Prostate biopsy

definition

During a prostate biopsy, the doctor takes a tissue sample from the patient's prostate. This biopsy is used to diagnose prostate cancer and is carried out if preliminary examinations of the prostate show an abnormal finding. The tissue taken from a biopsy can be examined microscopically. This will determine whether there is a malignant change in the organ.

When this procedure is necessary and how it works, you will find out in the following article.

Indications

A prostate biopsy is performed if a preliminary examination reveals suspicious results. A classic preliminary examination is the digital rectal examination. If the doctor feels a hardened or irregularly shaped prostate, this requires further clarification.

As part of the early detection of prostate cancer, a prostate-specific blood value is measured, the so-called PSA value. This is a substance that is produced exclusively by the prostate and released into the blood. If this value is increased, a biopsy may also be necessary.

An abnormal ultrasound examination, during which the prostate appears enlarged, can also be an indication of malignant growth and require further investigation with a biopsy.

Here you can find out more about prostate cancer screening: When can it be carried out? Who is it for? How does it work?

What types of biopsy are there?

There are two ways of accessing the person's prostate. The classic and most frequently performed method is the transrectal prostate punch biopsy, in which a biopsy needle is inserted through the patient's intestine.

Alternatively, the needle can enter the prostate through the perineal region. The intestine is not injured here. The dam is located between the anus and the genitalia.

In the following you can read about the different types of biopsy and how they work.

Transrectal prostate punch biopsy

This prostate biopsy method is the standard procedure that is most frequently used. The term “transrectal” stands for “through the rectum”. Fine tissue cylinders are punched out of the prostate under local anesthesia and simultaneous ultrasound control. The needle, with which the tissue is removed, reaches the prostate via a channel in the ultrasound probe, which is located in the patient's rectum. As the intestine, in which there is a large number of intestinal bacteria, is injured and these bacteria can get into the blood or surrounding tissue, antibiotic therapy is initiated as a prophylactic measure as part of this intervention.

Perineal biopsy

In this procedure, the prostate is accessed through the patient's perineum. This is the region between the intestine and scrotum. Since the patient's bowel is not injured, this procedure is associated with a lower risk of infection than with a transrectal biopsy. This type of biopsy is suitable for patients who have previous illnesses or operations on the intestine. However, since this is a complex and painful procedure, it is performed under general anesthesia.

MRI fusion biopsy

With the MRT fusion biopsy, an MRI examination of the abnormal area and an additional transrectal ultrasound are performed. The images of these two processes are superimposed. Depending on the result of this imaging, certain areas of the prostate that indicate suspicious growth are specifically biopsied. This increases the chances of reaching precisely those areas during tissue removal that are affected by a malignant event. The biopsy itself is then carried out transrectally or perineally as described above.

preparation

Different preparations are necessary depending on the procedure. In the case of a transrectal punch biopsy, antibiotic prophylaxis is used because the intestine is injured during this procedure and bacteria are flushed out. This is to prevent infection. In addition, the bowel should be emptied before the procedure and a laxative should be taken. Another preparatory measure for this procedure is local anesthesia in the patient's anal region.

The perineal biopsy is only performed under general anesthesia and the appropriate preparations. The patient must stay sober before the operation and, if necessary, may no longer take some medications, for example anticoagulants, immediately before the operation.

How painful is a prostate biopsy?

The transrectal punch biopsy is performed under local anesthesia. Here, only the limited area in which the procedure takes place is anesthetized. While the biopsy is being carried out, the patient does not feel any pain, only a feeling of pressure from the ultrasound probe inserted into the intestine. The tissue is punched out by means of a special device, which acts at lightning speed and is hardly noticeable.

The local anesthesia lasts for a few hours, during which time the patient feels numbness in the anal region. If the anesthetic wears off, pain can occur, but the procedure is very gentle and is associated with little pain.

In contrast, the perineal access is very painful and can only be performed under general anesthesia.

Is an anesthetic necessary?

