Name of the Procedure:

Prostate Needle Biopsy

Common Name(s): Prostate biopsy
Technical/Medical Term: Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method (G0416)

Summary

A prostate needle biopsy is a procedure where a small sample of tissue is taken from the prostate using a thin needle. This sample is then examined under a microscope to check for the presence of cancer or other abnormalities.

Purpose

Medical Conditions Addressed:

• Detection of prostate cancer
• Evaluation of prostate-specific antigen (PSA) test anomalies
• Investigation of abnormal findings from a digital rectal exam (DRE)

Goals/Expected Outcomes:

• Determine the presence or absence of malignant cells
• Guide treatment decisions based on histological findings
• Evaluate severity and grade of detected cancer

Indications

Symptoms/Conditions:

• Elevated PSA levels
• Abnormal DRE results
• Family history of prostate cancer
• Symptoms like difficulty urinating, blood in urine or semen, and pelvic discomfort

Patient Criteria:

• Men typically over the age of 50
• Patients with significant risk factors for prostate cancer

Preparation

Pre-Procedure Instructions:

• Fasting may not be required, but follow specific instructions from the healthcare provider
• Temporary discontinuation of blood thinners or other medications as advised by the physician
• Enema may be recommended for bowel clearing

Diagnostic Tests/Assessments:

• Blood tests, including PSA levels
• Physical examination
• Imaging studies such as MRI, if indicated

Procedure Description

1. The patient lies on their side or back, with knees drawn toward the chest.
2. An ultrasound probe is inserted into the rectum to visualize the prostate.
3. A thin needle is then guided through the rectal wall or perineum to the prostate.
4. Multiple tissue samples (usually 10-12) are collected.
5. The tissue samples are sent to a laboratory for histopathological examination.

Tools:

• Ultrasound probe
• Biopsy needle
• Specimen collection jars

Anesthesia/Sedation:

• Local anesthesia to numb the area
• Sedation or general anesthesia, less commonly, depending on patient preference and clinical recommendation

Duration

Typically takes 10-20 minutes.

Setting

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

Personnel

Healthcare Professionals Involved:

• Urologist
• Radiologist (if imaging guidance is used)
• Nursing staff
• Pathologist (for specimen analysis)

Risks and Complications

Common Risks:

• Bleeding or blood in urine/semen
• Infection
• Mild discomfort or pain at the biopsy site

Rare Complications:

• Significant bleeding
• Severe infection
• Urinary retention

Management:

• Antibiotics for infection
• Pain relief medications as needed
• Monitoring and follow-up for any complications

Benefits

• Accurate diagnosis of prostate conditions
• Informative results for creating an effective treatment plan
• Quick recovery with minimal downtime

Realization Time:
Results are typically available within a week, enabling timely decision-making for further treatment.

Recovery

Post-Procedure Care:

• Rest for 24 hours
• Avoid strenuous activity for a few days
• Drink plenty of fluids
• Monitor for signs of infection or excessive bleeding

Expected Recovery Time:

• Generally, less than a week

Restrictions/Follow-Up:

• Follow-up appointment to discuss biopsy results and next steps
• Avoidance of sexual activity for a week

Alternatives

Other Treatment Options:

• PSA Surveillance (watchful waiting)
• Multiparametric MRI
• Transrectal or transperineal needle biopsy

Pros and Cons of Alternatives:

• PSA surveillance is non-invasive but may miss early cancer detection.
• MRI provides detailed imaging but cannot replace histopathological analysis.
• Transrectal vs. transperineal biopsy types vary in complication risks and patient comfort.

Patient Experience

During the Procedure:

• Mild discomfort due to probe insertion and pressure
• Minimal pain due to local anesthesia

After the Procedure:

• Some soreness and mild bleeding
• Pain management through prescribed medications
• Temporary urinary or rectal symptoms

Comfort Measures:

• Local anesthesia to minimize pain
• Clear communication and reassurance from healthcare providers
• Recommended post-procedure care to enhance recovery