What can be done after a prostate biopsy

Prostate biopsy (prostate biopsy). Indications, contraindications, preparation, how it is carried out, complications.

Biopsy of the prostate (prostate gland) is an invasive diagnostic method, the purpose of which is to take thin tissue columns (biopsy specimens) from the prostate gland with their subsequent histological examination.

Indications for biopsy of the prostate (prostate gland)

• Digital rectal induration;
• Sustained increase in serum PSA (prostate-specific antigen).
• Prostate-specific antigen is a protein that is exclusively secreted by prostate epithelial cells. PSA levels can be affected by conditions such as prostate cancer (PCa), benign prostatic hyperplasia (BPH), chronic prostatitis, trauma, digital rectal examination, and taking 5-alpha reductase inhibitors. Therefore, for a correct diagnosis, it is necessary to take into account all possible factors that affect the change in the PSA level.

PSA norms: 40-50 years - from 0 to 2.5 ng / ml, 50-60 years - up to 3.5 ng / ml, 60-70 years - up to 4.5 ng / ml, 70-80 years - up to 6.5 ng / ml. With a PSA value of 2.5-10.0 ng / ml, 75 percent of patients are diagnosed with benign diseases of the prostate gland, with a PSA level above 10 ng / ml, prostate cancer is most likely.

• Decrease in the ratio of total and free PSA, increase in PSA density (ratio of PSA and prostate volume);
• Increased urinary PSA 3 levels. This marker is the most specific. It is recommended for use in patients with persistent elevated PSA levels and a negative biopsy.
• Detection of suspicious lesions by transrectal ultrasound (TRUS), MRI.

Do not try to engage in self-diagnosis and treatment, if you have symptoms of the disease, we strongly recommend that you seek the advice of a specialist.

Contraindications for biopsy of the prostate (prostate)

• Acute prostatitis
• Acute inflammatory process in the rectum
• Acute inflammation of hemorrhoids
• Severe coagulopathy (bleeding disorder)

Preparing for a biopsy of the prostate (prostate)

• withdrawal of antiplatelet agents and anticoagulants at least 3-5 days before the procedure to avoid the risk of bleeding;
• prescription of antibiotics (ciprofloxacin 500 mg 2 hours before the procedure and within 3 days after) to prevent infectious complications;
• cleansing enema;
• application of local anesthesia;

The diagnostic value of a prostate biopsy depends on two main factors: the correctness of tissue sampling by the urologist and the qualifications of pathomorphologists who give the final conclusion.

How a prostate (prostate) biopsy is done

Transrectal prostate biopsy

Re-biopsy is indicated if the initial biopsy is negative and there is still an indication for testing. Repeat biopsy detects prostate cancer in 20 percent of men in the absence of a tumor in the initial histological examination. Performed in 3-12 months.

Ultrasound image of the prostate during biopsy

During the manipulation, the specialist sees on the screen of the ultrasound machine a 5-7 times enlarged image of the section of the prostate gland. Through a special working channel in the rectal ultrasound sensor, a biopsy gun is used to perform precision "shots" in the required areas of the prostate.

Scheme of transrectal biopsy of the prostate

The incidence of prostate cancer detected on repeat saturation biopsy (>20 bars) varies from 30 to 43 percent and depends on the number of tissue bars. In special cases, saturation biopsy can be performed transperineally. This makes it possible to diagnose prostate cancer in an additional 38 percent of cases. It should be noted that 10 percent of patients after this study develop acute urinary retention

After the biopsy

• Possible discomfort in the anorectal region;
• In 70 percent of cases, patients complain of blood in the urine (hematuria) - disappears within 5 days, 35 percent - in semen (hemospermia) - may be present up to 2 months, 1 percent - rectal bleeding (disappears after 2 - 3 days).
• Urinary retention occurs in 1-2 percent of cases and usually resolves on its own;

Recommendations

• It is recommended to spend the first day after the procedure at home
• Limit sports in the first two weeks, start heavy physical activity no earlier than 1 month
• Sex is allowed after 7-10 days
• Drink plenty of fluids during the week after the procedure (1.5-2.5 liters per day).
• For a few weeks, eliminate alcohol, spicy writing, coffee,
• Reduce fiber-rich foods to prevent constipation.

