All of our urologists have extensive experience with conducting prostate biopsies. Since 2014 we have conducted over 500 of these procedures. We conduct these procedures in the office to limit costs to patients in the form of large facility fees. Beginning in 2015 we undertook an independent study to prevent post-biopsy infections, and as a result have decreased the risk of this problem to less than 1%. We adhere to specific practices that allow us to minimize pain and anxiety relating to this procedure.
A prostate biopsy allows for tissue from the prostate to be obtained so that it can be analyzed by a pathologist. The vast majority of biopsies are conducted to rule out prostate cancer. A probe about 2 cm in diameter is inserted through the anus. The area around the prostate is injected with lidocaine which is a numbing agent. A spring-loaded needle is then used to obtain 12 tiny bits of tissue from 6 regions of the prostate. These specimens are prepared and sent to the laboratory for pathologic analysis. The entire procedure takes approximately 15 minutes.
A prostate biopsy is the only reliable method to detect prostate cancer. If your PSA is elevated and/or if your prostate exam is abnormal then a prostate biopsy is required to assess whether you have a prostate cancer. There are urine tests and imaging studies such as MRI that can aid in screening for prostate cancer, but these are not diagnostic.
We pride ourselves on conducting prostate biopsies with minimal discomfort. The most uncomfortable part of the procedure is insertion of the probe, and this can discomfort can be alleviated by relaxing the pelvic floor. The injection of lidocaine is usually not felt because the area where the needle is inserted does not have pain-detecting nerve receptors. The lidocaine effectively eliminates pain from the biopsy needle.
The main risk with a prostate biopsy is infection within 48 hours of the procedure. All patients who undergo a biopsy are given and oral and an injected antibiotic to prevent this issue. Despite these antibiotics some men can develop an infection which usually results in fever, chills and feeling unwell. We admit these patients to the hospital for IV antibiotics. Potential side effects from the biopsy include blood in the stool, urine or semen. This usually lasts a days or two but can persists for a few weeks in some men. In most cases the problems improves on its own without the need for treatment. Contrary to some reports, we have not seen any association of biopsy with erectile dysfunction. Also there is no evidence to support that the biopsy spreads or accelerates prostate cancer.
Typically we recommend taking the day of the biopsy off from work. Most men resume all normal activities the following day. It is advisable to wait 48 hours to resume strenuous activities such as weight lifting or cycling. It is safe to resume sexual relations at anytime after the biopsy.
The pathologist usually requires 1 week to evaluate the specimens and compose a report. At Urology Specialists of Oregon we prefer to discuss results with the patient face-to face at an office visit 1 week after the biopsy. This allows the patient the best opportunity to learn about the pathology results and their options for treatment if cancer is detected.
SEQUENTIAL TRIAL OF INTRAMUSCULAR CEFTRIAXONE AND NEEDLE STERILIZATION FOR PREVENTION OF PROSTATE POST-BIOPSY INFECTION
M Simmons, A Neeb
The Journal of Urology 195 (4), e344-e345