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Prostate Biopsy: What To Expect

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Dear Dr. Levister: I am just shy of 52 years old and have a 5.1 PSA. I have been having some slow streaming in urination with a slight burning. My doctor wants to take 12 samples from my prostate. I am chicken and have a VERY low threshold for pain. What should I expect? R.S.

Dear R.S.: Prostate biopsy is a procedure in which small samples are removed from a man's prostate gland to be tested for the presence of cancer. It is typically performed when the scores from a PSA (prostate-specific antigen) blood test rise to a level that is associated with the possible presence of prostate cancer.

The procedure, usually an outpatient procedure, requires a local anesthetic, with fifty-five percent of men reporting discomfort during the biopsy. The most frequent complication of the procedure is bleeding in the urine for several days, some bleeding in the stool for several days, and blood in the ejaculate for several weeks afterwards. The procedure may be performed transrectally, through the urethra or through the perineum. The most common procedure is transrectal, and may be done with tactile finger guidance, or more commonly and precisely, with ultrasound guidance.

About a dozen samples are taken from the prostate gland through a thin needle - about six from each side. If the procedure is performed transrectally, antibiotics are prescribed to prevent infection. An enema may also be prescribed for the morning of the procedure. In both the transrectal and the transperineal procedure, the doctor inserts an ultrasound probe into the rectum to help guide the biopsy needles. A local anesthetic is then administered into the tissue around the prostate, similar to the local anesthetic administered for a dental procedure. A spring-loaded prostate tissue collection needle is then inserted into the prostate, through the rectum (or more rarely through the perineum), about a dozen times. It makes a clicking sound, and there may be considerable discomfort.

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