Urologist
How is prostate cancer diagnosed?
A biopsy is necessary for the diagnosis of prostate cancer. Physical examination, blood tests (PSA), or imaging methods are not sufficient to establish a definitive diagnosis. The diagnosis can only be made after tissue samples taken from the prostate are evaluated by a pathologist.
How is a prostate biopsy performed?
There are two methods for performing the procedure. In both methods, an ultrasound probe is inserted rectally to visualize the prostate. In the first method, the biopsy needle is inserted into the prostate through the rectum, while in the second method, the needle is advanced into the prostate through the perineum (the area between the anus and scrotum).
Typically, 12 samples are taken, with 2 samples each from the upper, middle, and lower parts of the right and left sides of the prostate, depending on its size.
The location of each numbered sample is recorded. When the pathologist identifies a cancerous sample, this allows us to determine the specific area of the prostate where cancer is present.
If the prostate is very large or there is suspicion of cancer in areas beyond the standard 12 regions, additional samples may be taken from those areas as well.
What are the disadvantages of prostate biopsy performed with examination and ultrasound guidance alone?
Prostate size varies from person to person. After the age of 40, the prostate begins to enlarge, reaching an average volume of about 40 ml (approximately the size of a large walnut) in the 50s. Cancer does not arise from every part of this organ; while a small region may have cancer, the rest of the prostate can be entirely normal.
Ultrasound unfortunately cannot distinguish between cancerous prostate tissue and normal prostate tissue. In prostate biopsies, ultrasound serves as a guide to locate the 12 standard regions predefined for all patients. In biopsies performed under ultrasound guidance alone, tissue samples are taken uniformly from the same regions of the prostate for every patient to investigate the presence of prostate cancer.
If the cancerous tissue is located outside the sampled areas, it may not be detected in biopsies performed with ultrasound guidance alone. In such cases, the pathology report might incorrectly indicate the absence of cancer, even if the patient actually has prostate cancer. For example, consider the red-shaded areas in Figure 4 representing cancer. If we only take samples from the prostate sections numbered 1 through 12, we would fail to detect the cancer.
What is the advantage of MRI fusion-guided prostate biopsy over biopsy performed with ultrasound alone?
On ultrasound, cancerous areas in the prostate appear the same as normal areas. Distinguishing between cancerous and normal tissue is only possible through MRI and computer technology.
Patients suspected of having prostate cancer are evaluated with multiparametric MRI for detailed imaging of the prostate. MRI creates a map of areas likely to harbor cancer. Unfortunately, it is not possible to differentiate these cancerous areas from normal prostate tissue using ultrasound alone.
Since biopsy is performed under ultrasound guidance, the MRI images of the prostate are fused with the ultrasound images using specialized software before the biopsy. This allows areas suspicious for cancer on MRI to be marked on the ultrasound images of the prostate.
This method enables the identification of potentially cancerous prostate regions with ultrasound and the collection of samples from those areas. This procedure is called MRI fusion-guided prostate biopsy.
Is a prostate biopsy a painful procedure?
It is a procedure that can be performed under local anesthesia. Before the biopsy, a local anesthetic is administered to the areas where nerves enter the prostate using ultrasound guidance to numb the prostate. For patient comfort, it is recommended to perform the procedure under light sedation, known as conscious sedation.
Is hospitalization necessary?
No, it can be performed as an outpatient procedure. Even patients who undergo the procedure under sedation can be discharged 2-3 hours after the procedure.
What needs to be done before a biopsy?
Since the procedure will be performed rectally, bowel preparation is necessary. For this, an enema can be used on the day of the procedure before going to the hospital.
If blood-thinning medications like aspirin are being used, they should be discontinued 5 days prior to the biopsy after consulting a doctor.
To prevent infection, the antibiotic prescribed by the doctor should be taken before the procedure.
What should be considered after a biopsy?
After the procedure, blood may appear in urine, stool, and semen for about a week. Blood in semen may persist for up to a month. For this reason, blood-thinning medications should not be used for about 5 days after the procedure.
Prostate infection may occur following the procedure. If fever or difficulty urinating develops after discharge, a urology specialist should be consulted.