Taking a Prostate Biopsy

Often, it is impossible to diagnose the pathological process of the prostate without a biopsy with cytology and histology of the tissues taken for analysis. This is the most informative study of the male organ for the occurrence of a benign or malignant process.

How is a biopsy performed, when is the procedure shown, what are the contraindications, complications and methods of its implementation.

What methods are used for biopsy

Taking prostate tissue for analysis is carried out in several ways:

• Sextant - through the lumen in the rectum during digital examination. The analysis is taken from 4-6 zones of the organ by the method of introducing a needle, controlling its movement with a finger.
• Polyfocal - a tissue fragment is taken for an ultrasound examination, samples are taken from 12 sites of prostate lesion.
• Saturation method - biopsy of samples is taken from 24 points of the prostate gland under ultrasound control.

The saturation technique is the most transmitting, so it allows you to detect a tumor at the initial stage of its development.

The sextant technique is in less demand, as it is considered more outdated due to the inability to provide high accuracy and the ability to collect samples from the required areas of the organ, which leads to inaccurate diagnosis.

There are also different methods for taking biopsy material:

• Transrectal biopsy of the prostate - tissue is taken through the rectum.
• Transurethral biopsy - through the urethral canal.
• Transperinal biopsy - through a small incision in the perineum.

Performing a multifocal transrectal biopsy

Multifocal biopsy of the prostate gland can be performed during an ultrasound examination on the apparatus, and during a finger examination of the organ. The process is performed in the supine position on the side, with the knees bent at the chest, and also in the supine position with the legs raised on the support. Sometimes the method is performed in a squatting position.

Before taking tissue in this way, the doctor performs local anesthesia. After that, the manipulation is carried out under ultrasound or finger control (for accurate penetration of the biopsy needle). You can take up to 10 pieces of tissue this way.

To conduct a biopsy taking of material with ultrasound control, it takes several minutes, and with a finger examination, the procedure is done for half an hour.

Performing a transurethral biopsy

How is a prostate biopsy performed?

To carry out such a technique for taking material, you need the help of a cystoscope with a special cutting loop. In this case, general anesthesia (anesthesia), local anesthesia or spinal, epidural anesthesia are applied.

The patient lies on his back in a chair with special supports for the support of the legs. The cystoscope is inserted into the lumen of the urethra. The procedure is performed using a micro camera and lighting. The device is moved to the depth of the prostate gland. Then the cutting loop takes the necessary samples from the required areas of the glandular organ. Then the cystoscope is removed from the urethra, the whole procedure takes from half an hour to 45 minutes.

Performing a transperineal biopsy

This method of material collection is very rare. This is due to the invasiveness and pain of the procedure. The method is performed in a supine position. The specialist performs anesthesia, after which an incision is made in the perineal area. The whole event is carried out under the control of ultrasonic equipment. When the removal of the fragments is completed with the needle, the needle is removed and the incision is sutured. This procedure lasts from a quarter to half an hour.

When biopsy is indicated

Primary indications for biopsy are recommended in the following clinical situations:

• when the results of the dog have increased standards;
• if nodes and seals are found during palpation of the rectum;
• if areas with low echogenic activity are detected during ultrasound examination (transabdominal or transurethral);
• what is the necessary control over the pathological process after transurethral resection or after removal of the prostate gland through lane surgery in the peritoneum or urethral wall.

Secondary prostate biopsy is indicated for:

• maintaining an increased or increasing existing dog level;
• when the ratio between free and common agent is less than 10%;
• prostatic intraepithelial neoplasia found on primary biopsy;
• antigen with a density higher than 15%;
• little material was taken during the initial biopsy study performed.

When biopsy is contraindicated

Sometimes biopsy sampling may be contraindicated:

• impaired blood coagulation system;
• acute inflammatory process in the tissues of the prostate;
• hemorrhoid inflammation (acute);
• significant anal strictures;
• previously performed perineal-abdominal extirpation;
• complex pathologies of the kidneys, liver, heart during the period of complications.

Sometimes patients themselves are categorically against the biopsy procedure.

Biopsy preparation guidelines

Biopsy is called a minimally invasive surgical procedure, for which you must carefully prepare. All recommendations for preparing for the sampling of material are given by the attending physician. The patient must also give written consent to this research method.

The doctor's recommendations are as follows:

Biopsy can be performed both on an outpatient basis and in an inpatient setting. In a medical institution such as a polyclinic, the procedure is carried out if the introduction of anesthesia by the intravenous route, as well as spinal or epiduar, is not required. In all other cases, the sampling session is carried out only after the patient has been hospitalized.

When the biopsy is performed under general anesthesia, spinal or epiduarial method, patients are under the supervision of specialists 48 hours after sampling. If no complications have been identified, then the patient can be discharged home.

What are the possible complications after taking tissue fragments for biopsy

If the preparation for the collection of material and the procedure itself was carried out in a competent way, then the risks of unwanted complications are minimal. In very rare cases, the following consequences may appear.

During urination, there may be traces of blood in the urine due to intravesical or urethral bleeding. Some patients may have obstructed outflow of urine, sometimes even anuria. Some patients begin to walk frequently due to small need. During the ejaculation of seminal fluid, traces of plasma are possible from the ejaculant.

Men note soreness in the rectum with pain radiating to the perineum. Sometimes there are blood rejections from the rectum. The most serious complication a biopsy can cause is an acute flare-up of orchitis, epididymitis, or prostatitis. Complications occur after the use of anesthesia or anesthesia (local).

If any unpleasant manifestations last more than three days, then the help of the attending physician is needed.