Prostate Biopsy: Fusion Transrectal Ultrasound Guided

                                                                                                                    
A prostate gland biopsy is a procedure to obtain small samples of prostate tissue to be examined under a microscope. This is done using MRI imaging obtained prior to the biopsy to detect abnormal areas to target.

During a transrectal prostate biopsy, a thin needle is inserted guided by transrectal ultrasound and superimposed on the MRI images with computer software to identify
the exact target areas. Twelve to twenty four cores of tissue are taken and are sent to a pathologist to be examined under a microscope. The pathologist performs special staining and processing of the tissue cores to specifically detect cancer cells.

Results are available within two weeks.
If cancer cells are present, a grade called a Gleason score is given. The Gleason score is a tool used by the pathologist for predicting how aggressive the cancer is.

Tell your doctor if:

Before your prostate biopsy, you will be requested to take antibiotics. The instructions and prescriptions will be given when the biopsy is scheduled. It is important that you fill the prescription and take the antibiotics exactly as prescribed. This will decrease the risk of infection significantly.

How it feels:

For a transrectal biopsy, you may feel pressure in the rectum while the ultrasound probe is guided in place. You also may feel a brief, sharp pain as the biopsy needle is quickly inserted into the prostate gland. Remember, it lasts just a few minutes and done with a prostate block. A patient may also use ProNox during the procedure for extra comfort and relaxation. 

Following the biopsy, you will be asked to avoid strenuous activities for about 24 hours. You may experience mild discomfort in the perineal area and a little blood in your urine
for a few days. You may also have some discoloration of your semen for one month or longer after the biopsy. It is also common to experience a small amount of bleeding from your rectum for 2 to 3 days after the biopsy.

After the biopsy call your doctor immediately if you:

  • Have heavy rectal bleeding or bleeding that continues longer than 2 to 3 days. You will see blood immediately after the biopsy, which is normal. (Some blood in the semen is normal too and can be seen for weeks afterwards. It takes several ejaculations to wash out the old blood).
  • Have increasingly severe pain.
  • Have a fever.
  • Are unable to urinate within 8 hours. 
  • Having some blood in the urine is normal, but if it is longer than 2 to 3 days, or you are passing clots please call.

What to think about:
  • Normal prostate biopsy results do not ALWAYS rule out cancer. A prostate biopsy is a systematic but random sampling and if there is only minimal disease, it can be missed. The good news that if there are so few cancer cells at the time of the biopsy, it may be not even warrant treatment until it becomes clinically significant.
  • The patient is followed with serial PSA blood levels and repeat imaging so a repeat biopsy will be performed if there is further suspicion of disease.
  • Not all types of prostate cancer are immediately treated. There are several factors to consider when deciding on a treatment plan: how many cores are positive on biopsy, the Gleason score and aggressiveness of the cancer, whether it is localized or more advanced, the age of the patient etc. 
  • A prostate gland biopsy does not cause problems with erections and will not make a man infertile.