Prostate biopsy

A prostate biopsy is a medical procedure that involves taking small tissue samples from the prostate, a gland located below the bladder in men. These samples are then examined under a microscope to see if there are any abnormal or cancerous cells. This test is usually performed if is still suspected a prostate cancer.

When is a biopsy necessary?

Typically, your doctor will recommend a prostate biopsy if your PSA (prostate-specific antigen) blood levels are higher than normal, or if you feel lumps or other abnormalities during a digital rectal exam. Sometimes, it may also be indicated if a previous exam showed abnormal but noncancerous cells.

How is it done?

The procedure lasts about 10-15 minutes and is usually done under local anesthesia, so you shouldn't feel any pain.

Before the biopsy, your doctor may ask you to do a few things:

• Provide a urine sample to rule out infections.
• Take antibiotics to prevent infections after the procedure.
• Temporarily stop anticoagulant medications to reduce the risk of bleeding.

Prostate biopsy can be performed using two main approaches: transrectal ultrasound (TRUS) and transperineal.

Both techniques aim to collect samples of prostate tissue to identify the possible presence of tumor cells, but they differ in terms of access methods, risk profile and diagnostic accuracy (source).

Transrectal biopsy (TRUS)

This is the most traditionally used technique. The biopsy needle is inserted through the rectal wall under ultrasound guidance.

It's a quick procedure, performed under local anesthesia, and widely available. However, passing through the rectum involves greater exposure to intestinal bacteria, with a higher risk of post-procedural infections, including sepsis.

Transperineal biopsy

In recent years, transperineal biopsy has become increasingly popular due to its improved infection safety profile. The needle reaches the prostate through the perineal skin, avoiding contact with the rectum.

This approach significantly reduces the risk of infection and allows for more accurate sampling of the anterior areas of the prostate, which are often less accessible with the transrectal technique. However, it generally requires deeper anesthesia and dedicated equipment (source).

What to expect after the biopsy?

After the biopsy, it's normal to see some blood in your urine or semen for a few weeks. You may also experience some rectal bleeding and difficulty urinating, but these symptoms usually resolve on their own. In rare cases, a temporary catheter may be necessary. If you develop an infection, your doctor will prescribe antibiotics.

What are the possible outcomes?

Tissue samples are analyzed to see if there are any cancer cells. If cancer is found, your doctor will assess its aggressiveness and discuss treatment options with you.

Limitations of biopsy

It's important to know that a prostate biopsy isn't foolproof. Sometimes it may miss cancer even if it's present, resulting in a false negative. In these cases, a second biopsy may be necessary.

Reference: https://www.mayoclinic.org/tests-procedures/prostate-biopsy/about/pac-20384734