Biopsy

A prostate biopsy consists in sampling one or more pieces of prostate tissue by going through the rectum wall. A biopsy is indicated with an abnormality has been detected by digital rectal exam or when PSA level is high. This sampling is done with a special needle. The doctor used an ultrasound probe to guide him as to where to take the tissue pieces.

A biopsy is the simplest way to sample prostate tissue without doing surgery. Different anomalies can be benign anomalies.

What should a patient do before a prostate biopsy ?

Sampling is done on an out-patient basis, most of the time without need for general anesthesia. According to the number of samplings needed to be done, a local anesthesia may be suggested. A bowel preparation may be useful to prevent the presence of stools and make the sampling easier. An antibiotic treatment before is necessary. he antibiotic treatment taken 2 hours before the biopsy helps in preventing urinary infection after the procedure.

If the sampling is done without general anesthesia, but under local anesthesia, the patient does not need to be NPO. To be more confortable it is advised to urinate before the biopsy. It is important that the patient mentions to the doctor all the medications he is taking especially the ones like aspirin, or anti coagulants. These medications decrease the coagulability of the blood and increase the risk of bleeding. On the day of the biopsy, the patient should be bringing with him:

The doctor’s prescription for the biopsy
The blood tests results previously done (especially PSA)
The radiography films done
A written list of all the medication he takes

How does a prostate biopsy occur ?

     First the urologist does a rectal ultrasound in order to properly visualize the area from where he will be taking the biopsy.

What is a rectal ultrasound?
     It consists in introducing an ultrasound probe in the anus to the rectum in order to obtain images of the prostate. It is done by a urologist or a radiologist. In general the doctor does a digital rectal exam before introducing the probe, which allows him to check the consistency of the prostate, and to lubricate the canal so that the introduction of the probe is the less uncomfortable possible. The probe that is sterilized and lubricated has a bigger size than a finger. It allows the doctor to properly visualise the prostate and surrounding organs. To facilitate the entrance of the probe, the doctor could ask the patient to “push” as if he wanted to pass a bowel movement.

     The doctor observes the images obtained through the ultrasound at a real time rate. If possible he can give the results to the patient and can send a report to the doctor that prescribed it. It is possible to repeat a rectal ultrasound has many times as needed without risk for the patient. It is not painful and lasts around 10 minutes. After that the doctor can realize prostate biopsies.

How does the doctor realize the sampling?
      The ultrasound probe is equipped with a guidance system that allows visualization of the entrance point of the automatic needle. This mechanism can produce a dull sound that can create surprise the first time it is heard. The prick is a bit painful: the needle penetrates and goes out of the prostate very rapidly. 6 to 12 samplings are done in different areas of the prostate: the superior region (base), the inferior region (apex) and the middle region. Additional biopsies can be taken if necessary. When the procedure is over, it is better to stay lying down for a few minutes to prevent dizziness. The quick and almost painless samplings are generally well tolerated by the patient. The discomfort increases with the duration of the procedure and the number of samplings done.

     Most of the patients only feel a mild discomfort. The duration of the procedure is between 5 to 15 minutes, depending on the number of samples taken. The patient can go home shortly after the procedure.
Then, the samples are observed under the microscope by a pathologist: histo-pathological exam of the sampled tissues. It is advised that the patient and his family obtain information such as this page, for them to know how the procedure is going to occur as well as its risks. This information paper should contain the number of the emergency department that should be contacted in case of complications.

What are possible complications of prostate biopsy ?

Mild bleeding in the stools and urine can happen up to a few days after the biopsy. Sometimes it stays in the sperm for a few weeks. The antibiotic treatment prescribed before the procedure will prevent an infection. Prostate infection after a biopsy is extremely rare (less than 2%) An additional antibiotic treatment after the procedure is necessary in case of malaise or painful urination.

In case of fever after the biopsy (more than 38.5°) a specific treatment should be started as soon as possible. It is important to communicate with the doctor as soon as those symptoms appear. It is advised not to do any intense exercises for 48h post procedure.

How do we get the results ?

It is through microscopic study of the tissues that it will be possible to confirm or not the diagnosis of cancer. The results of the biopsy are given to the doctor in a few days. The doctor then transmits the results to the patient. When the results do not show any cancerous abnormalities, the test is said to be negative. Other biopsies can be done in case some abnormalities are detected through digital rectal exam and the PSA level is increasing during follow up. When the doctor has the diagnosis he decides on the proper treatment.

If the biopsy reveals the presence of cancerous cells, the doctor can order additional tests to assess the spread of the disease, and help him choose the appropriate treatment. Those additional tests are not ordered systematically. The most common additional tests done are imaging studies (MRI, CT scan, Scintigraphy…) and blood tests.

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