DEAR DOCTOR K:
My last PSA test result was abnormal, so my doctor has scheduled a prostate biopsy. What can I expect? Is there anything I can do to make the procedure more comfortable and reduce the risk of complications?
An abnormal prostate-specific antigen (PSA) blood test result often leads to a prostate biopsy. A biopsy is the only way to confirm the presence of cancer.
The most common biopsy procedure is guided with transrectal ultrasound. While you lie on your side, the doctor inserts an ultrasound probe into your rectum. Ultrasound is like a tiny little radar device. It bounces sound waves off your prostate, and the reflected sound waves form a picture. Before doctors had ultrasound to use, they often performed biopsies of the prostate at random places — and sometimes missed cancers that were there.
The ultrasound scans the prostate, looking for areas that may contain cancer. When such an area is spotted by the ultrasound, a spring-loaded device rapidly inserts a needle through the rectal wall into the suspicious area of the prostate to retrieve tiny tissue samples.
The procedure usually takes less than 15 minutes. Later, the biopsy samples are examined under a microscope for signs of cancer.
Most men do not find prostate biopsy overly painful or uncomfortable. Complications occur in only about two men out of every 100, and the complications are not usually serious. But they can be.
I spoke to my colleague, Dr. Marc B. Garnick. He’s a prostate cancer expert at Harvard-affiliated Beth Israel Deaconess Medical Center. Following are our suggestions for reducing discomfort and the risk of complications. Discuss them with your doctor:
- ANESTHESIA. This shot is injected into the prostate to numb pain during the procedure. It can be the difference between a tolerable biopsy and an unpleasant one.
- PREVENTIVE ANTIBIOTICS. A prostate biopsy comes with certain risks, including infection. The biopsy needle can spread bacteria or an infection from the rectal wall to the prostate or bloodstream. Taking preventive antibiotics — before and after the procedure — greatly cuts the risk of infection.
- SKIPPING THE ENEMA. Doctors used to recommend an enema before a biopsy to reduce the chance of infection. The latest studies find that this isn’t necessary. The body can fight infection, especially if you take preventive antibiotics.
- YOUR MEDICATIONS. Before the biopsy, your doctor may advise you to briefly stop taking daily low-dose aspirin or blood-thinning medicines. These drugs reduce the blood’s ability to clot.
Minor and temporary bleeding is common and expected after the biopsy. However, if bleeding seems to be getting worse, or even if minor bleeding lasts more than 24 hours, tell your doctor. If you experience fever or chills, get to a hospital right away. These could be signs of infection.
Finally, seek care immediately if you stop being able to urinate after a biopsy. The biopsy produces some temporary swelling of the prostate, and this can temporarily make it harder to urinate. This problem is easy to fix, but needs to be treated promptly.