Prostate Biopsy: Transrectal Ultrasound Guided

                                                                                                                    
A prostate gland biopsy is a procedure to obtain small samples of prostate tissue to be examined under a microscope. 

During a transrectal prostate biopsy, a thin spring loaded needle is inserted through the rectum guided by transrectal ultrasound. Twelve to twenty four cores of tissue are taken and are sent to a uropathologist to be examined under a microscope.
The pathologist performs special staining and processing of the tissue cores to specifically detect cancer cells.

A transrectal prostate biopsy takes about 10 minutes.

Results are usually available within two weeks.
If cancer cells are present, a grade called a Gleason score will be given, which your doctor will discuss with you. The Gleason score is a tool used by the pathologist for predicting how aggressive the cancer is.

A prostate biopsy is ordered when a blood test shows a high level of prostate-specific antigen (PSA) or after a digital rectal examination finds an abnormal prostate mass or a lump.

Tell your doctor if:

The prostate biopsy is done through the rectum, so you will need to give yourself an enema before the biopsy. Special instructions for this will be given to you when the biopsy is scheduled. It is extremely important for you to complete this as directed because it will significantly reduce your chance for infection. 

Before your prostate biopsy, you will also be requested to take antibiotics. The instructions and prescriptions will also be given when the biopsy is scheduled. It is again extremely important that you fill the prescriptions and take the antibiotics exactly as prescribed. This will also 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 local anesthesia. Sometimes it is performed under general anesthesia, if a larger number of cores are needed.

Following the biopsy, you will be asked to avoid strenuous activities for about 4 hours. You may have mild pain in the pelvic area and blood in your urine for up to 5 days. Also, you may 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 rectal exam, so a repeat biopsy will be performed if there is further suspicion of disease.
  • Not all types of prostate cancer are treated. There are many things 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, etc. 
  • A prostate gland biopsy does not cause problems with erections and will not make a man infertile.