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Prostate biopsy is the only test capable of confirming the presence of cancer in the prostate and involves removing small pieces of the gland to be analyzed in the laboratory in order to identify the presence, or not, of malignant cells.
This examination is usually advised by the urologist when cancer is suspected, especially when the PSA value is too high or when changes in the size or shape of the prostate are found during digital rectal examination. Check out the 6 tests that assess prostate health.
Prostate biopsy does not hurt, but it can be uncomfortable and, for this reason, is usually done under local anesthesia or mild sedation. After the examination, it is also possible that the man may experience some burning in the region, but it will pass within a few hours.
When biopsy is recommended
Prostate biopsy is indicated in the following cases:
- Prostate rectal examination altered;
- PSA above 4 ng / mL at any age:
- PSA above 2.5 ng / mL in patients up to 55 years old;
- PSA density above 0.15 ng / mL;
- Speed of increase in PSA above 0.75 ng / mL / year.
In most cases, prostate cancer, when present, is identified right after the first biopsy, but the test can be repeated when the doctor is not satisfied with the result of the 1st biopsy, especially if there is:
- Persistently high PSA with a velocity greater than 0.75 ng / mL / year;
- High-grade prostatic intraepithelial neoplasia (PIN);
- Atypical proliferation of small acini (ASAP).
The second biopsy should be done only 6 weeks after the first. If a 3rd or 4th biopsy is necessary, it is advisable to wait at least 8 weeks.
Watch the following video and learn about other tests that the doctor can perform to identify prostate cancer:
How prostate biopsy is done
The biopsy is done with the man lying on his side, with his legs bent, properly sedated. Then the doctor makes a brief evaluation of the prostate by performing the digital rectal examination, and after this evaluation, the doctor introduces an ultrasound device in the anus, which guides a needle to a location near the prostate.
This needle makes small perforations in the intestine to reach the prostate gland and collects several pieces of tissue from the gland, and the regions around it, which will be analyzed in the laboratory, looking for cells that may indicate the presence of cancer.
How to prepare for biopsy
Biopsy preparation is important to avoid complications and usually includes:
- Take the antibiotic prescribed by the doctor, for about 3 days before the exam;
- Complete a full 6-hour fast before the exam;
- Clean the intestine before the exam;
- Urinate a few minutes before the procedure;
- Bring a companion to help you return home.
After a prostate biopsy, the man must also take the prescribed antibiotics, eat a light diet in the first hours, avoid physical effort in the first 2 days and maintain sexual abstinence for 3 weeks.
Understanding the biopsy result
The results of the prostate biopsy are usually ready within 3 days and can be:
- Positive: indicates the presence of cancer developing in the gland;
- Negative: the cells collected did not change;
- Suspect: an alteration has been identified that may or may not be cancer.
When the prostate biopsy result is negative or suspicious, the doctor may ask for a repeat test to certify the results, especially when he suspects that the result is not correct due to the other tests performed.
If the result is positive, it is important to stage the cancer, which will help to adjust the treatment. See the main stages of prostate cancer and how treatment is done.
Possible complications of biopsy
Since it is necessary to pierce the intestine and remove small pieces of the prostate, there is a risk of some complications such as:
1. Pain or discomfort
After the biopsy, some men may experience mild pain or discomfort in the anus region, due to scarring of the intestine and prostate. If this happens, the doctor may advise the use of some mild pain relievers, such as Paracetamol, for example. Usually, the discomfort disappears within 1 week after the exam.
2. Bleeding
The presence of a small bleed in the underwear or in the toilet paper is completely normal during the first 2 weeks, even in the semen. However, if the amount of blood is too high or disappears after 2 weeks, it is advisable to go to the doctor to see if there is any bleeding.
3. Infection
Since the biopsy causes a wound in the intestine and prostate, there is an increased risk of infection, especially due to the presence of various types of bacteria in the intestine.For this reason, after the biopsy the doctor usually indicates the use of an antibiotic.
However, there are cases in which the antibiotic is not enough to prevent infection and, therefore, if you experience symptoms such as fever above 38ºC, severe pain or strong smelling urine, it is advisable to go to the hospital to identify if there is an infection and initiate proper treatment.
4. Urinary retention
Although it is more rare, some men may experience urinary retention after biopsy due to inflammation of the prostate, caused by the removal of pieces of tissue. In such cases, the prostate ends up compressing the urethra, making it difficult for urine to pass.
If this happens, you should go to the hospital to remove the accumulation of urine from the bladder, which is usually done with the placement of a bladder tube. Understand better what a bladder catheter is.
5. Erectile dysfunction
This is the rarest complication of the biopsy but, when it appears, it usually disappears within 2 months after the exam. In most cases, the biopsy does not interfere with the ability to have intimate contact.
Created by: Tua Saúde Editorial Team
Bibliography>
- PROJECT GUIDELINES - BRAZILIAN SOCIETY OF UROLOGY. Prostate Biopsy. 2006. Available at:. Accessed on 22 Oct 2020
- BRAZILIAN SOCIETY OF UROLOGY. CLARIFICATION NOTE AND REPUDIO. Available in: . Accessed on 22 Oct 2020