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Concept
Prostate biopsy
Summary
Prostate biopsy is a procedure in which small hollow needle-core samples are removed from a man's prostate gland to be examined for the presence of prostate cancer. It is typically performed when the result from a PSA blood test is high. It may also be considered advisable after a digital rectal exam (DRE) finds possible abnormality. PSA screening is controversial as PSA may become elevated due to non-cancerous conditions such as benign prostatic hyperplasia (BPH), by infection, or by manipulation of the prostate during surgery or catheterization. Additionally many prostate cancers detected by screening develop so slowly that they would not cause problems during a man's lifetime, making the complications due to treatment unnecessary.
The most frequent side effect of the procedure is blood in the urine (31%). Other side effects may include infection (0.9%) and death (0.2%).
The procedure may be performed transrectally, through the urethra or through the perineum. The most common approach is transrectally, and historically this was done with tactile finger guidance. The most common method of prostate biopsy was transrectal ultrasound-guided prostate (TRUS) biopsy.
Extended biopsy schemes take 12 to 14 cores from the prostate gland through a thin needle in a systematic fashion from different regions of the prostate.
A biopsy procedure with a higher rate of cancer detection is template prostate mapping (TPM) or transperineal template-guided mapping biopsy (TTMB), whereby typically 50 to 60 samples are taken of the prostate through the outer skin between the rectum and scrotum, to thoroughly sample and map the entire prostate, through a template with holes every 5mm, usually under a general or spinal anaesthetic.
Antibiotics are usually prescribed to minimize the risk of infection. A healthcare provider may also prescribe an enema to be taken in the morning of the procedure. During the transrectal procedure, an ultrasound probe is inserted into the rectum to assist in guiding the biopsy needles.
Official source
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