BK Mr fusion Prostate biopsy

Prostate biopsy is a surgical procedure of obtaining tissue samples to detect prostate cancer in males. This is done when there is a suspicion of cancer. It involves using thin needles to obtain tissue samples from the prostate. The tissue obtained is analyzed under the microscope to guide the treatment. The prostate gland is one of the reproductive organs in males present in the pelvic area. 

Indications:

Prostate biopsy is indicated in suspicious cases of prostate cancer to confirm the diagnosis. Individuals who have suspicious findings on digital rectal examination (DRE) are recommended for biopsy. Prostate-specific antigen (PSA) value higher than 4 ng/ml is also another indication for prostate biopsy. Continuously raised levels of PSA in previous biopsied prostate is also indicated for prostate biopsy. 

History of the previous biopsy with abnormal cells is also indicated for prostate biopsy. Individuals with a clinical diagnosis of atypical small acinar neoplasia (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) in their previous biopsies are indicated for a repeat prostate biopsy. 

Contraindications:

Prostate biopsy is not indicated in individuals who do not have a rectum or those with a rectal fistula. 

Types of prostate biopsy:

Prostate biopsy is done in two ways. They are transrectal ultrasound-guided biopsy (TRUS) and transperineal biopsy.

• Transrectal ultrasound-guided biopsy (TRUS): This is the most common way of doing prostate biopsy and is done by passing the needle through the rectum (back). Depending on the anatomy of the rectum muscles, an ultrasound probe is gently passed between the anal muscles without causing any pain to locate the prostate gland. Based on the location and as guided by the probe, a needle is passed just beside the probe to take the samples. 

Samples will be taken from different sections of the gland like the apex, base, and midsurface. Generally, 12 standard samples with 2 additional samples are taken for biopsy. In the case of repeat biopsies, more samples are taken to enhance the cancer detection rates. 

• Transperineal biopsy: This is done by cutting the skin between the anus and scrotum in the perineal area. An ultrasound probe is passed to locate the presence of the prostate gland. This is again done in two ways. One way is to use an MRI-guided image to take the sample and the other is to use a template. 

The surgical templates are grids with holes that are placed on the perineum between the testes and anus. Using a needle that is passed through these holes, tissue samples are taken from the gland. This kind of biopsy is done when the TRUS procedure could not reveal any cancer but there is a suspicion of cancer. 

Advantages: 

A prostate biopsy is the only way to confirm a suspicious case of prostate cancer. This has many advantages like

• It helps to understand the stage of the cancer
• It helps in early diagnosis of the cancer
• Faster spreading cancers can be easily diagnosed with this 
• Early diagnosis helps in early treatment

Before the biopsy:

Before the prostate biopsy, it is important to understand the necessity of the procedure by discussing it with the healthcare provider (HCP). Complete details regarding the medical, surgical, allergic, and medication history should be given to the HCP. Diet will be restricted and a list of medications to be stopped and another list of medicines to be used before the procedure will be given. One has to undergo certain blood tests to understand the current medical condition. Certain advanced imaging studies like MRI or CT will also be conducted to check the extent of the disease. 

A prostate biopsy will be done on an empty stomach under anesthesia. Hence it is necessary to refrain from eating anything 8-12 hours before the procedure. Inform the healthcare provider of any previous allergies to anesthesia. In case of pregnancy inform the healthcare provider as certain imaging studies cannot be done in pregnancy. 

During the biopsy:

Prostate biopsy is done under local or general anesthesia. An individual undergoing the procedure is asked to lie on the side with knees pulled to the chest. The surgical site is cleaned with the help of an antiseptic solution. A gel is applied to the area and an ultrasound probe is sent through the rectum to locate the prostate gland. After locating the gland, the area is numbed, and using a spring-propelled needle samples is taken. If a transperineal biopsy is done MRI-guided or template-guided samples are taken. 

After the procedure:

The entire procedure takes about 20-30 minutes. There will be mild soreness due to the procedure. Antibiotics and painkillers will be given to subside the pain. After the procedure, one should refrain from lifting heavy weights. 

Side effects:

Side effects include pain, and bleeding from the rectum due to the procedure. Blood in the urine, stool, and semen is common after the biopsy. 

Interpretation:

Biopsy samples are sent to a lab where they will be observed under the microscope by a pathologist. The report consists of a detailed description of the biopsy sample like the color and consistency of the samples and gross details. The cells that are observed under the microscope are also described in the report. The details contain the types of cells, conditions, and dyes used. Grading of the prostate cancer is also done. Finally, the report ends with the diagnosis given by a pathologist as observed from the microscope. Based on the report further treatment will be planned. 

Risks and complications:

Bleeding and pain in the surgical site, development of infections, and trouble in urination are some of the risks and complications associated with the procedure. 

Conclusion:

Prostate biopsy is an important procedure that helps in the diagnosis of prostate cancer. It is the standard and cornerstone procedure to diagnose prostate cancer. With advancements in technology and imaging, sufficient samples can be obtained for proper diagnosis.  

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