According to the American Cancer Society, about 217,730 new cases of prostate cancer will be diagnosed in the United States in 2010, resulting in about 32,050 deaths. Modern methods of detection, such as the prostate-specific antigen, or PSA, test or the digital rectal exam, or DRE, allow many prostate cancers to be found earlier and treated more effectively. If these tests suggest the possibility of cancer, a prostate biopsy may help to make a more definitive diagnosis.
Early Testing Increases Survival Rates
Prostate cancer is the second-leading cause of cancer deaths in men in the United States, behind only lung cancer. Despite this grim statistic, more than 2 million men in the United States who have been diagnosed with prostate cancer are still alive. The National Cancer Institute reports that for all men with prostate cancer, the relative five-year survival rate is 99.1 percent and the relative 10-year survival rate is 91 percent. This high survival rate is due in large part to early testing, either by PSA analysis or DRE. If either of these tests reveals abnormalities, a biopsy may be performed to further determine if cancer is present.
Approaches to a Prostate Biopsy
According to the Mayo Clinic, if a urologist determines that a biopsy is warranted, and if the patient agrees, a tissue sample is removed from the prostate to determine whether the lump is in fact cancerous. In most cases, doctors retrieve biopsy samples through the wall of the rectum, called a transrectal biopsy. Less often, the prostate is accessed through the tip of the penis and through the urethra, known as a transurethral biopsy, or alternatively, through the space between the anus and scrotum, called a transperineal biopsy.
Transrectal Biopsy
The transrectal prostate biopsy is the procedure most commonly performed because it is the least invasive. According to the American Cancer Society, a thin ultrasound probe is inserted into the rectum to create images of the prostate to guide the biopsy device into place. After the prostate is numbed with an anesthetic injection, the biopsy device, using a hollow, spring-propelled needle, will pierce the wall of the rectum to enter the prostate gland. From 10 to 12 thin, cylindrical samples of tissue are retrieved in the hollow needle from several locations on the prostate.
Transurethral Biopsy
A less common procedure is a transurethral biopsy, which involves the insertion of a device called a cystoscope through the tip of the penis and into the urethra. According to the Prostate Cancer Treatment Guide, the cystoscope is lighted and allows the physician to directly observe the prostate. A cutting loop is passed through the cystoscope to retrieve a small sample of prostate tissue, and is then pulled out. The cutting loop works by turning and extracting a small amount of tissue with each turn.
Transperineal Biopsy
A third variation of this procedure is the transperineal biopsy. It first requires that a 2- to 3-millimeter incision be made in the perineum, the area in front of the anus extending to the scrotum, to allow a hollow sampling needle to penetrate the prostate. The urologist must hold the prostate stationary by inserting a finger into the rectum while the procedure is performed. When the needle is inside the prostate, it is turned and withdrawn, along with a tissue sample.
