure when the probe is inserted, but it is usually not painful. Usually between 6 – 12 (sometimes more) prostatic tissue samples are obtained and the entire procedure lasts about 10 minutes. A local anesthetic can be used to numb the area and reduce any pain, Doctors usually take a dozen samples from various parts of the prostate. The idea of such a procedure can make men nervous and it sounds painful. But the biopsy usually causes just brief discomfort. You may notice some blood in your pee and there could be some light bleeding from your bottom.
Post biopsy restrictions and instructions:
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Biopsies taken to diagnose prostate cancer commonly cause temporary erectile dysfunction and, in some cases, lingering urinary problems. Approximately 17 percent of biopsies resulted in complications, the most common of which included infections, bleeding and urinary retention. The overall complication rate decreased by 10 percent. However, the rate of individual complications increased from 14 to 18 percent, mostly due to infection.
You cannot drive for 24 hours after your procedure or until pain allows and an emergency stop can be handled pain free. Please arrange for someone to take you home from hospital after your procedure.
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