John J. Bauer, M.D.
Needle Biopsy of Prostate
John J. Bauer, MD, Urologist
The anxiety associated with the words "you need to have a biopsy of your prostate" is often higher than what the biopsy entails, and may be because of why the biopsy is required rather than the biopsy itself.
Prostates are usually biopsied because of the concern that there may be a cancer present. This may be because the prostate does not feel normal on a digital rectal exam (finger exam of the prostate), because the PSA is elevated, or an ultrasound exam of the prostate is abnormal. None of these exams are diagnostic enough on their own or in combination to know if cancer is present or not. Only the biopsy is accurate enough to make the diagnosis of cancer. The digital rectal exam (DRE) feels the size and texture of the prostate. Most cancers feel hard in comparison to the normal prostate and thus a lump or irregularity of the prostate needs further evaluation. The PSA is often elevated in patients with cancer of the prostate, but is NOT the only reason for an elevation. However, it may be the only indication of an underlying cancer. The transrectal ultrasound images the prostate with sound waves. It often "sees" things that the physician is unable to feel with a finger. The usual abnormality associated with a cancer is a hypoechoic lesion, but once again not all hypoechoic lesions are cancer. Thus to be accurate with the diagnosis of cancer, a biopsy must be done so that the pathologist can examine the tissue under the microscope.
The usual biopsy consists of six cores of tissue (six biopsies), one each from the base, mid portion, and apex of the gland from each side of the prostate. Additional biopsies may be done if the ultrasound or rectal exam is abnormal.
We currently use a spring-loaded biopsy gun to do our biopsies that allows us to do each biopsy in about 1/10 of a second. Thus, the pain associated with the biopsy is usually minimal. Patients tell us that almost half the biopsies are not felt, and the remainder is tolerable. There is the discomfort associated with the finger in the rectum as this biopsy is done through the rectum.
Other potential problems associated with the biopsy include bleeding, either into the rectum or into the urine. Usually this is a minor amount of blood noted with either a small streak of blood on the stool later that day or on the stool the next day or a pink tinged urine. Occasionally, the bleeding may be severe in which the patient moves his bowels a short time later and all of the "stools is blood. This degree of bleeding needs to be stopped immediately by burning the site of the bleeding. It is rare to have enough bleeding into the urine to cause a problem with urination due to the clot in the bladder, but this bleeding also needs to be treated urgently. Blood in the semen is a common problem and may be noted for months after a biopsy either because of a red color or because of a brown colored semen. The other main problem associated with a biopsy is the potential for infection. Because of this, patients are given a short course of antibiotics.
What do we learn from the biopsy? The biopsy establishes whether cancer is truly present or not. No other test is accurate enough to make the diagnosis. Occasionally, even the biopsy fails to make the diagnosis and the biopsy may have to be repeated. The biopsy also allows the pathologist to grade the tumor (how nice looking or how ugly is this tumor). It also helps in staging the tumor (how much is present). All of these help in determining if and how the patient should be treated.
As a rule, the biopsy goes very well with very little problems. For the majority of patients the biopsy is an uncomfortable experience. After the biopsy there are no restrictions with activity, sexual activity, or diet.