What is a Prostate Biopsy by Transrectal Route?
A transrectal prostate biopsy involves sampling one or several small pieces of prostate tissue by going through the rectal wall (transrectal route).
Sampling is performed with the help of a special retractable needle. The doctor is guided by a transrectal ultrasound probe that makes it possible to visualize the sampling location.
A biopsy can be indicated when an anomaly has been detected by digital rectal exam, when PSA levels are high given a man’s age or when levels increase over time. This is the simplest way to sample prostate fragments without surgical intervention.
What to Do Before Prostate Biopsy
Rectal cleaning is no longer required. A prior course of antibiotics is necessary. This antibiotic treatment limits the likelihood of prostate infection after the exam.
Since the exam is done under local anesthetic, the patient does not need to fast. To be more comfortable, it is recommended he urinate before the biopsy.
It is important that the patient tell the doctor what medications he is taking, in particular any medication of the aspirin or anticoagulant type since these medications reduce the quality of blood coagulation and increase the risk of bleeding.
What Is the Procedure for Prostate Biopsy?
The patient is placed on the side, legs folded, showing his back to the doctor so as to expose the rectal region.
First, the urologist performs an endorectal ultrasound in order to visualise the area where the sampling will be performed.
An endorectal ultrasound provides images of the prostate using an ultrasound probe introduced into the rectum via the anus.
In general, the urologist will perform a digital rectal exam before inserting the ultrasound probe, which allows him to examine the consistency of the prostate and also lubricate the area so that the introduction of the probe causes as little discomfort as possible.
The next step is to perform local anesthesia through transrectal route, using a small needle with Xylocaine 10cc. Patients generally report a warm, but not painful, sensation.
After this, prostate volume measurements are taken. Finally, the urologist performs the transrectal prostate biopsies. The ultrasound probe is equipped with a guidance system that allows for the visualisation of the correct entry point for the needle into the prostate and to follow its course.
The doctor uses an automatically retractable needle. This mechanism makes a “clicking” noise that can be surprising the first time. The injection itself is not painful: the needle penetrates into the prostate very quickly and retracts just as quickly.
Fourteen samples are collected from different areas of the prostate (more if the prostate is larger). When the series of samples are collected, it is best to stay seated for 15 minutes in the waiting room to avoid feelings of dizziness.
These quick and painless samples are generally well-tolerated by patients. Discomfort increases with the length of the exam and the number of samples taken. Most men report feeling only slight discomfort.
The length of the biopsy depends on the number of samples required. It usually takes about 15 minutes.
What Are the Possible Complications of Biopsy?
Light bleeding in the stool and in the urine can occur for several days after the biopsy. Sometimes it can occur for several weeks in the sperm.
A course of antibiotics is prescribed before the exam to avoid infection. Prostate infection after biopsy is rare (2% to 6 % of cases). Another antibiotic treatment will be necessary in case of discomfort or pain while urinating.
In case of fever appears after the biopsy (temperature over 38.5 °C), the patient must immediately go to the emergency room. It is imperative not to wait at home because this can cause a serious case of sepsis requiring intensive care if there is any delay. The emergency room doctor must be informed that you underwent a prostate biopsy under antibiotic treatment. Very specific treatment must be undertaken as quickly as possible.
Hospitalisation in the intensive care unit is rare in the case of sepsis (severe infection).
It is recommended to avoid intense physical activity for 48 hours following the exam.
How Do You Get the Results?
The tissues sampled are examined under a microscope by a pathologist who performs an anatomic pathology exam. This is also called a histopathology exam. This exam establishes whether or not there are cancerous cells in the sample tissues.
The results of the samples from the prostate biopsy are communicated to the doctor after several weeks. The doctor then tells you your results.
An appointment is scheduled for about 1 month after the biopsy.
When the results come back “negative”, that means the samples show no cancerous abnormalities.
Further biopsies can be required after a first series of normal biopsies, especially if an abnormality is detected in the prostate during digital rectal exam or persists, or if the PSA values remain elevated or continue to increase when monitored.
Once the doctor has made a diagnosis, he then proposes a treatment adapted to the patient’s situation.