Prostate Cancer Diagnosis

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Prostate Biopsy

A prostate biopsy is carried out to diagnose prostate cancer after receiving abnormal PSA and/or DRE results. There are two types of prostate biopsies routinely performed. The most common way that a biopsy is performed is transrectally. Typically, a transrectal biopsy is performed whereby a small spring-loaded needle is inserted through the anus and rectal wall into the prostate. This biopsy is guided by a transrectal ultrasound (TRUS) to enable visualisation of the prostate. This does not identify where the cancer is, but ensures samples are taken from different parts of the prostate in a systematic fashion. Transperineal prostate biopsies sample the prostate via the perineum, the area of skin between the scrotum and anus, also under TRUS guidance.

Sedation or pain relief is used for TRUS biopsies. A general anaesthetic is generally required for a transperineal biopsy, although it may sometimes be performed under local anaesthetic.

Biopsies are targeted to the peripheral zone of the prostate, where most prostate cancers occur. The number of biopsy cores taken with a TRUS biopsy is generally 10-12, but up to 18 cores may be taken. Generally, a greater number of cores will be taken via a transperineal biopsy [1, 2].  In some men who have had negative biopsies but continuing suspicion of prostate cancer remains, a “saturation” biopsy method may be performed whereby 20 or more cores are sampled from the prostate. This method follows the theory that the larger number of evenly distributed samples will increase the likelihood of picking up a cancer[3].

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Preparation for biopsy

To reduce the risk of infection following prostate biopsy, antibiotics are prescribed around the time of the biopsy. Use of anticoagulants should cease or be reduced prior to biopsy. There is a small chance of bleeding complications following TRUS biopsies. [4].

Side effects of biopsy

While most men have an uncomplicated biopsy with no side effects there are a number of possible side effects that can be experienced.

Bleeding from the rectum can occur in the hours, and sometimes days following biopsy. Sometimes men may need to wear a pad in their underwear to manage this bleeding. Men may also notice some blood in their urine. Blood can also be present in the ejaculate following a prostate biopsy for up to six months, depending on the number of times of ejaculation.

There is a 2-5% risk of significant infection, or sepsis following a TRUS guided prostate biopsy, which can require hospitalisation in severe cases.

Follow up after a biopsy

Once the pathologist has examined the biopsy specimens they will make a report on it. This report generally takes between 5-10 days following the biopsy. A follow-up appointment with your specialist will be scheduled to discuss these results. 

1.               Chun, F.K., et al., Optimizing performance and interpretation of prostate biopsy: a critical analysis of the literature. Eur Urol, 2010. 58(6): p. 851-64.

2.               Harvey, C.J., et al., Applications of transrectal ultrasound in prostate cancer. Br J Radiol, 2012.

3.               Raja, J., et al., Current status of transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer. Clin Radiol, 2006. 61(2): p. 142-53.

4.               Chowdhury, R., et al., Should warfarin or aspirin be stopped prior to prostate biopsy? An analysis of bleeding complications related to increasing sample number regimes. Clin Radiol, 2012.

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