The term “biopsy of the prostate gland” means an invasive study, during which a thin needle carries out the sampling of biomaterial for its subsequent analysis. Currently, in practice, many techniques are used. The doctor chooses the method that is most suitable for the patient in terms of individual characteristics of his health and psychological state. A biopsy is the most informative method for diagnosing prostate cancer.
Indications and contraindications
Depending on the sequence of the procedure, the procedure may be:
- Primary.
- Secondary.
In the first case, indications for prostate biopsy are:
- Suspicion of cancer during an ultrasound scan. It occurs when a region with an irregular shape and hypoechoic character is detected in the glandular tissues. As a rule, it is localized in the peripheral zone of the organ.
- Elevated levels of prostate-specific antigen in the blood (a protein produced by gland cells). The indicator is considered critical if it exceeds 4 ng / ml. In addition, the basis for the appointment of a biopsy of the prostate gland are elevated PSA density, the ratio of free and total protein, and also if it gradually increases every year. At the same time, if the result is below the minimum acceptable, this does not guarantee the absence of a malignant process.
- The presence of a seal detected during digital rectal examination. During palpation, the doctor can detect dense neoplasms, which serves as the basis for suspecting the presence of prostate cancer. The porous surface of the organ and poor mobility of the rectal mucosa can also indicate the disease.
A prostate biopsy procedure is not performed if the patient has the following contraindications:
- Episodes of exacerbation of hemorrhoids.
- Inflammatory processes in the rectum, which are acute.
- Obstruction of the anal canal.
- Inflammatory processes in the prostate.
- Blood coagulation disorders.
- Pathology of fluid connective tissue.
This list is basic, but not complete. The presence of contraindications to the procedure is determined in the course of a conversation with a doctor individually. In addition, the patient has the right to refuse a biopsy.
Preparation
The procedure can be performed in several ways:
- Transrectal.
- Transurethral.
- Transperianal.
The choice of technique is carried out by the attending physician taking into account the individual characteristics of the patient's health. Each of the above manipulations requires compliance with certain training rules.
A prostate biopsy provides the most reliable result if the patient has followed the following recommendations:
- Before the procedure, blood tests for coagulation, hepatitis, HIV, syphilis, PSA, as well as a clinical analysis should be performed.
- A week before the study, it is necessary to stop taking anticoagulants and antiplatelet agents. If this is not possible for health reasons, it is necessary to inform the attending physician about this.
- During the same time, it is recommended to undergo a preventive course of antibiotic therapy. This is necessary in order to minimize the risk of all kinds of complications after a biopsy.
- The physician must be informed in advance that the patient is allergic to latex and drugs.
If the procedure is carried out in a transrectal way, preparation for a biopsy of the prostate gland involves another step - a cleansing enema.
Immediately before the study, the patient signs a consent to its implementation. A person should be informed by a doctor about how a biopsy of the prostate gland is done, what sensations to expect in the process, whether there are consequences and which of the signs appear to be considered grounds for seeking medical help.
Transrectal method
This method is considered classic. The following tools are required for its implementation:
- Ultrasound Machine The device is equipped with a transrectal sensor.
- Special gun (automatic device for prostate biopsy).
- A device that is compatible with a rectal probe.
- Sterile disposable needle. The tool consists of several components.
Algorithm for a biopsy of the prostate by the transrectal method:
- The patient is placed on the couch. A person can take any convenient position. Most often, the patient fits on his left side and presses his legs bent at the knees to his stomach.
- If necessary, an anesthetic drug is administered. Most patients are interested in whether a prostate biopsy is painful. This procedure is rather associated with psychological discomfort. Based on the reviews, a prostate biopsy is not accompanied by severe pain. According to the indications or at the request of the patient, local anesthesia is possible. As a rule, it is carried out as follows: in the angle between the seminal vesicle and the base of the prostate, an injection of 1% lidocaine in an amount of 5 ml is carried out. Anesthesia can also be carried out by introducing an anesthetic gel into the intestinal lumen.
- Equipment for the collection of biomaterial is being prepared: the doctor puts on a mask, hat and sterile gloves, then opens the bag with the needle, and then charges it into the gun. The specialist attaches the disposable rectal nozzle to the ultrasound machine. Then he puts on her a special gel-treated condom. The final step in the preparation of equipment is the installation of a guide nozzle. Performing these measures, the doctor once again tells how to do a biopsy of the prostate gland and what sensations to expect from the procedure.
- A digital rectal examination is performed to identify suspicious areas. After that, a nozzle with a sensor is inserted into the lumen of the rectum. Then the doctor makes an ultrasound.
- The specialist removes the biopsy gun from the fuse. Having fired, a thin needle carries out the collection of tissue, after which the outer one pushes it into its inner space. Thus, the biomaterial is in the cavity of the instrument in the form of a column.
- Tissue samples are placed in sterile containers and sent to the laboratory for histological examination.
In fact, biomaterial sampling is carried out blindly, despite the availability of modern equipment. There is always a risk that the needles will not fall into the focus of the pathology. In this regard, tissues are selected from several points. Currently, it is considered standard to obtain 12 columns of biomaterial.
Transurethral method
Tissue collection for research is carried out using a cystoscope (endoscopic equipment) and a cutting loop.
The biopsy algorithm is as follows:
- The patient is placed on a special chair with footrests. Before the procedure, anesthesia is performed (general, local or epidural).
- The introduction of a cystoscope is carried out in the urethral lumen. The device is equipped with a camera and backlight for the best visualization. The cystoscope is advanced to the desired site and with the help of a cutting loop, the doctor collects biomaterial from the most suspicious areas.
At the end of the procedure, the device is removed from the urethra. On average, the process takes about half an hour.
