Prostate biopsy is an examination that is related particularly to older men. The main aim of the biopsy is to obtain a sample (or better samples) of prostatic tissue for histological examination.
The biopsy is done by a special needle-equipped bioptic device, which is inserted into the rectum. The rectum is in close anatomical contact with the prostatic tissue, which is located right in front of the anterior rectal wall. First, an ultrasound probe is inserted into the rectum to visualize the prostate and the biopsy itself is performed under ultrasound control. The needle is controlled by a special “gun”, which allows quickly ejecting and automatically reinserting the needle. This allows quick and multiple sampling to obtain more pieces of tissue (in ideal case 6-12 samples). The obtained tissue is then sent for histological examination.
The examination does not require any significant preparation. The patient is only administered a suppository the evening before the examination to make the rectum empty. Before the procedure, it is possible to administer some drugs to calm the patient and decrease any painful sensation.
The prostate biopsy is particularly important to rule out or confirm histological signs of prostate cancer. The examination takes place when thee diagnosis is suspicious, but can not be clearly confirmed. This usually means finding an enlarged prostate (either symptomatic or incidental) and elevation of PSA in patient’s serum. PSA is the prostate-specific antigen, which serves as tumor marker, i.e. its concentration increases in prostate cancer. However, higher level of PSA can be also found in benign enlargement of the prostate, in prostatitis and other non-malignant causes.
The examination may be painful. In addition, the prostate can be easily irritated and get swollen, which may cause troubles in outflow of urine from the bladder followed with blood in urine and burning and painful sensations during urination. The bleeding, however, is usually not strong and it subsides spontaneously. Even despite cautious aseptic execution of the examination, there is always a risk of infectious bacterial prostatitis accompanied with fever and pain.
Prostate biopsy is the only method that can in some cases accurately distinguish benign enlargement of the prostate from the prostate cancer. Enlarged prostatic tissue is not a clear symptom and the elevated PSA concentration may be misleading.