A needle biopsy of the prostate, in which tissue is removed to check for cancer, can cause apprehension and anxiety. A biopsy, however, is the only way the medical field has to diagnose prostate cancer effectively. According to the 2001 California Cancer Journal for Clinicians, about 200,000 cases of prostate cancer are diagnosed in the United States each year and 32,000 men die of the disease annually. There is no benefit to delaying a biopsy if medically indicated.
When a Biopsy is Indicated
The American Urologic Association recommends that most men begin prostate cancer screening at age 50 with a prostate-specific antigen level (PSA) test, coupled with a digital rectal exam (DRE). PSA is a protein produced by the prostate gland and is associated with prostate cancer when it rises above a certain level. An abnormality in either of these tests may warrant a biopsy.
Early Biopsies
Prior to the PSA test, prostate cancer was usually suspected following an abnormal DRE, or after advanced symptoms appeared, such as bone pain. Performed under general anesthesia, early biopsies were guided by finger touch. The physician would insert a needle equipped with a pair of cutting blades into the suspicious area of the prostate gland and remove one to three tissue cores, each measuring one inch long.
Current Biopsy Procedure
Today the transrectal ultrasound (TRUS) guided prostate biopsy is used. It is an imaging technique in which the prostate gland is examined by an ultrasound probe inserted in the rectum. The spring-loaded, hand-held biopsy gun fires a hollow 18-gauge needle into the prostate gland, then immediately sends a sheath to slice off and gather a core of prostate tissue. Commonly, 10 to 12 core samples, 12 to 15 mm long, are adequate.
Preparation
A biopsy is usually performed in an urologist's office or sometimes in a radiology department. A patient may be requested to take a Fleet enema and a broad spectrum antibiotic such as ciprofloxacin (Cipro) immediately before the procedure. Additionally, you may be asked to cease ingestion of aspirin, any anti-inflammatory medications, warfarin (Coumadin), herbal supplements, as well as vitamin E one week before the biopsy to minimize bleeding.
Patients who normally follow a powerful antibiotic regimen before dental treatment should follow the same regimen before a prostate biopsy.
Test
The test itself involves about 15 minutes for the ultrasound evaluation, plus 10 minutes to retrieve the tissue core samples. If a local anesthetic is administered, plan on another 10 minutes for it to take effect.
You will normally be asked to lie on your side in a loose fetal position. The ultrasound probe, about two to three inches long, will be inserted gently into your rectum. Discomfort from the needles is fleeting, and you should feel minimal pain. After the core samples are obtained, they will be sent to a pathologist for evaluation.
Tags: prostate cancer, prostate gland, core samples, prostate biopsy, regimen before, ultrasound probe