Transperineal method
This method is used in practice less often. This is due to the fact that the procedure is invasive in nature and is associated with the occurrence of severe pain.
The algorithm of carrying out:
- The patient is laid on his back and asked to raise his legs. Another option is a lying position on one side with limbs bent at the knees, pressed to the chest.
- The doctor performs local anesthesia or general anesthesia. After that, the specialist makes a small incision in the perineum.
- Under the control of an ultrasound machine from the prostate, biomaterial is taken by a biopsy needle. After receiving the required amount of tissue, it is removed. The final step is suturing the incision.
Despite the fact that the procedure is invasive in nature, its duration is 15-30 minutes.
Latest Techniques
Methods for diagnosing prostate cancer are improving every year.
Currently, the following modern technologies are actively used:
- Histoscanning. To conduct it, you need a monitor and an ultrasound machine, which is equipped with a rectal sensor. The patient is laid to one side and asked to tighten his legs. After preparing the equipment, a special condom is put on the rectal nozzle. Then the instrument is introduced to the patient into the lumen of the rectum. After that, a three-dimensional scan of the prostate is performed, the results of which are processed by a special program. The doctor receives a series of photographs in which suspicious areas are marked.
- Fusion biopsy. It implies the simultaneous use of ultrasound and MRI devices. As a result, the doctor receives images that accurately reflect the localization of foci of pathology.
Thanks to the development of the latest techniques, the biomaterial is taken with maximum accuracy, and not blindly.
Possible complications
After the procedure, the patient must observe the following rules:
- During the month, do not take a bath, do not visit the sauna and pool, do not swim in open water.
- In the same period, it is necessary to abandon high-intensity physical activity and the use of coffee and alcohol-containing drinks.
- Drink at least 2 liters of pure still water per day for 7 days.
- It is forbidden to have sex for 1.5 weeks.
With proper preparation, proper conduct and compliance with the above rules, the risk of consequences of a prostate biopsy is minimal.
However, the patient may show:
- Blood in urine.
- Difficulty in committing an act of urination.
- Pain in the perineum.
- Frequent urination.
- Isolation of blood from the anus.
- Signs of acute prostatitis.
- Elevated body temperature.
- Complications associated with anesthesia or local anesthesia.
These conditions disappear on their own within 1-2 days. They are not indications of immediate medical attention. The following conditions are considered alarming signs: intense and prolonged bleeding (more than 3 days), pronounced painful sensations, the patient does not feel the urge to urinate for 8 hours, and fever. In such cases, you must consult a doctor as soon as possible or call an ambulance team.
Deciphering the results
As a rule, they are ready 7-10 days after sampling the biomaterial for analysis. A prostate biopsy can confirm or refute the preliminary diagnosis (the presence of a tumor or inflammatory process).
When cancer is confirmed, a number reflecting the degree of tissue damage is also entered in the results:
- 1 - The neoplasm is represented by single glandular cells, the nuclei of which are not changed.
- 2 - A tumor consists of a small number of them. But at the same time they are separated from the healthy by the shell.
- 3 - The tumor is represented by a large number of glandular cells. In addition, their germination in healthy tissues was revealed.
- 4 - The neoplasm is represented by pathologically altered prostate tissues.
- 5 - The tumor consists of a large number of atypical cells. At the same time, they grow into healthy tissues.
The number 1 corresponds to the type of cancer cells, which are considered to be slightly aggressive, 5 - the most dangerous.
In addition, to assess the overall result, the Gleason index is entered in the conclusion form. Its decoding:
- 2-4. Means the presence of a malignant process, which is slightly aggressive and develops slowly.
- 5-7. Average
- 8-10. The cancer process is aggressive, characterized by a high rate of development. In addition, this index indicates a high risk of metastasis.
Based on the results, the doctor draws up the most effective treatment regimen, taking into account the individual characteristics of the patient’s health.
Misconceptions regarding the procedure
A prostate biopsy is shrouded in many myths. The most common:
- If there are no alarming symptoms, the need for a biopsy is exaggerated. In fact, prostate cancer is a disease, the course of which may not be accompanied by any signs for a long time. Even if the patient is not bothered by anything, the doctor can send him for a biopsy (if, according to the results of the tests, the specialist suspected cancer).
- The procedure is associated with the occurrence of severe pain. Currently, before a biopsy, the patient may be anesthetized. Thanks to this, the patient does not feel any discomfort.
- The needle damages the organ. Subject to all the rules (preparation and conduct) this does not happen.
- A biopsy helps to accelerate cancer. During the collection of biomaterial, contact with the deep layers of tissue does not occur. The needle is designed in such a way that the cells are excised without damage to the organ, respectively, the tool does not affect the rate of spread of cancer.
- Erectile dysfunction is one of the consequences of a biopsy. During the procedure, a point sampling of several columns of tissue is carried out. In these areas, as a result, a small inflammatory process occurs, which is stopped in a short time by drugs. Since the procedure is invasive, blood can be detected in the urine and even sperm for some time. This condition does not affect the fulfillment by the body of an erectile function.
Therefore, one should not believe common misconceptions. If the attending physician considers it appropriate to conduct a biopsy of the prostate, you need to pass the biomaterial for analysis. Timely diagnosis allows you to identify a malignant process at an early stage, which significantly increases the chance of a speedy recovery.
Finally
Finger rectal examination, blood and urine tests, ultrasound of the prostate gland can only suspect the presence of cancer. To make an accurate diagnosis, a biopsy is necessary. This is an invasive procedure, as a result of which the presence of a malignant process in the prostate is confirmed or excluded. In addition, when identifying an oncological disease, the doctor receives information regarding the degree of aggressiveness and the rate of spread. Due to this, it is possible to draw up the most effective treatment regimen.