It is difficult to overestimate the importance of Prostate Biopsy - all further tactics of diagnosis and treatment depend on its results. The use of modern equipment and materials makes the biopsy as informative and painless as possible.

Complications after prostate biopsy

The prostate biopsy procedure is generally well tolerated by patients. You can read more about this procedure in the articles "Transrectal Prostate Biopsy" and "Perineal Prostate Biopsy".

Why do complications occur after prostate biopsy?

The incidence of complications does not depend on the number of biopsy procedures, the number of punctures and the location of the needle during the procedure.

Factors of infectious complications after prostate biopsy

• diabetes,
• weakened immune system,
• taking steroids or other immunosuppressive agents.

• resistance to most antibiotics - usually with a history of long-term unsuccessful antibiotic treatment,
• History of infection after prostate biopsy.

In addition, complications after the procedure may occur if the doctor's instructions are not followed:

• disregarding the recommendation to take antibacterial drugs and other medicines;
• Diet errors (detailed in the article "Diet after prostate biopsy"),
• neglect of exercise restriction after biopsy.

What consequences and complications are possible after prostate biopsy?

Rectal discomfort after prostate biopsy

This is a fairly common complaint that does not require any intervention and usually resolves on its own. Usually, patients cannot accurately express the nature of the discomfort. Literally, it sounds something like this: -There is no pain, but there is a feeling that there was something there-. To alleviate discomfort, we prescribe non-steroidal anti-inflammatory drugs, which help to avoid the occurrence of such discomfort.

Bleeding as a consequence of prostate biopsy

One of the most common consequences after a prostate biopsy is bleeding, which can manifest itself as hematuria, hematospermia, or rectal bleeding. For patients without coagulopathy (blood clotting disorders), the incidence of these complications depends on the use of anticoagulant drugs and the level of blood flow in the prostate gland. Hematuria (blood in the urine) after prostate biopsy is the most common occurrence after the procedure, occurring in up to 74.4% of cases. Hematospermia (blood in semen) occurs in 14.5% of cases, rectal bleeding - 1.2%. Hematuria is expressed in the staining of urine in pink color. On average, the color of urine becomes normal after 2-3 days. In the future, colored urine remains for another 2-3 days at the beginning or at the end of urination.

It should be said that the described scenario develops in the vast majority of patients. However, each organism is individual and the duration of these events may vary somewhat in the time interval.

As a rule, the admixture of blood passes on its own. With continued impurity, it is necessary to consult a doctor. You will be prescribed bed rest, plenty of fluids and appropriate therapy.

Infectious complications and consequences after prostate biopsy

Fluoroquinolones are the most commonly prescribed antibiotics (in 93% of cases in the world). It has been proven that antibacterial prophylaxis significantly reduces the risk of developing bacteriuria, bacteremia, fever, and urinary tract infections.

In 2-4% of cases, after performing a transrectal biopsy, an infectious complication occurs, as a result of bacterial penetration of E. coli through the rectal mucosa into the urinary tract.

Acute bacterial prostatitis as a consequence occurs in 1% of cases and is characterized by pain in the perineum, fever, chills, dysuria or polyuria. In this case, hospitalization is necessary to prevent the spread of sepsis and the involvement of neighboring organs (adnexa and testicles) in the infectious process.

Severe consequences are rare, with less than 0.6% worldwide.

Retention of urination is another possible consequence after a prostate biopsy

Retention of urination occurs in 0.2 to 1.7% of cases. This consequence is usually temporary and does not require surgical intervention.

What are the most dangerous complications after prostate biopsy?

You must immediately contact your doctor or call an ambulance if:

• not urinating for more than 8 hours;
• intense blood in the urine or feces for more than 8 hours;
• high body temperature.

What is the treatment mechanism for complications after prostate biopsy?

Usually, the course of taking antibacterial drugs includes 5 days. Depending on the indications, if infectious complications occur after a prostate biopsy, a long course of antibiotic therapy is necessary (at elevated body temperature, urinary tract infections, the development of acute bacterial prostatitis) - taking quinolones, sulfamethoxazole-trimethoprim. Antimicrobial therapy may be adjusted based on the body's response to antibiotics, urinalysis for culture, and antibiograms. Very rarely, hospitalization may be required - 0.3% of cases.

