According to the American Cancer Society, almost 290,000 Americans have been diagnosed with prostate cancer since the beginning of 2023. While there are different ways to initially assess for the disease, only a prostate biopsy can definitively give a diagnosis. Here’s what you need to know about the procedure.
Generally, your doctor might ask you to undergo a prostate biopsy if they suspect you have cancer. This suspicion may be spurred by the presence of lumps during a digital rectal exam, high prostate-specific antigen (PSA) levels, or a previous biopsy that showed abnormal prostate tissue cells but they weren’t cancerous at the time. It’s also common to do another biopsy if the first one showed no cancerous cells but your PSA levels are still elevated.
Before doing a biopsy, there are a few things that your doctor will recommend to get you prepared. Since a biopsy carries a small risk of infection, you may be asked to take antibiotics beforehand to prevent that.
The procedure can also cause bleeding so you may have to stop taking any medication or supplements that increase bleeding risk a few days before doing the biopsy. These medications include ibuprofen, aspirin, and warfarin.
Additionally, it’s typical for you to provide a urine sample so your doctor can check for a urinary tract infection. If you have an infection, they won’t do the procedure and you’ll have to reschedule it once you’ve taken a course of antibiotics to treat the problem.
The last thing you usually need to do to prepare for a biopsy is to take an enema at home to make things easier during the procedure.
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The purpose of a biopsy is to collect tissue from the prostate for a laboratory examination. While this tissue is usually collected using a thin biopsy needle, the details of the procedure can vary depending on the method that’s used.
In the transrectal method, a surgeon uses a transrectal ultrasound to guide the biopsy needle through the rectal wall into the prostate gland. In the perineal method, a surgeon makes an incision between your scrotum and rectum.
After inserting a finger into the rectum to stabilize your prostate gland, they will insert the biopsy needle through the incision to take tissue samples from the prostate.
In the transurethral method, a surgeon inserts a flexible tube and viewing device known as a cystoscope into your penis. The tube is sent up to the prostate gland. They’ll then use other instruments to collect tissue from the prostate.
Regardless of which procedure your doctor employs, you’re likely to be given general or local anesthesia to numb any pain. It’s also essential to talk to your doctor about what to expect after the procedure. Some of the common effects include soreness in the rectum, light bleeding from the rectum, and blood in your urine, semen, or stool. If the pain gets worse, you develop a fever, the bleeding gets heavier, or you have difficulty urinating, you should call your doctor immediately.
If the results of the biopsy show that the cells aren’t cancerous, then your doctor is likely to propose regular monitoring to see what happens in the future. The monitoring may include another biopsy, PSA test, or physical examination in a few months.
If the cells are cancerous, the pathologist will use the samples to determine the stage of your prostate cancer. It will also be given a grade from 2 to 10 where the lower end of the scale describes tumors that aren’t aggressive. Staging and grading your cancer will be essential to determining the course of treatment that your doctor will recommend.
Non-aggressive cancer may be treated through surgery as the cancerous cells haven’t spread to any other organs. If the tumors have spread, you may need additional treatment like chemotherapy, immunotherapy, radiation therapy, or hormone therapy.
A prostate biopsy is how your doctor will determine if you have prostate cancer. Though there are risks, it’s an essential part of getting a diagnosis and determining what kind of treatment you need. If your doctor decides that you need a biopsy, it’s a good idea to have a detailed conversation about what to expect.
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