A prostate biopsy is a medical test in which a number of small tissue samples are removed from the male prostate gland and examined for signs of cancer.
What is the Prostate?
The prostate is a walnut-shaped gland that is part of a man’s reproductive system. It is located in front of the rectum, just below the bladder, and it surrounds the urethra (the tube in the urinary tract that transports urine from the bladder out of the body). The prostate produces fluid that makes up a large percentage of the ejaculate from the penis.
When is a Prostate Biopsy Done?
Physicians may order a prostate biopsy in a few situations:
- Abnormalities in a rectal examination: General practicioners perform these physical prostate exams--during which they use a gloved, lubricated finger (or "digit") inserted into the rectum to look for unusual tissue growth--as part of a man's annual check-up. When doctor feel a lump or something else abnormal during a rectal exam, they typically order a prostate biopsy.
- Elevated blood levels of prostate-specific antigen (PSA): PSA is a protein produced by the prostate. Historically, physicians believed that high PSA levels may indicate the presence of prostate cancer and ordered it as a routine screening test. However, a growing body of research has shown that high levels of PSA may be associated with other conditions, such as prostatitis. If elevated PSA is accompanied by other symptoms, a biopsy can determine whether prostate cancer is present.
The Prostate Biopsy Procedure
The most common method for a prostate biopsy uses transrectal ultrasound to guide a hollow needle to the prostate.
The ultrasound wand, an instrument just a little larger than a pen, is inserted into the rectum and moved into place near the prostate, where it can transmit images of the prostate and surrounding tissues. A spring-loaded needle is then inserted into the rectum and guided to the prostate. Several small pieces of tissue are sampled from both sides of the prostate, then sent to a lab to be examined by a pathologist—a doctor trained in diagnosing disease based on tissue and other biological samples.
The prostate biopsy, which takes around 30 minutes, can be done under local anesthesia at a doctor’s office or an outpatient clinic. If necessary, a sedative can also be prescribed to help a patient relax before the procedure starts.
How to Prepare for a Prostate Biopsy
A patient may be asked to self-administer an enema before the procedure in order to clean out the rectum and decrease risk of infection. He may also be prescribed antibiotics as an additional precaution against infection; these should be taken an hour before the procedure and for two to three days following it.
Additionally, certain drugs can increase the risk of bleeding. A patient shouldn't change medications unless instructed by his doctor, but should inform his physician if he is taking any of the following:
- Aspirin or other pain medications, such as ibuprofen and other NSAIDS
- Blood thinning medications, such as warfarin or heparin
- Herbal medicines, some of which can also act as blood thinners (including gingko biloba, garlic, ginseng, and fish oil)
Prostate Biopsy Risks and Side Effects
The most common side effects of a prostate biopsy are:
- Pain in the rectum and perineum (the area between the scrotum and the rectum)
- Blood in the semen and blood in the urine, which can last for 4 to 6 weeks
- Infection, such as a mild fever or a urinary tract infection (UTI)
If the patient experiences more severe symptoms, including chills, pain or high fever—or if he is concerned about any of his symptoms—he should contact his doctor immediately.
It usually takes a few days to get the results of a prostate biopsy. If they indicate the presence of cancer in the prostate, imaging exams (like a CT scan or MRI) may be conducted to see how far the cancer has spread. After that, various prostate cancer treatment options are available.
Trabulsi EJ, Halpern EJ, & Gomella LG. (2011). Ultrasonography and biopsy of the prostate. Campbell-Walsh Urology, 10th. ed.