The enlargement of the prostate may cause no symptoms or it may interfere with urination.
What is the prostate?
The prostate is a walnut-sized gland located in the male urinary tract. It lies below the bladder and surrounds the upper urethra.
The function of the prostate is to produce nutrients for the sperm. The prostate gradually increases in size around the time you reach middle age.
What is needle biopsy?
Needle biopsy is a minor procedure in which a needle is inserted into the prostate to take small samples of tissue for diagnostic examination. This procedure is performed in the urologist’s office or clinic.
Why do I need a needle biopsy?
The enlargement of the prostate may cause no symptoms or it may interfere with urination (voiding). Symptoms such as increased frequency of voiding, decreased force of urinary stream, difficulty voiding, or awakening at night to void may be signs of benign prostatic enlargement or a prostatic nodule. Benign enlargement is a normal increase in the size of the prostate and does not require a biopsy. A nodule is a firm or hard area within the prostate of which you might not be aware. Examination by your physician is needed in both cases to determine whether needle biopsy is necessary.
Another cause for a needle biopsy of the prostate is an elevation of the prostate-specific antigen (PSA) in the blood. This is a substance made by both normal and cancerous prostate cells. A needle biopsy might be necessary to determine the cause of PSA elevation.
In addition to the PSA level test and needle biopsy, a digital rectal exam is sometimes performed. In a digital rectal exam, your doctor places a gloved finger in the rectum to feel the prostate gland for any abnormalities. An ultrasound may also be necessary. Ultrasound testing involves placing a small probe in the rectum to view the prostate gland. This test may be done in the doctor’s office or the X-ray department of a hospital.
Preparation for a needle biopsy
It’s important to reduce the risk of infection by cleaning the rectum. Therefore, several hours prior to your scheduled surgery, you should administer an enema in the rectum. Ask your nurse or physician about how to administer the enema and where to purchase one.
Do not eat anything after using the enema. You may drink clear fluids, unless instructed otherwise by your physician. If you have diabetes, ask your physician about special dietary arrangements.
To further reduce chances of infection, some patients may need to take antibiotics before their needle biopsy. Your doctor will inform you if you need to do this.
Taking aspirin, ibuprofen, or other blood thinners may cause unnecessary bleeding after your biopsy. This does not apply to acetaminophen. Please discuss with your physician which medicines you should avoid and for how long.
Needle biopsy procedures
- Biopsy with ultrasound: Most needle biopsies are performed with the aid of ultrasound. The ultrasound probe is placed in the rectum and the prostate gland is visualized. If an abnormality (lesion) is identified, the needle is placed into that area to obtain a piece of tissue. Often, multiple (six or more) biopsies are performed. This is done because many prostate cancers are not visible on ultrasound. Multiple biopsies can further determine the cause and extent of the abnormality.
- Biopsy without ultrasound: Some needle biopsies are performed without ultrasound. In this case, a finger instead of the ultrasound probe is placed into the rectum to feel the area of the lesion. The needle is then guided to this area and a piece of tissue is obtained
Does every patient with an abnormality of the prostate need a needle biopsy?
The need for needle biopsy depends on several factors, including your PSA level and age. This complex issue should be discussed further with your physician.
What are prophylactic antibiotics?
Prophylactic antibiotics are medicines taken to prevent an infection from occurring.
What to expect after needle biopsy?
- After the procedure, your doctor may prescribe an antibiotic. If you do not receive a prescription prior to leaving the office or clinic, please ask your recovery nurse. Make sure that you take the medication as directed. Complete the prescription. Avoid using aspirin or other blood thinners for one week after biopsy to avoid bleeding.
- It is normal to have blood in your urine for three or four days, and possibly light rectal bleeding. To clean out the urinary tract, drink four to six 8-ounce glasses of water daily for three to four days. If you are passing large blood clots, call your doctor.
- It is normal to experience burning on urination for 24 hours after the biopsy. If you are having trouble urinating, try to urinate in warm baths. This may alleviate your discomfort.
- After the procedure, some men complain of a clear to brownish discharge from the penis. You may notice blood in your sperm for up to one month afterward.
- If you have nausea, vomiting, shaking chills and a fever greater than 101.4° F within the first 24 hours following the biopsy, call the doctor immediately (day or night).
- You should not do any heavy lifting for 24 hours. Do not strain during a bowel movement for 48 hours.
- Call for a follow-up appointment.
Call your doctor if:
- Your temperature rises above 101.4° F
- You have nausea, vomiting, or shaking chills
- You experience burning when urinating or pass blood clots
- You’re unable to urinate when you feel that your bladder is full
- You develop a reaction to your medication such as skin rash, nausea, or vomiting