Prostate biopsy: what is it, how is it done and possible risks

The prostate biopsy is the only test capable of confirming the presence of cancer in the prostate and consists of extracting small fragments of the gland to be analyzed in the laboratory with the aim of identifying the presence, or number, of malignant cells.

Generally, this exam is requested by a urologist when there is a suspicion of cancer, especially when the PSA value is high, when changes are found in the prostate during the rectal tact or when an MRI of the prostate is performed with suspicious hallazgos. Know the 6 exams that evaluate prostate health.

The prostate biopsy in the duel, however, can be uncomfortable and, therefore, is usually performed under local anesthesia or light sedation. After the examination, it is also possible for the man to experience something of ardor in the region, but it will take just a few hours.

when is indicated

The biopsy is indicated in the cases mentioned below:

• Altered prostate rectal touch;
• PSA greater than 2.5 ng/mL until age 65;
• PSA greater than 4 ng/mL after 65 years;
• PSA density above 0.15 ng/ml;
• PSA increase rate above 0.75 ng/mL/year;
• Multiparametric MRI of the prostate classified as Pi Rads 3, 4 or 5.

In the majority of cases, prostate cancer, when present, is immediately identified after the first biopsy, but it can be repeated when the doctor is not satisfied with the result of the first biopsy, especially if there is:

• persistently elevated PSA or at elevation and at a velocity greater than 0.75 ng/mL/year;
• High-grade prostatic intraepithelial neoplasia (PIN);
• Proliferation of atypical small acini (ASAP).

The second biopsy should be performed only 6 weeks after the first one. If a third or fourth biopsy is needed, it is advisable to wait at least 8 weeks.

See in the video other exams that the doctor can indicate:

See what are the symptoms of prostate cancer.

How is a prostate biopsy performed?

The biopsy is performed with the man lying on his side with the legs flexed, heavily sedated. The doctor performs a brief assessment of the prostate, performing the rectal tact and, after this initial assessment, the doctor introduces an ultrasound device in the year of the patient, which guides an aguja to a region around the prostate.

This aguja performs small perforations in the intestine to be able to reach the prostate, recovering several pieces of tissue from the gland and from the regions to its surroundings; this sample will be analyzed in the laboratory in search of cells that can indicate the presence of cancer.

How to prepare for the biopsy

Biopsy preparation is important to avoid complications and generally includes:

• Take the antibiotic prescribed by the doctor for 3 days before the exam;
• Carry out full ayuno, for at least 6 hours;
• Carry out a bowel cleansing before the exam;
• Pray a few minutes before the procedure;
• Acudir with a companion to help with the return home.

After the prostate biopsy, the man should also take the prescribed antibiotics, follow a light diet in the first hours, avoid physical exertion in the first 2 days and maintain sexual abstinence for 3 weeks.

How to interpret the biopsy result

The results of the prostate biopsy are usually found after 14 days and can be:

• Positive: indicates the presence of cancer developing in the gland;
• Negative: the sample of cells collected in the presentan alteration;
• suspicious: an alteration has been identified that may or may not be cancer.

When the biopsy result is negative or suspicious, the doctor may ask for a repeat examination to confirm the results, especially when it is suspected that the result is not good due to other tests performed.

In case the result is positive, it is important to carry out the stadification of cancer, which will help to adapt the treatment. Know the main stages of prostate cancer and how to carry out the treatment.

What are the possible risks of the biopsy

Since it is necessary to perforate the intestine and remove small parts of the prostate, there is a risk of some complications such as:

1. Pain or discomfort

After the biopsy, some men may have mild pain or discomfort in the region of the year, due to the healing of the intestine and prostate. In case this happens, the doctor may recommend the use of some mild analgesic, such as Paracetamol, for example. Usually, the discomfort disappears around 1 week after the examination.

2. Bleeding

The presence of a small hemorrhage in the underwear or in the toilet paper is completely normal during the first 2 weeks, even in the semen. However, if the amount of blood is much or does not disappear after 2 weeks, it is advisable to see a doctor to identify if there is any more severe bleeding.

3. Infection

Bearing in mind that the biopsy causes an inheritance in the intestine and in the 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 generally indicates the use of an antibiotic.

However, there are cases in which the antibiotic is not enough to prevent infection and, for this reason, in case there are symptoms such as fever above 37.8ºC, intense pain or urination with strong odor, it is advisable to go there hospital to identify if there is any infection and start the appropriate treatment.

4. Urinary retention

Even if it is more rare, some men may experience urinary retention after the biopsy due to the 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 the urine to flow.

In case this happens, you should go to the hospital to remove the accumulation of urine from the bladder. Normally, this is done with the placement of a urinary catheter. Know more details about what is a bladder probe.

5. Erectile Dysfunction

This is the most rare complication of the biopsy, but it usually disappears within 2 months after the examination. In the majority of cases, the biopsy does not interfere with the ability to have intimate contact.

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