Definition
In a prostate biopsy, the doctor takes a tissue sample of the patient’s prostate. This biopsy is used to diagnose prostate cancer and is performed when preliminary examinations of the prostate have revealed abnormal findings. The tissue that is taken during a biopsy can be examined microscopically. In this way it can be determined whether there is a malignant change in the organ. The following article will tell you when this procedure is necessary and how it is performed.
Indications
A prostate biopsy is performed if a preliminary examination has revealed suspicious findings. A classic preliminary examination is the digital-rectal examination. If the physician palpates 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. PSA is a substance that is produced and released into the blood stream exclusively by the prostate. If this value is elevated, a biopsy may also be necessary. A conspicuous ultrasound examination, in which the prostate appears enlarged, can also be an indication of malignant growth and may require further clarification by means of a biopsy.
What forms of biopsy are available?
There are two ways to reach the prostate of the affected person. The classic and most commonly performed method is the transrectal prostate punch biopsy, in which a biopsy needle is inserted through the patient’s bowel. Alternatively, the needle can penetrate the prostate via the perineal region.
This does not injure the intestine. The perineum is located between the bowel outlet and the genitals. This method of prostate biopsy is the standard procedure, which is used most often.
The term “transrectal” stands for “through the rectum“. Under local anesthesia and simultaneous ultrasound control, fine tissue cylinders are punched out of the prostate. The needle with which the tissue is removed reaches the prostate via a channel in the ultrasound probe, which is located in the rectum of the patient.
Since the intestine, in which a high number of intestinal bacteria are found, is injured and these bacteria can thus enter the blood or surrounding tissue, antibiotic therapy is initiated prophylactically as part of this procedure. During this procedure, access to the prostate is through the patient’s perineum. This is the region between the intestine and the scrotum.
Since the patient’s bowel is not injured, this procedure is associated with a lower risk of infection than transrectal biopsy. This type of biopsy is suitable for patients who have previous illnesses or operations on the intestine. However, since it is a complex and painful procedure, it is performed under general anesthesia.
In the MRI fusion biopsy, an MRI examination of the abnormal area and additionally a transrectal ultrasound are performed. The images from these two procedures are superimposed on each other. Depending on the result of this imaging, certain areas of the prostate, which indicate suspicious growth, are biopsied in a targeted manner. This increases the chances of reaching exactly those areas affected by a malignant event during tissue removal. The biopsy itself is then performed as described above, either transrectally or perineally.