It sounds scary, but it is clinically important in the diagnosis of prostate cancer. A prostate biopsy is performed when PSA levels are above normal and a rectal examination has detected any abnormalities. We advise you on how to prepare for the test …
More common than lung cancer
Prostate cancer is the most commonly recognized cancer among men in Poland. According to forecasts, the number of new cases in 2020 will amount to 19! For comparison, a decade ago, according to the data of the National Cancer Registry, only 050! The main risk factor is age, and given that we are an aging society, there will be many more sick people. Importantly, the cancer itself is not a sentence – its diagnosis at an early stage gives a chance of survival for 9%. men.
That is why all men over 45 years of age (men with a family history of prostate cancer over 40 years of age) should pay attention to the need for preventive examinations. Even in a pandemic, we must not give up on them! This was pointed out by Dr. Piotr Jarzemski in the first installment of the action “Healthy Masculinity – Cancer is not a sentence”.
Postponing your visit to the urologist for the next year is a terrible idea. Failure to make a diagnosis can have enormous consequences. You can die of prostate cancer. I agree that it is more difficult to access doctors in a pandemic, but it is not that we cannot do a PSA test. Laboratories are open, hospitals are open, and urology clinics are open. We conduct diagnostics and treatment all the time.
PSA (Prostate Specific Antigen) is a cancer marker used to detect prostate cancer at an early stage. It is a simple test that is performed on the patient’s blood. If the PSA level is above the norm and the rectal examination (through the rectum) doctor detects any abnormalities, the patient is referred for a prostate biopsy.
Before its commissioning, it is also recommended to perform prostate imaging with multiparameter magnetic resonance (mpMRI). Such procedure allows to reduce the risk of unnecessary biopsy and increases the chance of making a correct diagnosis.
A prostate biopsy is also indicated if:
- previous biopsy results were normal, but PSA was not normal and / or there were distressing symptoms,
- the result of the first biopsy is inconclusive or indicates the presence of a precancerous stage.
Less than 30 minutes
A prostate biopsy involves taking from a few to a dozen or so small sections of the gland transrectally. In order to reduce the discomfort and pain associated with the injection, the procedure is performed under local anesthesia. In rare cases, it is also possible to administer intravenous anesthesia.
When it comes to preparation for the procedure, the biopsy does not require fasting, but it is worth using an easily digestible diet. It is also recommended to have a bowel movement.
During the procedure, the patient is placed in the gynecological position (with the legs up) or on the side. Sometimes transperineal access is used. The procedure is performed under the supervision of TRUS (ultrasound with the use of a transrectal head) with a special gun and needle. Such a set allows for precise collection of material from suspicious fragments of the prostate. The examination takes about 20-30 minutes, and the patients themselves usually report that it is less painful than expected. The collected specimens are subjected to a histopathological examination by a pathologist. The result with the histopathological assessment according to the Gleason system is available after about two / three weeks and should always be consulted with a urologist in order to plan further treatment.
It should be borne in mind that even if the histopathological examination does not show any disturbing changes, the disease may still develop. This is because the neoplastic focus may be small enough to be missed during the biopsy. Only the excision of the entire gland makes it possible to 100 percent. Certainly, the presence of neoplasm is excluded.
Both before and after the prostate biopsy, you should take the prescribed antibiotics and anti-inflammatory agents. Importantly, anticoagulants (anticoagulants) should be discontinued in the peri-biopsy period.
Prostate biopsy, like any invasive medical procedure, has some risk of complications. Rectal bleeding may usually persist for 2-3 days after a prostate biopsy, while an admixture of blood in the semen may appear up to a month. Occasionally, blood may also appear in the urine. Rare complications include urinary tract infection (UTI) manifested by: fever, lower abdominal pain, and urination disorders. Suspicion of an infection always requires a medical consultation.
According to the recommendations, after the biopsy, it is worth allowing yourself to rest for several hours, and also to give up physical activity for several days.
Finally, remember: prevention is your best friend. Cancer is a more common killer than COVID-19. If you catch the coronavirus, your chances of survival are better than if the neoplastic lesions are detected too late. Depending on the interpretation of the results of the aforementioned diagnostic tests, the stage of the tumor, the pathomorphological characteristics of the tumor and the assessment of the level of the PSA marker concentration in the serum, there are many treatment options. For low-risk prostate cancer, you can adopt a “watchful eye” approach. Only when low-risk cancer progresses to intermediate or high-risk cancer then it is time for active radical treatment.