What Is A Prostate Biopsy?
Your prostate gland is an organ that lies under your bladder and surrounds your urethra (tube that carries urine and semen to the tip of your penis (see figure 1).
Your prostate gland produces a fluid that makes up part of your semen and nourishes the sperm. The fluid enters your urethra through two ejaculation glands. A prostate biopsy involves removing small pieces of tissue from your prostate gland using a needle. The procedure is performed by an urologist (doctor who specialises in urinary tracts and the male reproductive system).
Figure 1 The prostate gland
Dr Vasudevan has recommended a prostate biopsy. However, it is your decision to go ahead with the procedure or not.
This document will give you information about the benefits and risk to help you to make an informed decision. If you have any questions that this document does not answer, ask Dr Vasudevan.
What Are The Benefits Of A Prostate Biopsy?
It is normal for your prostate gland to get larger with age but sometimes the growth can be caused by prostate cancer.
Dr Vasudevan is concerned that there may be a problem with your prostate gland. You may already have had a rectal examination, MRI scan or blood test (PSA test) that has shown a problem.
The tissue that Dr Vasudevan removes will be examined under a microscope to help make the diagnosis to help Dr Vasudevan to decide the best treatment for you. If a problem is found, Dr Vasudevan will discuss the appropriate treatment for you.
If the biopsy is normal, Dr Vasudevan can reassure you accordingly.
Are There Any Alternatives To A Prostate Biopsy?
A blood test, urine test or scan may show that you have a problem but a biopsy may help to confirm the diagnosis and for Dr Vasudevan to decide the best treatment for you.
What Will Happen If I Decide Not To Have A Prostate Biopsy?
Dr Vasudevan may not be able to confirm what the problem is or decide the best treatment for you. If you decide not to have a prostate biopsy, you should discuss this carefully with Dr Vasudevan.
What Does The Procedure Involve?
Before the procedure
The healthcare team will carry out a number of checks to make sure you have the procedure you came in for. You can help by confirming to Dr Vasudevan and the healthcare team your name and the procedure you are having.
Dr Vasudevan will give you antibiotic tables and an antibiotic injection prior to the procedure. He will discuss this with you.
In the treatment room
A prostate biopsy usually takes less than 20 minutes. It involves using a biopsy needle to take samples of tissue from your prostate gland.
Dr Vasudevan will ask you to lie on your side with your knees drawn up. He will use a lubricating jelly to help place an ultrasound probe into your back passage. Any discomfort usually settles soon after the probe is in position.
Dr Vasudevan will use the ultrasound probe to take pictures of your prostate gland and assess the volume of your prostate.
The procedure is commonly done under a general anaesthetic.
Dr Vasudevan will pass a biopsy needle down the ultrasound probe, through the wall of your rectum and into your prostate gland. He will take a number of samples of tissue from your prostate gland (see figure 2).
Dr Vasudevan will remove the needle and then ultrasound probe on completion of the procedure. It is normal to have some minor bleeding from your back passage. The healthcare team will usually give you some absorbent pads to use.
What Should I Do About Medication?
Let Dr Vasudevan know about all the medication you take and follow his advice. This includes all blood-thinning medication as well as herbal and complementary remedies, dietary supplements, and medication you can buy over the counter.
What Complications Can Happen?
Dr Vasudevan will try to make the operation as safe as possible but complications can happen. Some of these can be serious. You should ask Dr Vasudevan if there is anything you do not understand. Dr Vasudevan may be able to tell you if the risk of a complication is higher or lower for you.
If you have any pain after the procedure let Dr Vasudevan know. It is common to have some discomfort in the perineum (the area between your scrotum and back passage), which can be controlled with simple painkillers such as paracetamol.
It is normal to have some bleeding from your back passage and in your urine for up to a week, and in your sperm for up to a month. Sometimes bleeding can be heavy and you may need a blood transfusion (risk: 1 in 500).
Infection (risk: 2 in 100)
To reduce the risk, you will be given antibiotics to take home for a few days after the procedure. Let Dr Vasudevan know if you get a high temperature, feel unwell or have a burning sensation when you pass urine.
Making a hole in nearby structures with the needle
This does not usually cause any problems.
To the equipment, materials or medication. The healthcare team is trained to detect and treat any reactions that might happen. Let Dr Vasudevan know if you have any allergies or if you have reacted to any medication or tests in the past. You should discuss these possible complications with Dr Vasudevan if there is anything you do not understand.
How Soon Will I Recover?
After the procedure you will be transferred to the recovery area where you can rest. You will be allowed to eat and encouraged to drink after about 10 minutes.
You should be able to go home after about 30 minutes, usually after you have passed urine. However, Dr Vasudevan may recommend that you stay a little longer.
A responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. Be near a telephone in case of an emergency. Do not drive, operate machinery (this includes cooking) or do any potentially dangerous activities for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination. You should also not sign legal documents or drink alcohol for at least 24 hours. If you take blood-thinning medication, Dr Vasudevan will tell you when you can start taking it again.
You should be able to return to work the next day unless you are told otherwise. Do not do strenuous exercise for one to two days.
If any bleeding from your back passage or in your urine does not settle within a few days, let Dr Vasudevan know.
Results from the biopsy will not be available for at least a week or two. Please ring Dr Vasudevan’s office to arrange a follow-up appointment. He will discuss the results with you and any treatment or follow-up you need.
There is a risk the biopsy may not detect a small cancer so, if your symptoms continue or PSA levels stay higher than normal, Dr Vasudevan may recommend another biopsy or further imaging.
If you smoke, stopping smoking will improve your long-term health.
Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.
Regular exercise should improve your long-term health.
A prostate biopsy is usually a safe and effective way of finding out if there is a problem with your prostate gland. However, complications can happen. You need to know about them to help you to make an informed decision about the procedure. Knowing about them will also help to detect and treat any problems early.