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The Prostate Cancer Biopsy Procedure

The prostate biopsy is the taking of tissue samples from the prostate gland and examining them underneath a microscope for cell differentiation. Cancerous cells are shaped and arranged differently than healthy cells. The more differentiated cancerous cells are from healthy cells, the more aggressive the cancer. If the biopsy reveals no cancerous cells, either you do not have prostate cancer, or the prostate biopsy missed the tumor. If the doctor believes the biopsy missed a tumor based on other factors such as your family history, a particular irregularity in the digital rectal exam, or a rising PSA density, you will receive a follow-up biopsy in six months. Seventy-five percent of men have negative primary prostate biopsies.

Before the Prostate Biopsy
Before undergoing the biopsy, a patient may take antibiotics to reduce the risk of infection after the prostate biopsy. The patient also should stop anti-inflammatory drugs, such as aspirin or ibuprofen, that may increase the risk of bleeding after the biopsy. Finally, the doctor may also order an enema before the prostate biopsy to remove feces and gas that may complicate the transrectal biopsy.

Types of Prostate Biopsies
There are three types of prostate biopsies: the transrectal, the transurethral, and the transperineal. The transrectal prostate biopsy is guided by the transrectal ultrasound (TRUS) through the anus and into the rectum. The transurethral biopsy is performed with a lighted cystoscope up through the urethra so the doctor can look directly at the prostate gland. The transperineal biopsy collects the tissue through a small incision in the perineum.

The transrectal and transperineal prostate biopsies both use spring-loaded needles to collect their samples as quickly, efficiently, and painlessly as possible. The biopsy gun can collect between 6 and 13 samples, depending on how many a doctor believed is necessary to diagnose you correctly.

Transperineal Prostate Biopsy
Patients opting to undergo the transperineal biopsy may also be put under general anesthesia if they wish to be unconscious during the biopsy. Men who opt to have the transperineal biopsy performed may experience some tenderness as well as blood in the semen for one to two months afterwards.

Transrectal Prostate Biopsy
In the transrectal biopsy, transrectal ultrasound guides the doctor and the biopsy gun to the proper place. Patients who opt for this prostate biopsy may experience a small amount of bleeding from the rectum as well as blood and urine in the semen afterwards.

Transurethral Prostate Biopsy
The transurethral biopsy inserts the cystoscope into the urethra. Local anesthesia is given to numb the area. The doctor looks directly at the prostate through the cytoscope and then inserts a cutting loop to extract tissue. The cutting loop works by turning and extracting a small amount of tissue with each turn.

Side Effects of Prostate Biopsy
Only minimal pain is associated with both procedures, though, doctors are more commonly using local anesthesia to numb the tested area. After having the prostate biopsy, men may experience blood in their urine and their semen for a few weeks or up to two months afterwards. Some soreness or minimal bleeding (after the transperineal biopsy) may also be experienced for a few days. Some doctors recommend having someone drive the patient home to avoid unpleasantness or soreness. Also, patients who opt for local anesthesia may be groggy for a short time after the prostate biopsy. Patients may return to normal activities as soon as they feel able.

In all three procedures, the pathologist needs multiple samples from different areas of the prostate to make an accurate diagnosis. Remember, if a tumor is small enough, it can be missed during the prostate biopsy. A doctor will examine patient's circumstances and determine whether he needs a follow-up biopsy. If the pathologist does find prostate cancer, the next step is to assign a Gleason score.


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