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Located between the bladder and penis in men, the walnut-sized prostate gland helps nourish and protect sperm. As men get older, there's a greater risk of cancer developing within this gland.
Most cases of prostate cancer are diagnosed when men are in their 60s, although men of any age may have suspicious tissues that need to be further evaluated.
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A prostate biopsy refers to the collection and testing of tissues taken from the prostate gland. A specialized needle is used to collect the required samples during an outpatient procedure. The collected samples are then examined in a laboratory under a microscope.
A biopsy of prostate tissue is often recommended if there are abnormal results from a routine screening for prostate cancer. Specifically, it's usually unusual results from a digital rectal exam (DRE) and/or a prostate-specific antigen (PSA) blood test that warrant the need for a prostate biopsy when cancer is suspected. A biopsy may also be recommended if a previous biopsy showed abnormal cells were present but they weren't cancerous at the time.
Prior to having a prostate biopsy, patients are usually asked to provide a urine sample. This is done to look for signs of a urinary tract infection (UTI). If a UTI is present, the biopsy will likely be rescheduled. Men are also normally advised to stop taking certain medications that may increase bleeding risks, particularly blood thinners and certain NSAIDs and herbal supplements. Patients are sometimes advised to do a cleansing enema at home prior to arriving for their biopsy. Antibiotics may be given to a patient shortly before the test to reduce the risk of infection from the procedure.
There are different methods that may be used to perform a prostate biopsy. The most common option is what's called a transrectal biopsy. It's done by inserting a needle through the wall of the rectum to reach the prostate gland. Sound waves are used to produce an image of the gland so the needle can be accurately directed. Typically, several tissue samples are taken. There may be a brief unpleasant sensation each time the needle takes a sample, although the entire procedure is often completed in about 10 minutes.
If a transperineal biopsy is done, the needle is inserted between the anus and scrotum (perineum). With this approach, a CT scan or MRI is usually used to provide guidance to ensure correct needle placement as samples are collected. There may be some temporary soreness in the area where the sample was collected, and light rectal bleeding following the procedure. Patients are generally advised to avoid strenuous activities for a day or two after a prostate biopsy.
Results from a prostate biopsy are evaluated to determine if cancer is present. If cancer is detected, the sample is usually further evaluated to determine how aggressive it is. A grade from 2-10, referred to as the Gleason score, is also applied to the cancer to get an idea of how likely it is to grow and spread. If results show no sign of cancer, routine prostate cancer screenings are often recommended as a precaution.
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