What is the prostate cancer biopsy?

Your internist or family doctor or community clinic will have recommended you for a prostate biopsy, if prostate cancer is suspected.  A urologist will likely be the clinician who performs your biopsy.  You may hear this called a transrectal ultra sound (TRUS) guided prostate needle biopsy.

TRUS guided prostate needle biopsy

A prostate biopsy involves taking small pieces of prostate tissue to be looked at more closely under the microscope. The aim of a biopsy is to detect prostate cancer that has the potential to cause symptoms or affect your life expectancy.

Your urologist should talk to you about the advantages and disadvantages of having a biopsy and discuss any concerns you may have before you decide whether or not to have the test, before the test is performed.

If you decide to have a biopsy you should be given written information about the procedure and what it involves.

What does a biopsy involve?

If you decide to have a biopsy, you may be given an appointment to come back to the hospital at a later date or you may be offered a biopsy straight away.

The biopsy involves taking around ten to 15 small samples of tissue from the prostate. If you have a bigger prostate you may have more samples taken. You should be told how many to expect. A trans rectal ultrasound scan (TRUS) is carried out at the same time and helps the urologist to guide the biopsy needles and measure the size of the prostate gland.

Before the biopsy you should tell your doctor or nurse if you are taking any medicines, particularly drugs to prevent blood clots (anti-coagulants), including warfarin, aspirin or clopidogrel.

About half an hour before your biopsy you will be given antibiotic tablets or an antibiotic injection to help prevent infection. You will need to continue your course of antibiotics when you go home. After the biopsy you may also be given an antibiotic suppository in your rectum .

The ultrasound probe is lubricated with gel and passed into your back passage (rectum), as shown below. The probe is the size of a fat finger. Some men find this a little uncomfortable. You should also be given a local anaesthetic injection into the prostate to help reduce any discomfort when the biopsy samples are taken. The needle is then placed down the shaft of the probe and is passed through the wall of the back passage into the prostate gland, under the guidance of the ultrasound image.

You may feel a short sharp sensation each time the needle goes in. Each man is different and while some describe the biopsy as painful, others have only slight discomfort. The biopsy will take 10 to 15 minutes. You may be asked to wait for about half an hour after the biopsy or until you have passed urine before going home.

What are the possible side effects of biopsy?

Short-term bleeding

Once you have gone home, you may see blood in your urine or bowel motions for up to two weeks. You may find blood in your semen for up to six weeks. If it takes longer than this to clear up, or gets worse after a period of recovery, you should see a doctor straight away.

Urine retention

Some men are unable to pass urine after a biopsy. This is called urine retention. If this happens to you it is important to contact your doctor or specialist team urgently or visit the accident and emergency (A&E) department.

Infection

A small number of men (about one per cent) get an infection of the blood called septicaemia, which can cause symptoms similar to flu. It is very important to take all of the antibiotics that you have been given to help prevent this happening. If you have a high temperature, pain or burning when you pass urine, or difficulty passing urine, you may have an infection, even if you have been taking antibiotics. If you have these symptoms you should go to your local hospital emergency room right away.

What are the advantages and disadvantages of a biopsy?

Advantages

Biopsy is the most accurate way of finding out whether prostate cancer is present in the prostate gland, and if so, how much cancer is present in the samples taken. This can help your specialist team to decide which treatment options may be suitable for you.

Disadvantages

The biopsy can only show whether there was cancer found in the samples taken. If your biopsy result is normal it cannot rule out cancer completely. This is because the biopsy collects tissue from a small area of the gland, so it is possible that cancer can be missed.

The biopsy may find a slow growing cancer that may not have caused any symptoms or shortened your life. If your results suggest you have slow growing prostate cancer you may face difficult decisions about treatments which may cause significant side effects.

What do my biopsy results mean?

A doctor who specialises in examining cells using a microscope (pathologist) will examine the biopsy samples and will tell your specialist if any cancer is found. They will also tell your urologist how many samples are affected and how much cancer is present in each sample.

If no cancer is found

If no cancer is found this is obviously reassuring. However, strictly speaking this would mean ‘no cancer found’ rather than ‘no cancer present’. There could be a small cancer that the needles did not hit. Your urologist will want to keep an eye on your prostate with further PSA tests and DREs.

If your PSA stays higher than normal and the doctor cannot find any other cause, you may be invited to have another biopsy in the future.

If further TRUS biopsies are negative but your urologist still suspects that cancer is present, you may be offered a template or saturation biopsy.

Template or saturation biopsy

This type of biopsy involves taking more tissue samples than a TRUS biopsy. You will usually have about 32 to 60 samples taken from different areas of the prostate gland. This procedure is usually carried out under a spinal or general anaesthetic but may occasionally be carried out under a local anaesthetic if necessary.

During the template biopsy an ultrasound probe is passed into the back passage so that the doctor can see where the needles are placed. The needles are then inserted through a grid (or template) passing into the prostate gland through the perineum (the area of skin between the scrotum and back passage).

There is a greater chance of finding prostate cancer cells using one of these biopsies because more of the prostate is being examined, however the cancer may be small or very slow growing and may not cause any troublesome symptoms or shorten your life expectancy. Talk to your urologist about the advantages and disadvantages of this type of biopsy.