PROSTATE BIOPSY: HOW IS IT DONE AND WHAT’S INVOLVED?

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, also called a core needle biopsy, a fine needle is used to collect a number of tissue samples from your prostate gland.  A prostate biopsy is performed by a doctor who specializes in the urinary system and men’s sex organs (urologist).

Dr. Bellman may recommend a prostate biopsy if results from initial tests, such as a prostate-specific antigen (PSA) blood test or digital rectal exam (DRE), suggest you may have prostate cancer.

Following a prostate biopsy, 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 grow and spread and to determine your best treatment options.

Why is it Done?
A prostate biopsy is used to detect prostate cancer. Your doctor may recommend a prostate biopsy if:

• Results of a prostate-specific antigen (PSA) test are higher than normal for your age
• Your doctor found 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

Common risks associated with a prostate biopsy include:

• Infection- The most common risk associated with a prostate biopsy is infection. Rarely, men who have a prostate biopsy develop an infection of the urinary tract or prostate that requires treatment with antibiotics.
• Bleeding at the biopsy site- Rectal bleeding is common after a prostate biopsy. Don’t start taking any blood-thinning medications after your biopsy until your doctor says it’s OK.
• Blood in your semen- It’s common to notice red or rust coloring in your semen after a prostate biopsy. This indicates blood, and it’s not a cause for concern. Blood in your semen may persist for a few weeks after the biopsy.
• Difficulty urinating- In some men, prostate biopsy can cause difficulty passing urine after the procedure. Rarely, a temporary urinary catheter must be inserted.

To prepare you for your prostate biopsy, Dr. Bellman may have you:

• Stop taking medication that can increase the risk of bleeding, such as warfarin (Coumadin), aspirin, ibuprofen (Advil, Motrin, others), and certain herbal supplements for several days before the procedure
• Do a cleansing enema at home before your biopsy appointment
• Take A 3-day course of antibiotics ; starting the day before your prostate biopsy to help prevent infection

What to Expect During Transrectal Prostate Biopsy
In most cases, the urologist performs a transrectal prostate biopsy.  For this procedure, Dr. Bellman will start by having you lie on your side, with your knees pulled up to your chest.

After cleaning the area and applying gel, Dr. Bellman will gently insert a thin ultrasound probe into your rectum.  Transrectal ultrasonography is used to create images of your prostate using sound waves.  He will use the images to identify the area that needs to be numbed with an anesthetic injection, if one is used.  The ultrasound images are also used to guide the prostate biopsy needle into place.

In most cases, an injection of a numbing medication is used to reduce the discomfort associated with the prostate biopsy.  A needle is used to inject the anesthetic at various points near the base of the prostate.

Once the biopsy device is situated, Dr. Bellman will retrieve thin, cylindrical sections of tissue with a hollow, spring-propelled needle.  The procedure typically causes a very brief, uncomfortable sensation each time the spring-loaded needle takes a sample.  In most cases, doctors will take 10-14 tissue samples. The entire procedure usually takes about 10 minutes.

After a prostate biopsy, you may feel slight soreness and have some light bleeding from your rectum.  You may have blood in your urine or stools for a few days.  You may also 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.

Contact our office if you have:

Prolonged or heavy bleeding
Pain that gets worse
Swelling near the biopsy area
Difficulty urinating
In rare cases, a prostate biopsy can lead to infection. If you have any signs of infection, call our office immediately. Signs and symptoms of infection include:

• Fever
• Pain when urinating
• Discharge from your penis

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. The pathologist also compiles the laboratory findings in a pathology report that’s given to Dr. Bellman.  From there, he will explain the findings to you and, if you like, you can ask for a copy of your pathology report for future reference.