Name of the Procedure:

Biopsy, prostate; incisional, any approach

Summary

A prostate biopsy is a surgical procedure where a small tissue sample is taken from the prostate gland for examination. The procedure can be performed using different approaches, such as transrectal, transurethral, or transperineal.

Purpose

The purpose of the prostate biopsy is to diagnose potential conditions such as prostate cancer, benign prostatic hyperplasia (BPH), or other prostate diseases. The goal is to determine the presence and extent of abnormal cell growth by examining the tissue sample under a microscope.

Indications

• Elevated prostate-specific antigen (PSA) levels
• Abnormal findings during a digital rectal exam (DRE)
• Symptoms such as difficulty urinating, blood in urine, or pelvic pain
• Family history of prostate cancer

Preparation

• Patients may be instructed to fast for a few hours prior to the procedure.
• Any blood-thinning medications may need to be adjusted in consultation with the healthcare provider.
• An enema or laxative might be recommended to clear the bowels.
• Prophylactic antibiotics may be administered to prevent infection.

Procedure Description

1. Anesthesia: Local anesthesia or sedation is typically administered to minimize discomfort.
2. Positioning: The patient is positioned on their side, back, or abdomen, depending on the approach being used.
3. Incision: A small incision is made to access the prostate.
4. Sample Collection: Using a small, specialized needle or surgical tool, the physician extracts tissue samples from various parts of the prostate.
5. Closure: The incision is closed with sutures, and a sterile bandage is applied.
6. Laboratory Analysis: The tissue samples are sent to a pathology lab for microscopic examination.

Duration

The procedure typically takes around 30 to 45 minutes.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Urologist or surgeon
• Anesthesiologist or nurse anesthetist (if sedation is used)
• Surgical nurse or assistant

Risks and Complications

• Infection at the biopsy site
• Bleeding or bruising
• Hematuria (blood in the urine)
• Difficulty urinating
• Discomfort or pain at the incision site
• Rare complications include sepsis or significant organ damage

Benefits

• Accurate diagnosis of prostate conditions
• Early detection of prostate cancer, which can significantly improve treatment outcomes
• Informing appropriate treatment plans and management strategies

Recovery

• Patients may be advised to avoid strenuous activities for a few days.
• Mild pain or discomfort can usually be managed with over-the-counter pain relievers.
• Antibiotics may be prescribed to prevent infection.
• Follow-up appointments may be scheduled to discuss biopsy results and next steps.

Alternatives

• Non-invasive imaging tests like MRI
• Transrectal ultrasound (TRUS)
• Monitoring PSA levels and performing periodic digital rectal exams
• Pros: Less invasive options may involve fewer risks and discomfort.
• Cons: Less precise than a biopsy, potentially delaying diagnosis or treatment.

Patient Experience

• During the procedure, patients might feel slight pressure or discomfort.
• Post-procedure: Mild pain or soreness is common.
• Pain management includes local anesthetic during the procedure and over-the-counter pain relief afterward.
• Emotional support and clear communication about the process can help alleviate anxiety.