Preparation
As with any medical procedure or intervention, the risks and benefits must be explained to the patient and consent obtained. Blood thinning medications such as warfarin must not be taken seven to 10 days before the biopsy. The patient should also be given antibiotic prophylaxis 30 to 60 minutes before the biopsy and continue it for three days; usually a fluoroquinolone class of antibiotic such as ciprofloxacin is used. The patient is also advised to use a cleansing enema at home before the biopsy, which reduces the amount of feces in the rectum. This helps with not only imaging of the prostate but also theoretically lowers the chance of infection. As far as pain control goes during the biopsy, local anesthesia is injected around nerve bundles. The patient is positioned in the left lateral decubitus position, with knees and hips flexed to 90 degrees.
Technique
The prostate is imaged with ultrasound to determine the best site for the biopsy. The doctor then uses a "biopsy gun" to insert a needle into the biopsy site. The needle is inserted roughly 0.5cm and samples the subsequent 1.5cm of tissue with the tip further advanced 0.5cm past the tissue being sampled. Pressing the probe against the rectum also minimizes the discomfort of needle advancement, and can reduce the risk of bleeding. The samples are then sent to pathologists for examination.
Risks
Infections have been reported after prostate biopsy, most of which are simple urinary tract infections. These are readily treated with antibiotics. One of the more common complications that can occur is bleeding, which can usually be controlled with pressure from the ultrasound probe during biopsy. Some men also experience varying amounts of blood in the ejaculate. This is not of major concern, but can cause significant distress in patients if not discussed earlier. Occasionally, some patients tend to retain urine in their bladder after biopsy, which can necessitate catheterization; this is usually temporary, and normal urinary function returns shortly after biopsy.
References
- "Campbell-Walsh Urology, 9th Edition;" Wein; 2007
- "Urology"; Contemporary Prostate Biopsy Complication Rates in Community-Based Urology Practice; Sieber, P., et al.; September 2007
