Prostate biopsy is a surgical method to remove small samples of prostate tissue for examination under microscope. The prostate gland is situated just beneath the urinary bladder and covers the urethra. The gland generates enzyme-rich secretions that add to the seminal fluid through ducts that enter the urethra.
Ferguson was the firms to perform the prostate needle biopsy in 1930. He explained a transperineal aspect with an 18-gauge needle in which he sucked a sample of prostate tissue. The first transrectal biopsy of prostate was performed by Astraldi in 1937. In the mid 1980s, a transperineal ultra-sound machine was fitted with biopsy tool to enable direct sonographic views of focal prostatic lesions with the microscopic structure of tissue of these lesions. After many years, a spring-loaded actual biopsy device was invented that operated via a TRUS probe.
In 1987, the first printed material explaining the use of TRUS with transrectal biopsy appeared. Since then, as ultrasound technology has got more improved, this technique has been considered as a better process of conducting a core biopsy of the prostate.
Since the initial findings of TRUS of the prostate by Wild and Reid, comprehensive technologic advances have bettered the diagnostic potentials of this modality. The current state-of-the-art TRUS tool is a 5-8 MHz hand-held, high-resolution tool with multiaxial planar imaging potentials, having the capacity for both transverse and sagittal imaging of the prostate. This tool can be fitted with an adapter that includes the needle of a spring-loaded biopsy gun, thus enabling multiple cores of tissue to be easily acquired. The visualization offered by the new higher resolution transducers, along with the ability to instruct the biopsy needle into various portions of interest and to offer uniform spatial separation of the locations to be sampled, has enabled to make TRUS-driven prostate biopsy a paramount technique in the diagnosis of prostate cancer.
A prostate biopsy is basically conducted to ascertain whether the patient is suffering from prostate cancer. Often, it may also be leveraged to diagnose a situation called benign prostatic hypertrophy (BPH), an enlargement of the prostate that may lead to obstruction of urine flow in older males.
This procedure which is also known as transrectal ultrasound-guided biopsy is the most generally performed prostate biopsy type and can basically be conducted in the physician's office without using any anesthesia. The patient is instructed to lie on his side or on his back hanging the legs in stirrups. After applying local anesthetic the urologist uses a thin needle attached to a spring-driven gun guided by ultrasound to take samples from the prostate. The gun is capable enough to insert and remove the needle into the prostate tissue quickly, generating less discomfort and trauma for the patient. The process can often be finished within 30 minutes. Generally the tissue samples are taken by fine-needle aspiration, unlike larger core tissue samples that generate more discomfort for the patient.
If the probability of complication for the patient is too high for the transrectal ultrasound-guided biopsy, the urologist may opt for another route through the perineum to reach the prostate. The skin of the perineum is properly cleansed and a local anesthetic is administered at the site where the biopsy is to be conducted. After the area is numb, the physician creates a small (1 in/2.5 cm) incision in the perineum. The physician puts one finger in the rectum to guide the biopsy needle, and the needle is then pushed into the prostate. A small issue is taken and the needle is withdrawn. The needle is then again guided into another portion of the prostate and another sample of tissue is taken. In this way, samples are collected from multiple areas. After the collection, the biopsy site is cease by putting pressure to stop bleeding. The patient generally experiences only slight discomfort and the procedure takes 30 minutes.
The physician would monitor the patient for any complications, excessive bleeding, or pain due to the procedure. After the procedure, the patient generally experiences minor rectal bleeding, blood in urine or feces, and often blood in the semen. These side effects may last for a few days.
Prostate biopsy conducted with a bioptic gun is a low-risk method. The possible risks include abnormal bleeding, urinary tract infection, or some trouble in urination. These complications are treatable, and the patient should consult physician promptly if symptoms occur. The patient may develop high fever, chills, or unexplained pain or bleeding after the procedure.
The prostate tissue is put, stained, and prepared on glass slides for test under the microscope by a pathologist who will study the samples for the presence of cancerous cells. If the prostate tissue samples display no sign of inflammation, and if no cancerous cells are found, the results are normal. If malignant cells are detected, the pathologist grades them, in order to evaluation the aggressiveness of the tumor.