How to avoid complications after prostate biopsy?

If all the doctor's prescriptions are followed and proper preparation for a prostate biopsy (stopping anticoagulants and antiplatelet agents, taking antibiotics, diet, bowel preparation, limiting the load on the first day after manipulation), the risk of possible complications and consequences after the procedure is reduced to a minimum.< /p>

Many men face a biopsy. What types of it exist, and what reviews do many people who have passed it have?

Can a complication occur after a prostate biopsy? The question is relevant for those who have come across this research method. A biopsy is by far the most effective way to identify defects and pathologies of internal organs in a patient, the stage of their development and the nature of the disease.

This procedure is very simple for the average person to understand, as it consists in a simple laboratory analysis of tissues taken in various ways. With the development of medicine, such analyzes are carried out more and more simply and reliably and provide almost 100% guarantee of detecting the disease at the earliest stage. Men will be able to start treatment in time in accordance with the diagnosis made with the help of a biopsy. But it happens that complications after the procedure appear in many men.

To determine the presence of prostate cancer, its stage, a prostate analysis technique is used: a piece of the prostate gland is taken for a sample in order to examine it in the laboratory and make a specific diagnosis for the patient.

Three main methods of the procedure

Performing a prostate biopsy

The man lies on his left side, presses his legs to his stomach. In order for him not to be hurt, anesthetics are administered intrarectally (into the rectum). An ultrasound transducer is then inserted into the rectum. A special gun, which is placed in the rectum, controlled by an ultrasound machine, shoots the required number of times, taking 17 millimeters of samples for analysis from different parts of the organ.

How much does it hurt?

Usually not, but in some cases there is pain, followed by blood in the urine.

Most of the patients described the pain as mild, but only if they were previously provided with all the information on this issue in an exhaustive volume.

Also, pain is reduced by an anesthetic tablet or injection, which is given to the patient during the preparations for the operation. If a man is not being treated in a hospital, he can immediately go home after the procedure.

He receives recommendations from doctors not to drive a car for at least 1 hour, to avoid sexual contact for at least a week. In the urine, you can also see the consequences of the operation.

After treatment

Shortly before the operation, a course of antibacterial drugs is prescribed, and it is also continued for some time after the operation for safety and prevention of bacterial diseases.

Also, after this procedure, complications occur in some cases. Some of them are quite natural and minor - blood in the urine, while others are much more serious. In any case, everyone is warned about all the possible consequences before the operation, he must be aware of this issue and have an idea of \u200b\u200bprobable and rare complications.

Often this simple operation is easy, but for a group of patients there is an increased risk factor for some complications.

These complications can rarely lead to re-hospitalization of the patient, most often they resolve themselves at home, and the patient himself continues to be monitored as an outpatient.Serious complications occur only in 3% of cases according to statistics.

Infectious infection in men after the intervention

It is precisely because of the infection that most of the cases of hospitalization of the patient after the operation occurred. According to leading European clinics, cases of such serious complications after surgery are less than 1%. If everything was carried out in proper sanitary and hygienic conditions, with the proper implementation of all the rules of asepsis and antisepsis, the likelihood of developing blood poisoning is very, very insignificant, practically excluded. Unless, with the exception of those cases when the infection occurs due to the internal bacteria of the human body, but very few such situations have been recorded.

As already mentioned, the patient takes antibiotics before and after the intervention, 2 days before and 3 after the operation. This is all done in order to minimize the risk of infection.

Symptoms of infection after intervention in men

• weakness, fatigue, poor appetite in the patient;
• temperature rises to 38 and above;
• The patient is very chilly.

It is possible to minimize the risk of infection

Hemorrhagic complications after a prostate procedure

One of the most common symptoms after the procedure in men is the appearance of some blood in the stool or urine. This symptom is not dangerous, it is the norm and it occurs in more than a third of patients. Usually, this phenomenon continues to bother men from three days to a week after surgery. Also, blood can be seen in seminal fluid - this is typical for 37% of cases.

