Risks of Prostate Biopsy
A biopsy is the removal and examination of tissue from a patient to check for cancer. Prostate biopsies are usually performed by a urologist after a higher than normal prostate-specific antigen (PSA) level has been indicated, and after a digital rectal exam (DRE) detects an abnormality at the rear of the prostate. A "positive" biopsy means that prostate cancer has been discovered.
While the patient should understand the risks and complications which sometimes are associated with prostate biopsies, it is important to note that cancer cells never sleep. Delaying a biopsy is not beneficial.
Preparations to Avoid Risks
Tell your doctor about any illnesses, bleeding, allergies to medications and prescriptions you are taking, especially any blood thinners. The biopsy procedure involves passing needles through the rectum and infection is a possibility, so doctors usually prescribe an antibiotic to be taken the night preceding the test. Patients with heart murmurs, who are required to take antibiotics before dental work, should follow a strict antibiotic regimen for a week before the prostate biopsy. The taking of all aspirin and anti-inflammatories should cease a week prior to the test as well, to minimize bleeding.
Biopsy Procedure
A transrectal ultrasound (TRUS) takes about 15 minutes for the test itself and another 10 minutes to harvest the sample tissue cores. An additional 10 minutes may be needed if a local anesthetic is administered. The ultrasound probe, about the size of a thumb, is gently passed into the rectum. Discomfort is usually fleeting, although men who are anxious about the procedure or have active hemorrhoids tend to experience more pain. This dissipates when the probe is in place. The probe emits sound waves which hit and bounce off the prostate and nearby tissue. The waves return to the probe and a picture is projected onto the screen by which the urologist evaluates the best locations for six to eight biopsies. After these have been obtained, a pathologist determines if cancer is present.
Minor Complications
On occasion, minor complications may arise from a biopsy procedure. Soreness in the rectum or penis is to be anticipated for several hours after the test. A small amount of bleeding may occur from the rectum for a day or two. Blood and clots may pass in the urine, which can present a problem from a few days up to a few weeks. Usually, rest and an increase in fluid intake alleviate these issues. Do not hesitate to contact a doctor if these problems persist.
Significant Risks
About 3 to 10 percent of patients will suffer from urinary tract infections or bacterial prostatitis a week after the biopsy. Men with symptoms including high fever, chills, muscle aches or urinary urgency or burning should make an immediate emergency room visit. A patient may become septic if the infection is left untreated for more than 12 hours, requiring a long hospital stay and serious health risks.
Acute urinary retention, an inability to urinate, sometimes occurs with men who had an enlarged prostate before the biopsy. This requires immediate medical attention.
Although rare, occasionally an artery in the rectal wall will be hit accidentally during the biopsy causing severe bleeding. Hospitalization involving transfusions, cauterization, and sutures may be necessary.
Warning
Perhaps the biggest risk of a prostate biopsy occurs when it misses a cancer. Since just a minute fraction of the prostate tissue can be removed for study, only 75 percent of cancers are found on the first test. Although three to four sets of biopsies are sufficient, cases of 12 rounds have been documented before the prostate cancer was detected. Because six weeks to three months must pass between tests, a patient might be living with cancer for a year or more without medical attention.
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