A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. Tissue samples from the prostate biopsy are examined under a microscope for cell irregularities that may indicate prostate cancer.
During the procedure, the doctor inserts an ultrasound probe (Transrectal Ultrasound or TRUS) into the rectum to create an image of the prostate gland. Ultrasound is harmless and is commonly used to image a foetus in the womb. The prostate is located just on the other side of the rectal wall. Using the ultrasound image as a guide, the doctor removes several samples from the prostate with a spring-loaded device. This device quickly punches a needle through the rectal wall into the prostate and removes minute cylindrical cores of cells. Typically, a biopsy removes around 10 to 12 core samples, usually five or six from each side of the prostate.
It is my understanding, from my research, that relying on ultrasound alone to detect prostate tumours is not very reliable because of its poor resolution of soft tissue. This approach to prostate biopsy has been described as a ‘hit-or-miss’ or ‘blind’ procedure. My Urologist, a week before my biopsy, arranged for me to have an MRI scan of my prostate. A Consultant Radiologist analysed the MRI images and reported to my Urologist. This detailed image of my prostate was then used to identify areas that might be malignant which allowed those areas to be targeted when taking tissue samples from my prostate.
At my appointment my Urologist had arranged that I would have a second PSA test and also checked the prostate with a DRE. My PSA result indicated that my PSAs had increased and he also confirmed the presence of a nodule. I had 13 samples taken the ‘extra’ one was taken from the nodule.
Antibiotics are given to the patient to take prior to a biopsy as there can be some side effects associated with it which may include;
- Bleeding at the biopsy site.
- Blood in your semen. It is common to notice red or rust colouring in your semen after a prostate biopsy. This indicates blood, and it is not a cause for concern. Blood in your semen may persist for a few weeks after the biopsy.
- Blood in your urine. This bleeding is usually minor.
- Difficulty urinating. In some men, prostate biopsy can cause difficulty urinating after the procedure. Rarely, a temporary urinary catheter may be inserted.
- Infection. Rarely, men who have a prostate biopsy develop an infection of the urinary tract or prostate that requires treatment with antibiotics.
I did have blood in my semen which persisted for some weeks after the biopsy. It didn’t present a problem.
I was very happy that my Urologist had recommended an MRI scan prior to the biopsy since without an MRI prostate tumours could be missed completely. There is another important reason for obtaining the imaging before and not after a prostate biopsy. Blood and haemorrhaging left behind from the needle punctures create 'confusion' in the MRI scan making it difficult to identify tumours clearly. There is evidence to suggest that MRIs taken after a biopsy may lead to overestimation of cancer in 20% of cases.
“If you think about breast cancer,” says Johns Hopkins urologic Pathologist Angelo M. De Marzo, M.D., Ph.D., “you never make the diagnosis other than by sticking a needle into a lesion that somebody felt or saw. But in prostate cancer, most diagnoses are made by sticking a needle blindly, into something we can’t see or feel. Prostate cancer is the only cancer where you are systematically making the diagnosis in a blinded way. That’s not done with any other cancer: every other cancer, you can see or feel.” (https://www.pcf.org/c/on-the-horizon-more-accurate-biopsy)
"Recent technological advancements and the development of specific imaging techniques have allowed MRI to emerge as an effective way to visualize the prostate gland that can aid in prostate cancer detection. Multiparametric MRI provides detailed anatomical and functional information unavailable from grey scale ultrasound". (http://paact.help/adding-multiparametric-mri-to-prostate-cancer-screening-will-save-lives-and-money)
"The future holds great promise for the accurate detection of prostate cancer before having a biopsy. The single most important factor in this change is the addition of multiparametric MRI (mpMRI) before having a prostate biopsy. There is compelling research-based evidence, both in the U.S. and abroad, that mpMRI can help determine if a biopsy is not yet necessary. This means sparing men from conventional TRUS-guided biopsy that has a discouraging track record of inaccuracy. On the other hand, if mpMRI detects a suspicious area, a real-time MRI guided targeted biopsy facilitates pinpoint diagnosis and treatment". (https://prostate.net/articles/should-i-do-a-multiparametric-mri-before-having-a-prostate-biopsy)
Multiparametric MRI is not currently available in Ireland.