In more rare cases, patients after implantation may have more severe bleeding, most often rectal. But these cases are rare. However, if this happens, and heavy bleeding bothers the man for more than two days, you need to see a doctor to stop the bleeding by surgery. Such bleeding is sometimes accompanied by pain and a slight increase in body temperature.

If a man takes anticoagulants, then before intervening in the prostate gland, he must warn the doctor about this so that he takes this fact into account and takes the necessary measures. Anticoagulants are substances that thin the blood, which means that after a biopsy they can cause more severe bleeding and serious complications in the patient. One week before the operation, they must be stopped. If this is unacceptable due to the health of the man, then after the biopsy he remains under the supervision of doctors in the hospital.

Pain in the perineum and anus

In turn, some of the unpleasant consequences in men after a prostate biopsy are pain in the perineum and in the anus. This symptom is much less common - up to 5% of cases. Such symptoms cannot be called complications. Pain in 9 cases out of 10. As studies by urologists in Europe, Asia and North America show, it is more psychological than physiological in nature. Usually pain and discomfort last no longer than 3 days.

Still observed. Such a symptom is possible, rare and is a signal that you need to see a doctor immediately. The cause of urinary retention (sometimes up to 8 hours), accompanied by pain in the perineum, may be the formation of bruises in the urethra. After a prostate biopsy, such symptoms are rare, up to 1% of cases.

The whole thing took about five minutes. Then he immediately got up and left. It didn't hurt at all. After four hours I walked calmly, there was no discomfort. Then he sat behind the wheel, and then felt a sharp pain. That is why the doctor did not recommend not driving for at least five or six hours - it was unbearable to sit straight. Blood in the urine did not appear for another day after the procedure.

The next day, my physical condition was in order. There was no pain and bleeding, there was also no temperature, only for 2 days I had to take time off from work to rest. It was possible not to do this. Minor things like this aside, the biopsy was a success.

Prostate biopsy performed. Holes were pricked, but they could not say anything. I also had a temperature for 3 days, blood in my urine and semen.

A biopsy is a minimally invasive surgical diagnosis of tissues and sections of internal organs obtained by puncturing the skin and collecting cells or sections of a diseased organ or its affected part (neoplasms, inflammation, purulent abscess, etc.) A biopsy is divided into several main types by the type of instruments used, localization, use of additional instruments and the nature of tissue penetration.

When is a prostate biopsy prescribed?

The following data from preliminary studies serve as the reason for performing a diagnostic biopsy:

- As a result of the tests, an elevated level of prostate-specific blood antigen (PSA) was detected. Such data indicate that the patient may have prostate cancer.

Techniques used in prostate biopsy

There are three methods for performing a biopsy:

- Transrectal biopsy is a method of obtaining prostate aspirate, in which a needle is inserted into the prostate gland through the anus and rectal septum. This manipulation is convenient due to the close proximity of the prostate to the rectum. Before the biopsy, local anesthesia is administered to reduce discomfort and pain.

Possible complications and consequences of prostate biopsy

After the diagnosis, the patient is recommended to spend at least a day at rest, without physical and psychological stress. Prostate biopsy causes complications in very rare cases, of the possible consequences, mild pain and discomfort in the manipulation area can be noted. If blood appears in the urine or feces, do not be afraid. The alarm should be beaten in the event that this does not go away within the next few days or bleeding opens. Also, dangerous symptoms include any urination disorders, an increase in body temperature to 37.5 degrees and above, as well as severe unrelenting pain.

What can a patient experience after a prostate biopsy?

According to the European Association of Urology, the incidence of complications after prostate biopsy is low. The frequency of hospitalizations for complications that occur after prostate biopsy is 0.4-3.4%.

If all the doctor's prescriptions are followed and proper preparation for a prostate biopsy (stopping anticoagulants and antiplatelet agents, taking antibiotics, diet, bowel preparation, limiting the load on the first day after manipulation), the risk of possible complications and consequences after the procedure is reduced to a minimum.< /p>

Rectal discomfort after prostate biopsy

This is a fairly common complaint that does not require any intervention and usually resolves on its own. Usually, patients cannot accurately express the nature of the discomfort. Literally, it sounds something like this: -There is no pain, but there is a feeling that there was something there-. To alleviate discomfort, we prescribe non-steroidal anti-inflammatory drugs, which help to avoid the occurrence of such discomfort.

