Prostate biopsy is a procedure in which several samples are obtained directly from the prostate to find out if the patient has prostate cancer.
What types of prostate biopsy are there?
Prostate biopsy is called “transrectal” because it is performed through the rectum, which is the last part of the intestine. To obtain the samples, an ultrasound scanner is used, which has a channel or duct through which a needle is inserted to automatically obtain several 15-20 mm samples. The visualization of the prostate during the whole procedure thanks to the ultrasound machine allows us to be very selective at the moment of obtaining the sample.
There is another type of prostate biopsy which is not performed through the rectum, but the samples are obtained through the skin of the perineum area (between the anus and the scrotum). This access route requires general anesthesia, hospital admission for its performance, and more special and expensive equipment, so it is used much less.
Does it require any previous preparation?
It is usually advisable to give a small enema to facilitate visualization of the prostate during the ultrasound, as well as to give an antibiotic prior to the biopsy to avoid infection of the prostate.
Is anesthesia required?
General anesthesia is not necessary to perform a prostate biopsy. The administration of local anesthesia allows the biopsy to be performed with little discomfort and, once it is over, the patient can return home.
When is it necessary to perform a prostate biopsy?
There are mainly two reasons why a prostate biopsy should be performed.
The first of these is the finding in a routine blood test of elevated PSA (prostate specific antigen) levels. PSA is a substance produced in the prostate that travels through the blood and is elevated mainly when there is prostate cancer, but also when the prostate is inflamed or infected, which is known as prostatitis.
The second reason for performing a biopsy is when we find an abnormally hard area on the surface of the prostate when we perform a rectal examination or digital rectal examination. We must remember that the best certainty or information to diagnose prostate cancer is offered by the PSA and the digital rectal exam together. That is why it is not enough to have a normal PSA, but we must always perform a rectal examination as well. The reason is that there are prostate cancers that do not produce PSA and generally have the worst prognosis, and only a digital rectal examination is capable of detecting them.
What complications can appear after a prostate biopsy?
Complications are rare. The most frequent is the expulsion of blood in the urine or stool. No treatment is necessary for this as both situations resolve spontaneously in a few hours. Another more infrequent complication is infection of the prostate, which would cause fever and the need to start appropriate antibiotic treatment. To avoid this complication, a dose of antibiotic is administered preventively before the biopsy.
Are there any radiological tests or techniques that can avoid prostate biopsy?
At present, neither CT, MRI nor ultrasound can reliably identify the existence of prostate cancer. The biopsy is always necessary to confirm the diagnosis of cancer and it also gives us a lot of information about the aggressiveness of that cancer since not all prostate cancers are equally bad.
What we do know already is that prostate MRI should always be performed before any prostate biopsy, as it is able to detect the most aggressive cancers which are the most dangerous and will need immediate treatment.