The procedure through the ultrasound probe in the rectum is not very invasive and does not require anesthesia. Local anesthesia is sufficient in this case. If the prostate is reached via the perineal region, this is more complex and very painful for the patient. The perineal prostate biopsy is only performed in an inpatient setting under general anesthesia.

Is an outpatient prostate biopsy possible?

The punch biopsy using transrectal ultrasound is usually performed on an outpatient basis, which means that the patient can return home shortly after the procedure. Only in rare cases does it have to be hospitalized and the method performed under general anesthesia.

Duration

In most cases, a prostate biopsy is performed on an outpatient basis in a hospital or urological practice. It is a routine procedure that takes about 15 minutes, depending on the doctor's experience. After the procedure, a short observation period is planned before the patient can go home.

Results

The tissue removed during the biopsy is examined microscopically by a pathologist. This specializes in recognizing and classifying pathological changes. First, the tissue of origin is identified. If there is a malignant change, it is mostly degenerate glandular tissue of the prostate. This is known as adenocarcinoma. The appearance of the degenerated tissue is assessed with regard to its abnormality in comparison to the healthy tissue, which is used to assess the degree of severity. This contrasts with findings ranging from well-circumscribed, less degenerate tissue to glandular tissue, which is no longer morphologically recognizable as such and partly consists of dead cells. This assessment by the pathologist, together with the spread of the cancer in the body, results in a stage classification of the disease, which then results in appropriate therapy.

Find out more about the different stages of prostate cancer here.

Duration until the results

The time it takes until the results of the biopsy are available depends on various factors. If the procedure is carried out in a specialized center that has a laboratory in which the microscopic analysis can be carried out, the result can be available after two to three days. If the sample has to be sent to an external laboratory, this can lead to a delay in the delivery of the results. It may also be that the findings are unclear or the type of tumor is very rare, which requires an assessment by a second, more highly specialized facility. This then also results in a longer time until the final diagnosis is made.

Side effects and risks - how dangerous is a prostate biopsy?

Possible side effects of a prostate biopsy are pain, bleeding, infection or, in rare cases, the spread of tumor cells.
Pain during the procedure is prevented by using a local anesthetic. The manipulation can nevertheless lead to a feeling of pressure and slight pain after the procedure.
Since access to the prostate is via the rectum or perineum, intestinal bacteria can enter the prostate or damage blood vessels into the bloodstream. To prevent infection, an antibiotic is given prophylactically before the procedure.
If there is a tumor in the prostate, there is theoretically the risk that tumor cells will enter the bloodstream through damage to blood vessels and tumor cells can be carried along in this way. However, this assumption could not be scientifically proven and is not a contraindication for performing a biopsy.

Prostate biopsy is a well-established and low-risk procedure.

Blood in semen

The prostate lies around the urethra and secretes its glandular secretions, which are part of the composition of the sperm, into it. Removing tissue from the prostate can damage blood vessels. The blood that escapes can be released when the secretion produced by the prostate is secreted, which can result in the appearance of blood in the sperm.

Blood in the urine

The blood enters the urethra via the route mentioned above. The urethra itself is not injured during the procedure, but the blood can be deposited in the urethra and flushed out when you urinate. This is not a complication and should only be clarified by a doctor in the event of a long duration and very heavy loss of blood.

Find out more about the causes of blood in the urine here.

costs

If the indication is given, a prostate punch biopsy is paid for by a doctor from the health insurance company.

The fusion biopsy by means of MRI is usually not covered by the statutory health insurance companies. The costs for such a biopsy should be inquired at the performing practice. The amount can vary depending on the location, a price of approx. 2000 euros serves as a guide. A cost estimate can be made and the assumption by private health insurance companies can be clarified.

What are the alternatives?

Further methods for the early detection of the prostate are the digital rectal examination and the determination of the PSA value. During the digital rectal examination, the doctor feels the patient's prostate by inserting his finger into the anus and paying attention to the shape and consistency of the prostate. The PSA value is a blood value that is prostate-specific and can be increased if prostate cancer is present.
An ultrasound examination can also be carried out.

If all preliminary examinations yield suspicious results, a biopsy is necessary to confirm the diagnosis before initiating cancer therapy.