Bleeding as a consequence of prostate biopsy

One of the most common consequences after a prostate biopsy is bleeding, which can manifest as hematuria, hematospermia, or rectal bleeding.

For patients without coagulopathy (blood clotting disorders), the incidence of these complications depends on the use of anticoagulant drugs and the level of blood flow in the prostate gland.

Hematuria (blood in the urine) after a prostate biopsy is the most common occurrence after the procedure, occurring in up to 74.4% of cases. Hematuria is expressed in the staining of urine in pink color. On average, the color of urine becomes normal after 2-3 days. In the future, colored urine remains for another 2-3 days at the beginning or at the end of urination.

Hematospermia (blood in semen) occurs in 14.5% of cases, rectal bleeding 1.2%.

As a rule, the admixture of blood passes on its own. With continued impurity, it is necessary to consult a doctor. You will be prescribed bed rest, plenty of fluids and appropriate therapy.

Infectious complications and consequences after prostate biopsy

It has been proven that antibacterial prophylaxis significantly reduces the risk of developing bacteriuria, bacteremia, fever, and urinary tract infections.

In order to minimize the risk of an infectious and inflammatory complication, the patient should take prophylactic antibiotics for at least two days after the prostate biopsy procedure.

Patients who are at risk of developing bacterial endocarditis, who have heart valve defects or an artificial pacemaker, always require special attention from the doctor because of the greater likelihood of infectious complications. In such cases, the doctor prescribes a longer prophylactic antibiotic therapy.

Symptoms associated with infectious and inflammatory complications:

• Temperature is usually above 38.5C
• Chill
• Weakness, lethargy

The risk of infectious complications is reduced:

• Prophylactic antibiotic therapy
• Giving an enema before a prostate biopsy
• Antiseptic treatment of the ultrasound transducer and use of a rectal condom
• Use of disposable biopsy needles and guidewires

Hemorrhagic complications

The presence of a slight admixture of blood in the feces (rectorrhagia), urine (hematuria) or seminal fluid (hematospermia), which persists for 2-3 days after a prostate biopsy, is considered normal, and the patient should be warned about this by a doctor.

According to the European Association of Urology, hematospermia is observed in 37.4% of cases, hematuria - in 14.5% of cases, rectorrhagia in 2.2% of biopsies. These conditions do not require hospitalization and treatment and stop on their own.

Rarely, patients may experience more severe bleeding. According to the study by Djavan et al, severe hematuria after prostate biopsy was observed in 0.5-0.7% of patients and in most cases stopped spontaneously. In 0.7% of cases, rectal bleeding occurs for more than two days, requiring surgical control.

It is worth paying attention to the fact that the main cause of heavy bleeding after a prostate biopsy is the constant use of anticoagulants (blood thinners) by the patient. Therefore, it is very important to let your doctor know that you are taking anticoagulants before a prostate biopsy. Unless there are strong medical indications requiring continuous anticoagulation, in other cases, anticoagulant therapy should be suspended 7 days before the procedure to minimize the risk of bleeding after prostate biopsy.

If anticoagulant therapy cannot be interrupted, then the prostate biopsy procedure is carried out in a hospital, followed by an extended stay of the patient in the hospital for postoperative observation.

The risk of bleeding after a prostate biopsy is much lower in patients taking anti-inflammatory drugs on a regular basis compared to patients taking anticoagulants. Aspirin and other non-steroidal anti-inflammatory drugs reduce the activity of platelets involved in blood clotting, resulting in an increased risk of bleeding. Although there are data on the possibility of bleeding in patients taking aspirin and other non-steroidal anti-inflammatory drugs, there are no reliable facts proving a higher likelihood of bleeding in such patients. Therefore, there is still no consensus on the need to cancel anti-inflammatory drugs before prostate biopsy. And according to the recommendations of the European Association of Urology, taking aspirin in small doses is not a contraindication for prostate biopsy.

Pain in the perineum and rectum

Pain and discomfort in the perineum and rectum after a prostate biopsy, according to various sources, is a concern for 3-5% of men. However, it should be noted that descriptions of sensations are absolutely subjective data and largely depend on the lability of the male nervous system. The higher the lability of the nervous system of a man and the severity of anxiety, the more often such a patient experiences pain and discomfort after a prostate biopsy. The duration of such sensations does not exceed 2-3 days.

