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Biopsy for Prostate Cancer

Prostate biopsy is done to confirm the presence or absence of cancer cells in the prostate. It involves removing small pieces of prostate for examination under a microscope to differentiate benign from cancer. The prostate biopsy is essential to confirm with certainty the diagnosis of prostate cancer.

Who Should Undergo Prostate Biopsy?  

Usually a prostate biopsy is recommended when other tests show a suspected malignancy in the prostate gland. That is, if the urologist recommend a biopsy is that he has detected an abnormality in the prostate. The abnormality may be detected during physical examination by digital rectal examination during which the health care provider felt an abnormal mass or hardening. Prostate problems may also be suspected during imaging technique procedures (MRI for instance) or blood test: PSA levels may be too high. All these results may suggest the presence of cancer. However, many prostate diseases can cause symptoms similar to cancer. Therefore, a microscopic analysis in the laboratory by pathologist (biopsy) is crucial to confirm or refute the doubts. 

Prostate Biopsy Procedure 

A prostate biopsy requires some preparations, although it is practiced on an outpatient basis (no hospitalization required), and lasts between 10 and 20 minutes. The night before the exam and sometimes two hours before the biopsy, the patient must take an antibiotic prescribed by the health care provider. This treatment aims at preventing infections of the prostate after the procedure. In addition, a rectal enema can be required. It is better to undergo the examination with the rectum empty. The ultrasound probe must be able to easily enter the rectal wall and especially make a visible image. If the patient is undergoing treatment to reduce blood clotting, or taking anticoagulants or antiplatelet platelet, it is important to stop taking his medications several days (about 8 days) before the biopsy; a prostate biopsy can cause bleeding. 

A prostate biopsy may be performed under local or general anesthesia. It is rather local anesthesia that is often recommended since the discomfort of the exam is still moderate and that biopsies are relatively painless and well tolerated. Once the patient is fully anesthetized, the urologist takes fragments of prostate using a needle through the rectal wall, all under endorectal ultrasound (ERUS) guidance. 

During the biopsy, the patient lies either in the lithotomy position (on the back, legs apart) or lying on the side. The doctor then introduced through the anus, the ultrasound probe protected, lubricated and equipped with a harmless recording system. It is through this ultrasound device that the doctor can then follow the path of the needle on his screen. The urologist will then perform the biopsy itself, by removing tiny amount of tissue, usually 12 to 18 punctures in general. The needle penetrates and withdraws quickly into the prostate. The punctures are painless. It is recommended, however, that after the biopsy the patient lie a few minutes longer, because getting up quickly can cause dizziness. Even in the absence of complications, it is common to see trace of blood in stool, urine or semen, during the few days following the biopsy. This is normal. The rectal wall and prostate have been punctured in several places.  

Prostate Biopsy Complications 

The antibiotic treatment that was prescribed and the patient took a few hours before the biopsy is used to prevent the risk of prostatitis that are rare risks which can occur in less than 2% of cases. However, in very rare cases, it can happen that some patients develop a form of sepsis which requires immediate medical care. Therefore, if in the following days, the patient experiences a fever over 38.5 ° C, chills, malaise, or urinary burning, he must notify his health care provider immediately. This is a therapeutic emergency. 

Microscopic Analysis of the Samples 

Each sample taken from the prostate during the biopsy will be deposited in a separate tube. These tubes will be then sent to the pathology laboratory for analysis under a microscope. Results will be announced in consultation at the earliest possible, not later than eight to ten days. If the biopsy is positive, the urologist will guide the patient for an appropriate prostate cancer treatment. If the biopsy is negative, this does not mean the patient does not have prostate cancer. If the suspicion is too strong, the doctor may request to perform a repeat biopsy or to have more frequent monitoring. This is what happens in 15 to 20% of negative biopsies. 

 

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