Name of the Procedure:

Biopsy, prostate; needle or punch, single or multiple, any approach
Common Name: Prostate Biopsy
Medical Term: Transrectal Ultrasound-guided Biopsy (TRUS-guided Biopsy)

Summary

A prostate biopsy involves taking small samples of tissue from the prostate gland using a needle. These samples are then examined under a microscope to detect any signs of cancer or other abnormalities.

Purpose

Medical Condition Addressed: Prostate cancer, benign prostatic hyperplasia (BPH), or other prostate abnormalities.
Goals/Outcomes: To diagnose or rule out prostate cancer, determine the nature of prostate abnormalities, and help guide treatment decisions.

Indications

Symptoms/Conditions: Elevated prostate-specific antigen (PSA) levels, abnormal digital rectal exam (DRE) findings, or imaging results suggesting prostate abnormalities.
Patient Criteria: Men with risk factors for prostate cancer, such as family history, age, or symptomatic presentation.

Preparation

Pre-procedure Instructions:

• Fasting may not be required but typically patients are advised to maintain clear liquids a few hours before the procedure.
• Antibiotic medication might be prescribed to prevent infection.
• Avoid certain blood-thinning medications as advised by the healthcare provider.

Diagnostic Tests: Urine and blood tests, including PSA levels, and imaging studies such as MRI or ultrasound.

Procedure Description

1. Patient Positioning: The patient is positioned on their side or back with knees brought up to the chest.
2. Anesthesia: Local anesthesia or sedation may be administered to minimize discomfort.
3. Insertion of Ultrasound Probe: An ultrasound probe is inserted into the rectum to visualize the prostate.
4. Biopsy Needle Insertion: A hollow needle is guided through the rectal wall to the prostate.
5. Tissue Sample Collection: Multiple tissue samples are taken from different areas of the prostate.
6. Sample Analysis: The collected tissue is sent to a laboratory for pathological examination.

Tools/Equipment: Ultrasound probe, biopsy needle.

Duration

The procedure typically takes around 10-20 minutes.

Setting

Performed in an outpatient clinic, hospital, or specialized surgical center.

Personnel

Involved Professionals: Urologist or radiologist, nursing staff, potentially an anesthesiologist.

Risks and Complications

• Common Risks: Bleeding, infection, discomfort, blood in urine/semen.
• Rare Risks: Severe infection, sepsis, prolonged bleeding.
• Management: Antibiotics for infections, monitoring and supportive care for bleeding.

Benefits

Expected Benefits: Accurate diagnosis of prostate conditions, early detection of prostate cancer, which can lead to more effective treatment.
Realization of Benefits: Diagnostic results are usually available within a few days to a week.

Recovery

Post-procedure Care:

• Continue taking prescribed antibiotics.
• Avoid strenuous activities for a few days.

• Monitor for signs of infection or excessive bleeding.

  Recovery Time: Most patients recover within a few days.
  Follow-up: Appointment for results discussion and further management planning if needed.

Alternatives

Other Options:

• MRI-guided biopsy: More precise but may be more expensive and less widely available.

• PSA monitoring and DRE: Less invasive but not as definitive.

  Pros and Cons: MRI-guided biopsy may have higher accuracy. PSA and DRE are non-invasive but may miss some cancers or lead to false positives.

Patient Experience

During Procedure: Some discomfort from the ultrasound probe and needle insertion, managed with anesthesia or sedation.
After Procedure: Mild pain or soreness in the rectum, presence of blood in urine or stool, which should resolve in a few days.
Pain Management: Over-the-counter pain relievers, adequate hydration, and follow instructions provided by the healthcare team.