Prostate needle biopsy is the only definitive method to diagnose prostate cancer.
It is conducted under ultrasound guidance typically without sedation. The ultrasound probe is passed into the rectum to take measurements of the prostate then to guide needle core samples of about 12 areas around the prostate after the injection of local numbing medication.
When to ask a Urologist about Prostate Needle Biopsy
You should speak with a Urologist about Prostate Needle Biopsy if you have an elevated PSA level or if there are abnormalities on your digital rectal examination.
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Transrectal ultrasound-guided prostate needle biopsy is the gold standard method to diagnose prostate cancer. Ultrasound itself rarely can identify discrete prostate tumors, and therefore the biopsy samples are obtained randomly in an even pattern from the different geographic regions of the prostate. Due to this distribution and relatively small overall percentage of tissue removed, the biopsy is positive about 70% of the time when prostate cancer is present. Consequently continued follow-up is important even with negative findings. Although prostate MRI is improving and useful in certain circumstances, it is not currently recommended prior to initial biopsy.
Possible Side Effects
The risks of prostate needle biopsy include about a 50% chance of minor blood in the urine, stool and semen for up to 6 weeks and a 2% chance of temporary difficulty urinating, serious bleeding or serious infection requiring hospitalization. About 5% of men experience simple urinary tract infection. Urinary burning or frequency may last for several days. There has never been conclusive evidence that prostate biopsy affects erectile function in any way.
No other methodologies exist to definitively diagnose prostate cancer. An alternative is observation though this approach risks advancement of a possible underlying prostate cancer.
What to do to Prepare for Procedure
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive. To limit infectious risk, you will be prescribed antibiotics for the day of the procedure. If you do not have regular bowel movements, you will be instructed to perform an enema at home on the day of procedure to clear stool from the area.
Unless the procedure is planned with sedation, you may eat and drink on the day of surgery. You should take your other home medications as usual. Certain patients with higher likelihood of colonization with antibiotic resistant bacteria will be asked to arrive early for an additional antibiotic injection (recent antibiotic use, healthcare workers, recent foreign travel).
What to Expect after Procedure
The procedure is typically performed without sedation in the outpatient setting after a local injection of numbing medication. The entire procedure takes about 10 minutes. At the conclusion of the procedure, rectal pressure will be temporarily held with the ultrasound probe or finger to stop any lingering bleeding areas. The pathology results are typically returned in 1-2 weeks. Most patients have minor bleeding notable in the urine, stool and semen. Unless performed with sedation, you can drive yourself home. You may have some blood spotting from the rectum on the drive home and may want to consider placing a pad on your car seat.