Pathology Center at USMD
A biopsy is the only way to know if you have prostate cancer. A prostate biopsy removes small samples of prostate tissue from the body. The samples are then assessed for the presence of cancer cells.
To prepare for the biopsy, you may need to stop taking some medications and start taking others. Medications to stop include blood thinners like warfarin (coumadin) and Aspirin. Taking antibiotics do minimize developing an infection after the procedure and patients will be prescribed either an oral medication or an injection which will be administered roughly one hour prior to the biopsy.
Right before the biopsy, local anesthesia will be given to numb the area. Tell your doctor if you've had any reactions to anesthesia in the past. With local anesthesia, you'll feel a small needle prick and a little burning with some pressure for less than a minute. You will have a loss of feeling in that area for a short time. You may feel pressure during the biopsy but should have minimal if any discomfort.
The most common type of prostate biopsy is the transrectal method using a spring-loaded needle. For this biopsy, a probe is inserted into the rectum. The needle travels through the probe to reach the prostate. To make sure the best tissue sample is collected, a transrectal ultrasound is used. This device is also inserted into the rectum. It uses sound waves to make a picture of the prostate that is seen by your doctor on a computer.
The needle removes tissue about the length of a dime and the width of a toothpick. Typically, 14-18 samples - called cores are taken. This is done to check for cancer in different areas of the prostate. Prostate biopsies aren't perfect tests. They sometimes miss cancer when it's there. If no cancer if found, your doctor may likely monitor blood tests and rectal exams closely over the next several years to ensure that there is no further suspicion and that a repeat biopsy is not needed.
Prostate biopsies often occur with no problems; however, side effects are possible. You may experience hematospermia, hematuria, rectal bleeding, or an infection. These will be discussed at the time of the procedure to educate you as to what is normal and abnormal after the procedure.
Tests Performed After Diagnosis
To plan your treatment, it is important to know the status of your cancer. Prostate cancer can metastasize before treatment has started or any time after. Your doctor will assess your chances of having metastases based on your PSA test, rectal exam and biopsy. Further imaging tests may be ordered such as an MRI, CT scan or bone scan.
After treatment tests can show if the cancer was cured or has returned. For long term treatment, tests can show if the cancer is under control or if treatment is harming your body.
- Blood Tests - may help tell if your prostate cancer has spread and if your organs are working properly. It can also be used to monitor the disease after diagnosis.
- Imaging Tests - take picture of the inside of the body. These tests are often easy to undergo. Imaging machines are large and have a tunnel in the middle.
- Bone Scan - this scan may show if you have bone metastases. For this test you will receive injection of radioactive dye into your vein. The dye will travel to diseased bone cells throughout your skeleton within several hours. A special camera will then take pictures and the dye in the bones. Disease will show as a dark areas called "hot spots". Hot spots may be metastatic cancer, but many abnormal results aren't cancer. Arthritis and previous trauma to the areas may also cause an abnormal finding. This is routinely confirmed with further X-Rays or an MRI of the area.
- CT Scan - Computed tomography test is often called CT or CAT scan. It tells if the cancer has spread or if cancer has returned after treatment. A CT scan takes many picture of a body part from different angles using x-rays.
- Lymph Node Biopsy - Lymph is a clear fluid that returns fluid and protein to the blood. It travels between tissues, blood and lymph nodes in long, tube-shaped vessels. Lymph vessels and nodes are everywhere in the body, which allows prostate cancer to spread to other organs. Prostate cancer often spreads to the lymph nodes in the pelvis. Cancer continues to grow inside lymph nodes causing them to increase in size. A CT scan can show if lymph nodes are enlarged. A lymph node biopsy is performed by fine needle aspiration. This biopsy uses a very thin needle to remove very small pieces of a lymph node. A CT scan is used to guide the needle into the lymph node. With a local anesthetic, this test causes little discomfort and doesn't leave a scar.