Impaired urination

Retention of urination occurs in 0.2 to 1.7% of cases. This consequence is usually temporary and does not require surgical intervention.

Urination disorders can be manifested by acute urinary retention up to 8 hours or more and difficulty urinating. The frequency of complications after a prostate biopsy is extremely low, and, as a rule, adequate preventive measures help to reduce the likelihood of complications to zero.

What are the most dangerous complications after prostate biopsy?

You must immediately contact your doctor or call an ambulance if:

• not urinating for more than 8 hours;
• intense blood in the urine or feces for more than 8 hours;
• high body temperature.

Usually, the course of taking antibacterial drugs includes 5 days. Depending on the indications, if infectious complications occur after a prostate biopsy, a long course of antibiotic therapy is necessary (at elevated body temperature, urinary tract infections, the development of acute bacterial prostatitis). Very rarely, hospitalization may be required in 0.3% of cases.

Recommended diet after prostate biopsy

After a prostate biopsy, a light diet should be followed.

The first rule of thumb regarding diet after a prostate biopsy is to highlight fluid intake.

It is necessary to drink plenty of fluids for 10-12 days (soups, broths, water, compotes, juices) 1.5-2.5 liters per day. This is important to prevent infections after a prostate biopsy.

Diet to prevent constipation after prostate biopsy

Involves eating foods rich in fiber to avoid constipation. These include:

• berries (raspberries, blackberries, blueberries, strawberries);
• legumes (lentils, beans);
• vegetables (beets, broccoli, Brussels sprouts, cauliflower, carrots, bell peppers, potatoes, pumpkin);
• fruits (avocados, bananas, grapefruit, oranges, peaches, pears);
• dried fruits (dried apricots, dried peaches, dried dates, raisins, prunes);
• nuts (pumpkin seeds, almonds, sunflower seeds, peanuts, walnuts);

Diet for the prevention of flatulence

To prevent flatulence after a prostate biopsy, it is necessary to limit products that cause increased gas formation.

• black bread
• sauerkraut
• kvass
• grapes and grape juice
• peas.

Diet to prevent bleeding after prostate biopsy

To prevent bleeding after a prostate biopsy, we recommend that you include foods that increase blood clotting in your diet for at least 2 months.

• greens (dill, parsley, coriander, spinach),
• rose hips,
• buckwheat,
• bananas

Immune Boosting Diet

The diet after a prostate biopsy should include foods that increase the body's immunity to prevent infections.

• products containing phytoncides (onion, garlic, radish, black currant, cherry, blueberry),
• foods rich in vitamin A (egg yolk, liver, red and orange vegetables and fruits),
• foods rich in vitamin C (citrus fruits, cabbage, currants, rose hips, spinach),
• fish containing Omega-3 polyunsaturated fatty acids (sardine, tuna, trout, salmon).

When following a diet, it is important to exclude substances that can irritate the urinary system after a prostate biopsy:

You will need to strictly refrain from drinking alcohol for at least a month, this is important to avoid weakening the immune system and irritating the digestive system and bladder. And most importantly - alcohol can provoke an exacerbation of the inflammatory process and cause urinary retention.

Caffeinated drinks (coffee, green tea, cola)

If you are used to drinking coffee in the morning, then it may be appropriate for you to temporarily replace your favorite drink with chicory.

Green tea, although it contains useful polyphenolic components that are a good immunomodulator and a preventive measure to reduce the risk of prostate cancer, we recommend that you temporarily stop this drink for 2 weeks.

Spicy food is contraindicated after prostate biopsy

Spicy food (high in hot pepper, horseradish, vinegar, mustard, garlic).

It is not recommended to consume these products in large quantities. If you like spicy and sour, then you don’t need to completely avoid these products, it is important to reduce their consumption.

In addition to the diet after a prostate biopsy, it is important to observe the food culture and the correct daily routine:

• get up and go to bed at the usual time;
• the interval between meals should not exceed 4 hours;
• do not eat two hours before bedtime;
• chew food thoroughly.