Prostrate Biopsy

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Prostrate Biopsy

Indications for biopsy

There are four basic reasons why your urologist would recommend that you receive an initial prostate biopsy:

	You have an elevated standard PSA level (of 4.0 ng/ml or more).
	There is a significant change in your standard PSA level over time.
	You have a standard PSA level of between 2.5 and 10.0 ng/ml and a low free/total PSA ratio as indicated by the PSA II test.
	You have a suspicious-feeling prostate on digital rectal examination.

Highlights

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Expert urologists now recommend that if any one of these indicators is present, you should have a biopsy even if your ultrasound evaluation is normal.

Procedures for prostate biopsy

Specialists in the diagnosis of prostate cancer now recommend that biopsies of the prostate be carried out under ultrasound guidance and that several samples of tissue be taken from the prostate using an ordered method normally called sextant biopsy.

The urologist will often ask you to have an enema prior to carrying out the biopsy, but there is no need for anesthesia. You will be given an antibiotic in order to prevent any possible infection. In all likelihood you will be asked to stop taking certain drugs for one or two weeks before the biopsy in order to minimize the risk of bleeding problems.

In carrying out the actual biopsy, using Trans-Rectal Ultrasound (TRUS) to guide the precise placement of the biopsy needle, the urologist will take six or more samples of tissue from the prostate and then send them to the pathologist for examination. The precise number of samples taken will depend upon what the urologist is able to see using the ultrasound machine. Normally, he or she would expect to take six evenly spaced specimens from different areas of the prostate (called a systematic sextant biopsy), and then additional specimens from areas which look suspicious according to the ultrasound. In this way the urologist will maximize the chance of finding prostate cancer tissue if it is there in the prostate.

The urologist will send the biopsy specimens (often called "cores") to a pathologist for evaluation. The pathologist will then study these specimens carefully under a microscope, and will send a report back to the urologist which includes the following information:

	Which specimens contain prostate cancer and which do not.
	The amount of prostate cancer in the specimens which do show signs of cancer.
	Where in the specimen that the prostate cancer can be found.
	The grade or grades of the prostate cancer in each specimen which shows signs of cancer.

This information is designed to help the urologist (and the patient) in deciding what to do next.

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