What is a Prostate Biopsy?
A prostate biopsy (sampling of tissue with needles) is the definitive method to diagnose prostate cancer. It is not a perfect test but it remains the only method to do so. This is usually performed after screening tests (PSA and prostate examination) are done and the patient is deemed to have a reasonable chance of having prostate cancer.
How is it done?
This is an outpatient procedure takes about 15 to 20 minutes. It can be done either under local anaesthetic or under intravenous sedation. You will be asked to lie in a left lateral position, with your knees tucked into your chest and your buttocks at the edge of the bed. A drip will be put into your arm. Sedative medications are then infused through the drip to make you sleepy. Antibiotics are also given this way.
A prostate examination with a gloved finger is first done to feel for any palpable abnormalities. A lubricated ultrasound probe is then inserted into the rectum and the prostate is visualised on the ultrasound machine. If you did not have IV sedation, then two injections of local anaesthetic will be given through the probe into the prostate, to numb the region.
The prostate volume is then measured on machine, whilst the local anaesthetic is taking effect. A biopsy needle is then inserted into the probe and samples will be taken at different parts of the prostate, one at a time. With each biopsy, you may hear a ‘pop’ sound as the needle gets deployed. Most of the time, about 12 samples will be taken. More samples may be taken if the prostate is large or if this is a repeat biopsy.
What are the possible complications?
You are expected to get some blood in the urine, the sperm and the stools. Most of the time, the bleeding settles down after a few days, but sometimes it can take a few weeks to do so. It is quite uncommon for the bleeding to be severe unless you have a bleeding disorder or you are on a blood-thinning medication that was not stopped before the biopsy.
Infection is a possibility too. This can range from a simple bladder infection (symptoms are burning when urinating, smelly urine, frequent need to urinate) to an infection in the blood system (sepsis). Sepsis is a dangerous complication that can happen in about 2% to 3% of patients even with the use of preventative antibiotics. The symptoms are feeling generally unwell, shakes, chills and fevers (> 38 degrees Celsius). This usually happens within a few days of the biopsy. If it occurs, you must go to the emergency department for admission into the hospital to get antibiotics treatment through a vein.
Some patients can go into urinary retention (cannot pass urine), especially if they have pre-existing prostate related bladder symptoms. If this happens, a catheter must be placed into the bladder to drain it.
How do I prepare for a prostate biopsy?
You will be given a 3-day course of antibiotics to take, starting on the day before the biopsy. It is important that you finish the whole course to reduce the chances of sepsis.
If you are on certain blood-thinning medications (eg. Aspirin, Warfarin, Plavix, Iscover), you may be asked to withhold them before the biopsy. Most of these medications take at least 5 to 7 days to clear out of your body, so you will need to follow the instructions (regarding when to stop them) very carefully. If the medication is not stopped adequately in advance, then the biopsy may be postponed due to the risk of bleeding. After the biopsy, you may be asked to keep withholding the medications for a few more days until the bleeding settles.
On the day of the biopsy, you have to fast (no food or drinks) from 6 hours prior, if you are having intravenous sedation. You do not need to fast if the biopsy is to be done under local anaesthetic.
What happens after the biopsy?
At the end of the procedure, a small sponge pack may be inserted into the rectum to help reduce some of the bleeding. You will be brought to the recovery area. Once you are able to pass urine, you should be able to go home. If you had sedation, you should not drive home.
You should rest well and drink lots of fluids at home. Remember to finish the course of antibiotics. Do light duties as long as there is still some bleeding. Once the bleeding stops, you can resume normal activities.
You will be given an appointment to follow up on your results, usually within 2 weeks. If you have any problems, you can contact us, your family doctor, or go to the emergency department.