Table of contents:
- When is biopsy recommended
- How a prostate biopsy is performed
- How to prepare for the biopsy
- How to understand the biopsy result
- Possible complications of the biopsy
Prostate biopsy is the only test capable of confirming the presence of prostate cancer and involves the removal of small pieces of the gland to be analyzed in the laboratory, in order to identify the presence, or not, of cells evil.
Usually, this test is recommended by the urologist when cancer is suspected, especially when the PSA value is elevated, when changes are found in the prostate during digital rectal examination, or when an MRI of the prostate is performed with suspicious findings. Check out the 6 tests that assess prostate he alth.
Prostate biopsy does not hurt, but it can be uncomfortable and for this reason it is usually done under local anesthesia or light sedation. After the examination, it is also possible for the man to feel some burning in the region, but it will go away in a few hours.
When is biopsy recommended
Prostate biopsy is indicated in the following cases:
- Altered prostate rectal examination;
- PSA above 2.5 ng/mL up to age 65;
- PSA over 4.0 ng/mL over 65 years;
- PSA density above 0.15 ng/mL;
- Speed of PSA increase above 0.75 ng/mL/year;
- Multiparametric MRI of the prostate classified as Pi Rads 3, 4 or 5.
In most cases, prostate cancer, when present, is identified soon after the first biopsy, but the exam can be repeated when the doctor is not satisfied with the result of the 1st biopsy, especially if there is:
- PSA persistently elevated and with a velocity greater than 0.75 ng/mL/year;
- High-grade prostatic intraepithelial neoplasia (PIN);
- Atypical proliferation of small acini (ASAP).
The second biopsy should only be performed 6 weeks after the first one. If a 3rd or 4th biopsy is necessary, it is advisable to wait at least 8 weeks.
Watch the following video and learn about other tests that the doctor can perform to identify prostate cancer:
How a prostate biopsy is performed
The biopsy is performed with the man lying on his side, with his legs bent, properly sedated. Next, the doctor makes a brief assessment of the prostate by performing a digital rectal examination, and after this assessment, the doctor introduces an ultrasound device into the anus, which guides a needle to a location close to the prostate.
This needle makes small punctures in the intestine to reach the prostate and collects several pieces of tissue from the gland, and from the regions around it, which will be analyzed in the laboratory, in search of cells that may indicate the presence of cancer.
How to prepare for the biopsy
Biopsy preparation is important to avoid complications and usually includes:
- Take the antibiotic prescribed by the doctor, for about 3 days before the exam;
- Fast for 6 hours before the exam;
- Do a bowel cleansing before the exam;
- Urinating a few minutes before the procedure;
- Bring a companion to help you return home.
After the prostate biopsy, the man should also take prescribed antibiotics, eat a light diet for the first few hours, avoid physical exertion for the first 2 days, and maintain sexual abstinence for 3 weeks.
How to understand the biopsy result
Prostate biopsy results are usually ready within 14 days and can be:
- Positive: indicates the presence of cancer developing in the gland;
- Negative: collected cells showed no change;
- Suspect: an alteration has been identified that may or may not be cancer.
When the result of the prostate biopsy is negative or suspicious, the doctor may ask for a repeat of the exam to certify the results, especially when he suspects that the result is not correct due to the other tests performed.
If the result is positive, it is important to stage the cancer, which will help to adjust the treatment. See the main stages of prostate cancer and how to treat it.
Possible complications of the biopsy
Since it is necessary to perforate the intestine and remove small pieces of the prostate, there is a risk of some complications such as:
1. Pain or discomfort
After the biopsy, some men may experience slight pain or discomfort in the anus area, due to scarring of the intestine and prostate.If this happens, the doctor may advise the use of some mild painkillers, such as Paracetamol, for example. Usually, the discomfort disappears within 1 week after the exam.
The presence of a little bleeding in your underwear or toilet paper is completely normal during the first 2 weeks, even in the semen. However, if the amount of blood is very high or disappears after 2 weeks, it is advisable to go to the doctor to identify if there is any bleeding.
Since the biopsy causes a wound in the intestine and prostate, there is an increased risk of infection, especially due to the presence of various types of bacteria in the intestine. For this reason, after the biopsy, the doctor usually recommends the use of an antibiotic.
However, there are cases in which the antibiotic is not enough to prevent infection and, therefore, if you have symptoms such as fever above 37.8ºC, intense pain or strong-smelling urine, it is advisable to go to the hospital to identify if there is an infection and start the appropriate treatment.
4. Urinary retention
Although more rare, some men may experience urinary retention after a biopsy due to inflammation of the prostate, caused by the removal of pieces of tissue. In these cases, the prostate ends up compressing the urethra, making it difficult for urine to pass.
If this happens, you should go to the hospital to remove the accumulation of urine from the bladder, which is usually done with the placement of a urinary catheter. Understand better what a urinary catheter is.
5. Erectile Dysfunction
This is the rarest complication of the biopsy but, when it arises, it usually disappears within 2 months after the exam. In most cases, the biopsy does not interfere with the ability to have intimate contact.