You may feel discomfort or pressure when the needle enters the prostate gland. The needle is put in several times to take tissue samples from different parts of the gland.
You will be positioned on your left side, with your knees bent, or lying on your back with your knees bent and thighs apart. You will feel a needle stick when the local anesthetic is injected. This may cause a brief stinging sensation. When the area is numb, the healthcare provider may make a tiny incision cut in the skin. The healthcare provider will place a gloved, lubricated finger into your rectum to locate and stabilize the prostate gland.
The biopsy needle will be inserted through the incision and into the prostate several times to get samples from different parts of the gland. The biopsy needle will be removed and firm pressure will be applied to the biopsy site until the bleeding has stopped. Sutures are usually not needed. The procedure may be done under a local or general anesthetic. Local anesthetic means medicines are used to make you numb.
General anesthetic means medicines are used to put you into a deep sleep during the procedure. The healthcare provider will insert a cystoscope a flexible tube and viewing device into the opening at the end of your penis, through the urethra, and up to the prostate gland.
The healthcare provider will insert tiny instruments through the cystoscope to take out samples of the prostate gland. Your recovery process will vary depending on the type of anesthesia that is used. If you were given general anesthesia, you will be taken to a recovery room for observation.
Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.
If local anesthetic was used, you may go back to your normal activities and diet unless otherwise instructed. You may feel the urge to urinate or have a bowel movement after the biopsy. This feeling should pass after a few hours. There may be blood in your urine or stool for a few days after the biopsy. This is common. Blood, either red or reddish brown, may also be in your ejaculate for a few weeks after the biopsy.
This, too, is normal. The biopsy site may be tender or sore for several days after the biopsy. Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding, so be sure to take only recommended medicines. Changes in the way your urine looks or smells or burning with urination may be signs of infection.
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The probe picks up the echoes, and a computer turns them into a black and white image of the prostate. You will feel some pressure when the probe is inserted, but it is usually not painful.
The area may be numbed before the procedure. Newer forms of TRUS, such as color Doppler ultrasound, might be even more helpful in some situations.
MRI scans create detailed images of soft tissues in the body using radio waves and strong magnets. MRI scans can give doctors a very clear picture of the prostate and nearby areas. A contrast material called gadolinium may be injected into a vein before the scan to better see details.
To improve the accuracy of the MRI, you might have a probe, called an endorectal coil , placed inside your rectum for the scan.
This can be uncomfortable for some men. If needed, you can be given medicine to make you feel sleepy sedation. Multiparametric MRI: This newer MRI technique can be used to help better define possible areas of cancer in the prostate, as well as to get an idea of how quickly a cancer might grow.
It can also help show if the cancer has grown outside the prostate or spread to other parts of the body. The results of the different scans are then compared to help find abnormal areas. In this system, abnormal areas in the prostate are assigned a category on a scale ranging from PI-RADS 1 very unlikely to be a clinically significant cancer to PI-RADS 5 very likely to be a clinically significant cancer.
This can help ensure the doctor gets biopsy samples from any suspicious areas seen on the images. If prostate cancer spreads to distant parts of the body, it often goes to the bones first. A bone scan can help show if cancer has reached the bones. For this test, you are injected with a small amount of low-level radioactive material, which settles in damaged areas of bone throughout the body. A special camera detects the radioactivity and creates a picture of your skeleton.
A bone scan might suggest cancer in the bone, but to make an accurate diagnosis, other tests such as plain x-rays, CT or MRI scans, or even a bone biopsy might be needed. A PET scan is similar to a bone scan, in that a slightly radioactive substance known as a tracer is injected into the blood, which can then be detected with a special camera.
But PET scans use different tracers that collect mainly in cancer cells. However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells. Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers. A CT scan uses x-rays to make detailed, cross-sectional images of your body. Still, it can sometimes help tell if prostate cancer has spread into nearby lymph nodes.
If your prostate cancer has come back after treatment, the CT scan can often tell if it is growing into other organs or structures in your pelvis. CT scans are not as useful as magnetic resonance imaging MRI for looking at the prostate gland itself. In a lymph node biopsy, also known as lymph node dissection or lymphadenectomy , one or more lymph nodes are removed to see if they have cancer cells. If there is more than a very small chance that the cancer might have spread based on factors such as a high PSA level or a high Gleason score , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy see Surgery for Prostate Cancer.
The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.
A lymph node biopsy is rarely done as a separate procedure. I've been recommending and performing MRI-fusion biopsies for the past seven years. Two years ago, the NCCN added it to its standard-of-care guidelines for initial prostate biopsy. Our team has expertise with these tests and procedures, allowing us to work quickly and efficiently. We give you the pros and cons of the treatment options available to you, allowing you time to talk with your team of doctors and other experts about those options.
Our cancer experts are also vigilant about what patients need and when they need it. If you choose to receive treatment with us, you may benefit from our integrative approach to cancer treatment. Our multidisciplinary team works together to help prevent and manage the side effects of cancer and its treatment, providing supportive care services , such as:.
Before you make a decision about whether to have a prostate biopsy, we recommend you have a conversation with your physician and ask:. You may also want to consider getting a second opinion and, if possible, consult with a urologic oncologist. It's important to remember that the statistics surrounding prostate cancer, its diagnosis and treatment are gathered at the population level. They are, in other words, generalizations.
Individual patients, on the other hand, are more than just numbers. When deciding whether to get a prostate biopsy, don't let generalizations about the procedure and the disease determine what's right for you.
Make a difference in the fight against cancer by donating to cancer research. Call us anytime. Should I get a prostate biopsy? But controversy surrounding the PSA blood test and concerns about prostate biopsies cause many patients to ask: Should I get a prostate biopsy?
Are the risks of a prostate biopsy worth it? Are there alternatives to a prostate biopsy? Controversies and misconceptions surrounding prostate biopsies The PSA test measures the levels of PSA proteins in the body, and when it was first developed, it was quickly implemented by many physicians as a screening test for prostate cancer.
Common objections from patients regarding prostate biopsies Urologists often hear some common objections from patients after a prostate biopsy is recommended, and most of them stem from misconceptions about prostate cancer. Benefits of getting a prostate biopsy A prostate biopsy is the only way to definitively determine whether you have prostate cancer and, if you do, how aggressive it is. Prostate biopsy risks There are risks associated with prostate biopsies, but physicians can take steps to reduce those risks.
Risks and ways to manage them include: Infection: The most serious risk of a prostate biopsy is the risk of infection, including urinary tract infections and, less commonly, sepsis.
Patients may experience some soreness in the rectum or scrotum afterwards. Additional tests that may aid prostate cancer diagnosis There are few other diagnostic tools or tests, which can be performed before you have a prostate biopsy, that may help your physician gather more information about your specific case.
Those tests include: 4Kscore blood test is a molecular test that helps predict the likelihood and risk of a patient having aggressive prostate cancer. Multiparametric MRI The use of multiparametric MRI mpMRI imaging of the prostate gland before a biopsy has been a game changer in prostate cancer diagnosis, increasing the accuracy of biopsies over standard biopsies. Are we doing all the necessary testing to appropriately perform a risk-benefit analysis of getting a prostate biopsy?
Related Articles Are cancer clinical trials safe? Answers to common patient concerns. Know your prostate cancer options. Donate to Gateway for Cancer Research Make a difference in the fight against cancer by donating to cancer research.
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