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If prostate cancer is suspected, a biopsy is recommended. A prostate needle biopsy is a surgical procedure in which a small sample of tissue is removed from the prostate gland and examined under the microscope by a pathologist, a doctor specializing in identifying disease through the study of cells, tissue and organs.
The procedure takes about 15 minutes and is usually performed in the urologist's office in conjunction with transrectal ultrasound (TRUS), a procedure that uses sound waves to create a video image of the prostate gland. A local anesthetic is routinely used. With the help of TRUS, a doctor guides a biopsy gun — a hand-held device with a spring-loaded, slender needle — through the wall of the rectum into the area of the prostate gland that appears abnormal.
The rectal wall is thin, so it is possible to place the needle more accurately and with less injury to other tissues. When activated, the needle can remove a slender cylinder of tissue (about 1/2" by 1/16"), called a core, in a fraction of a second. Biopsy needles are tiny -- only 1.2 millimeters in diameter and less than 1/2" long -- and very precise. A sliding sheath opens once the needle enters the prostate, closes onto a sample of tissue and the needle is withdrawn.
A sextant (six-part) biopsy is the most common prostate biopsy procedure. An average of six cores are taken from the prostate (top, middle and bottom; right and left sides) to get a representative sample of the prostate gland and determine the extent of any cancer.
The results of the biopsy are not available immediately following the procedure. The tissue samples must examined by a pathologist, who then generates a report of the findings.
Preparation for the biopsy
As with TRUS, the patient may be instructed to have an enema prior to the procedure to remove feces and gas from the rectum, which might impede the progress of the rectal probe. In addition, patients may take oral antibiotics beginning the night before the biopsy and for 24 to 48 hours afterwards, to protect against possible infection. To limit the risks of bleeding, patients are advised to stop taking aspirin seven to 10 days before the biopsy and to stop taking anti-inflammatory medications such as ibuprofen, Advil, or Motrin, three days before the biopsy.
Risks and complications
It is normal to expect some minor bleeding after needle biopsy, because the needle has entered areas that contain small veins. Blood in the urine, semen and with bowel movements may occur intermittently for a few days and possibly for a few weeks. The two primary risks of needle biopsy are severe bleeding and infection of the prostate gland or urinary tract. These risks are very rare, occurring in less than 1 percent of patients.
Transurethral resection of the prostate (TURP)
Prostate tissue is also examined following transurethral resection of the prostate (TURP), a surgical procedure used most often to treat men with benign prostatic hyperplasia (BPH). The operation removes part of the prostate gland surrounding and constricting the urethra (the tube that takes urine from the bladder through the penis and out of the body). A tool with a wire loop on the end is passed into the penis and through the urethra to the prostate gland. Electricity is then passed through the wire to heat it and cut the tissue. A representative sample of the prostate tissue removed during TURP is examined by a pathologist to determine whether any cancer is present. Although BPH is not malignant, it is possible for BPH and prostate cancer to exist within the same prostate gland at the same time.
The Prostate Cancer pages of this website are part of the Comprehensive Prostate Cancer Awareness Program (CPCAP), a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.