A biopsy involves removing and examining tissue, cell, or fluid samples from a living body, according to Merriam-Webster's Medical Dictionary. Although a biopsy may be used to determine a number of diseases, a prostate biopsy is most often done to determine cancer.
Transrectal Ultrasound
Before a prostate biopsy the doctor conducts a physical exam, blood test and urinalysis to try to diagnose the problem. If these tests eliminate other possible diseases, the National Kidney and Urologic Diseases Information Clearinghouse says the doctor may conduct a transrectal ultrasound. This is an imaging technique using high-frequency sound waves to produce a picture of the prostate. The ultrasound probe is inserted into the rectum to produce the image on the monitor.
Preparation for Prostate Biopsy
If the picture shows suspicious looking areas in the prostate, the doctor may recommend that a urologist conduct a needle biopsy. MayoClinic.com says that before a prostate biopsy, precautions are taken to minimize risks of bleeding and infections that can occur. The doctor likely will ask that you stop any medications that reduce blood clotting, such as aspirin, warfarin or nonsteroidal anti-inflammatory drugs. A cleansing enema may be done at home before the appointment, and an antibiotic may be given an hour or so before the procedure.
Needle Biopsy
This 20- to 30-minute procedure is typically performed in the doctor's exam room under local aesthetic. It involves a special hollow needle designed to extract tissue samples. It usually is inserted through the wall of the rectum, or the perineum, the area between the anus and scrotum. Less often, it may be necessary to go through the tip of the penis. Using transrectal ultrasound the urologist guides the needle into the suspicious mass to collect tissue samples from the mass, and sometimes from other areas of the prostate. The standard, according to the Prostate Cancer Treatment Center, is a sample of six to 12 cores, meaning the doctor takes samples from multiple areas of the prostate. The doctor sends the samples to a pathologist to be examined under a microscope.
Risks And Complications
Prostate biopsy carries rare risks of infection and urinary difficulties following the procedure, according to MayoClinic.com. More common are the risks of bleeding at the biopsy site and blood in the semen. Up to half of those who undergo a prostate biopsy experience blood in the semen, but this is not serious and will usually resolve within four to six weeks. Patients often continue taking antibiotics for a few days, and most feel soreness or discomfort where the needle was inserted.
Pathologist's Report
A pathologist will examine the core samples taken from the prostate biopsy under a microscope to determine if any cancer cells are present. If there is, MayoClinic.com says the pathologist will determine how abnormal the cells are and grade them on a scale called the Gleason Score, which tells the urologist how aggressive or fast-growing the cancer is likely to be. A low score indicates slow-growing cancer, and a high score indicates fast-growing cancer. The pathologist's report will also show the number of samples taken, and the percentage of cancer cells found in the samples. All this information will guide the urologist in recommending and planning treatment.
