What is a Prostate Biopsy?
Transrectal prostate biopsy involves collecting small cylindrical fragments of prostate tissue for analysis in a laboratory by specialists in histopathology.
A final prostate cancer diagnosis is only obtained after this ultrasound-directed biopsy.
It is sometimes necessary to repeat the biopsy 2 or 3 times if the results are not entirely clear or if there is a high suspicion of a tumour and successive biopsies are negative.
Importance of Transrectal Prostate Biopsy
Transrectal prostate biopsy with analysis of cells under a microscope is very important in effective analysis of prostate pathologies, as it is the only test that accurately diagnoses prostate cancer.
This exam is therefore absolutely vital for correctly assessing the illness, its stage and defining the treatment measures to be adopted.
What is the Procedure?
The biopsy is performed under local anaesthetic. A special anaesthetic gel is applied to the anal canal and the nerves around the prostate are injected with a local anaesthetic product.
Despite what some patients might think (many are afraid of doing the exam and are generally apprehensive when it is performed), a biopsy is very well tolerated, provided it is done in the appropriate conditions.
At least 12 fragments must be collected for analysis during the biopsy: at least 6 from each lobe (“half” prostate), in previously defined and standardised regions, in accordance with well-defined and thorough protocols.
In most cases today, 12 or 14 fragments are removed in this type of biopsy.
Performing a Saturation Biopsy
In some specific cases, a so-called “saturation biopsy” may be necessary.
This involves taking a standardised biopsy using a template – i.e. a uniform collection of fragments from every part of the prostate – to obtain 30, 40 or more fragments depending on the volume of the prostate. It is generally performed perineally (rather than the more common transrectally).
A saturation biopsy can be used on patients who are highly suspected of having prostate cancer (by digital rectal exam or PSA) but whose prior biopsies have been negative (i.e. free of neoplastic cells).
The technique is recommended for these patients for “definitive” etiological clarification.
In some highly selective cases, it may be performed with a view to doing a focal prostate treatment (i.e. in which only part of the organ is treated without surgically removing all of it or without treating its entire volume, for example with cryotherapy).
In these cases, it is essential to ascertain the area or areas of the prostate affected by the tumour so that these can be treated and the rest of the organ preserved.
Transrectal Prostate Biopsy Complications
Complications that can occur with this procedure are haemorrhaging and infection (prostatitis).
To combat these complications, patients receive clear preparatory instructions. These include not taking antiaggregant and anticoagulant medication a few days before, doing a micro-enema for an intestinal/rectal cleanse and taking prophylactic antibiotics starting the night before the exam and usually for 5 days afterwards.
The urologists at the Instituto da Próstata have years of experience in performing this and other prostate-related exams, ensuring maximum effectiveness with the minimum possible discomfort. They are performed in line with the recommended guidelines of the world’s most important and prestigious urology associations.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about Transrectal Prostate Biopsy
What is a transrectal prostate biopsy?
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- DIAS, José Santos, Urologia Fundamental: na prática clínica. Lisbon: Lidel - Edições Técnicas, Lda, 2010.
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