If you're facing a prostate biopsy, it's natural to be apprehensive. Here's a realistic guide to this commonly-performed procedure.
An abnormal prostate-specific antigen (PSA) test provides an important clue to your prostate health. But it cannot determine with certainty whether you have prostate cancer. Until more sophisticated tests are developed, a biopsy of the prostate -- though not perfect -- is the best way to find out whether a high PSA level indicates cancer.
About 800,000 prostate biopsies are performed in the U.S. each year. Known formally as transrectal ultrasound-guided biopsy, prostate biopsy is an in-office procedure that takes about 15 minutes to perform. Despite its reputation as a very painful procedure, a prostate biopsy can be performed with minimal to moderate pain through the use of lidocaine, a local anesthetic. Lidocaine gel can be applied inside the rectum, or the anesthetic can be injected through the rectal wall to numb the nerves around the prostate. Some urologists also may give a mild sedative before the procedure. Good pain control not only keeps you comfortable during the prostate biopsy, but it also helps ensure that the proper number of samples can be taken.
You will be advised to discontinue blood-thinning medications like aspirin, Coumadin (warfarin), or Plavix (clopidogrel) seven-10 days before the prostate biopsy to help prevent excess bleeding after the procedure. If you take vitamin E, fish oil, ginkgo biloba, or other dietary supplements with blood-thinning effects, be sure to let your doctor know. He or she may recommend that you stop taking those as well.
Because the prostate biopsy usually is taken through the wall of the rectum, an enema is required the day of the procedure to clean out the intestines and reduce the risk of fecal contamination and infection. As an extra precaution against infection, most doctors also prescribe an antibiotic to be taken before and after the prostate biopsy.
During the prostate biopsy, you will be asked to lie on your side, with your knees pulled toward your chest. A thin ultrasound probe is inserted into the rectum. The probe emits sound waves that are converted into video images of the prostate. These images are used to guide the lidocaine injection (if one is used) and to position the biopsy device. The spring-loaded biopsy “gun,” with its hollow, ultra-thin needle, is mounted on the ultrasound probe. The biopsy device is directed at varied areas of the prostate, removing a thin (1/16 of an inch) column of prostate tissue (called a core) with each split-second firing through the rectal wall. At least 10-12 cores should be taken and sent to the pathologist for evaluation.
You may experience minor rectal bleeding, or see blood in your stool or urine for a few days. Small amounts of blood in your semen may give it a pinkish tinge for several weeks.
Bear in mind that infection is rare but serious. Call your doctor if you experience any symptoms of infection: fever, painful urination, or discharge from the penis. You also should call your doctor if you experience heavy or prolonged bleeding; significant pain, swelling, or redness near the biopsied area; or difficulty in urinating.
