Prostate biopsy

A prostate biopsy is a test which involves the use of thin needles to take small samples of tissue from the prostate.

A prostate biopsy is undertaken to diagnose prostate cancer. The biopsy results show how aggressive the cancer is, ie how likely it is to spread beyond the prostate. This is referred to as the Gleason grade, Gleason score or grade group.

The procedure is advised for patients whose prostate blood test is in an abnormal range, or whose prostate looks unhealthy on examination by a doctor, in order to take views to guide treatment.

The main kind of prostate biopsy is a TRUS – trans-rectal ultrasound guided biopsy. Patients can also have a template (transperineal) biopsy.

A prostate biopsy is the only way of discovering for certain if you have prostate cancer. It can pick up a faster-growing cancer at an early stage, when it is possible to treat it to stop it spreading to other parts of the body. It can assess how aggressive your cancer is, and help your doctor decide which treatment options are appropriate for you through analysis in the lab of tissue samples containing cancerous cells.

The disadvantages are that the biopsy can only show if there is cancer in the samples taken, so up to one in five cancers might be missed. You may need another biopsy if their symptoms persist. There are some side-effects and risks, including the risk of serious infection. The biopsy may also detect a slow-growing or non-aggressive cancer that may not lead to any problems in a patient’s lifetime, but which may cause them anxiety if left untreated.

The doctor will show you diagrams of how the biopsy is done on a computer, give you leaflets and advise on follow-up. You will confirm that you are not on blood-thinning tablets e.g. warfarin or aspirin, or be advised to stop taking them as appropriate.

You will be given a prescription for antibiotics to take before the biopsy to help prevent infection, and for antibiotics to take at home afterwards.

On the day of the biopsy, you will come in with someone who can take you home afterwards. The consultant will take consent and go through the benefits and side-effects of the procedure.

You will lie on your side on an examination table with your knees up towards your chest. The doctor or nurse puts an ultrasound probe into the rectum, applying a gel to reduce discomfort. The probe scans the prostate, bringing up an image on the screen which is used as a guide for where to take the cells from.

The procedure is uncomfortable and can be painful, so you are given local anaesthetic to numb the area around the prostate. The doctor or nurse puts a needle alongside the probe in the rectum, inserts it into the prostate and takes up to 12 small pieces of tissue from different areas of the prostate.

The biopsy takes 10-15 minutes. Generally, you will be asked to stay until you pass urine, then sent home with an appointment to see your consultant within two weeks.

Possible side effects of the procedure include pain or discomfort, short-term bleeding from the water pipe or the back passage, infection including sepsis, acute urine infection and very rarely erectile dysfunction.

Some men may experience pain in their back passage for a few days or weeks after a prostate biopsy – mild pain-relieving drugs such as paracetamol may be prescribed to ease this.

It’s normal for about two weeks after a prostate biopsy to see small amounts of blood in your urine or bowel movements, and for a couple of months afterwards to notice blood in your semen. This should get better by itself – if it doesn’t, you should see a doctor.

Antibiotics are taken after a prostate biopsy to prevent infection, but even patients who take them may develop an infection.

Symptoms of urine infection include:

  • pain or a burning sensation when urinating
  • strong-smelling, dark or cloudy urine
  • needing to urinate more often than usual
  • pain in the lower abdomen.

Patients who develop any of these symptoms should connect the doctor or nurse who treated them in hospital or their GP right away.

Around 3 per cent of men who have undergone a prostate biopsy may get a more serious infection that requires admission to hospital. If it spreads to the bloodstream, it is called sepsis, a very grave condition with symptoms including:

  • fever
  • chills and shivering
  • a fast heartbeat
  • fast breathing
  • confusion or behavioural changes.

A small number of patients discover that attempting to urinate is painful and they are unable to pass any urine after the procedure, because the biopsy has caused the prostate to swell. Patients who find themselves in this situation should contact the doctor or nurse who treated them or go to A&E – they may need a catheter for a few days.

Men can continue sexual activity normally after a prostate biopsy. A small number of men may experience erectile dysfunction – this should get better over time, usually within two months.

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