The Truth About Prostate

Prostate biopsies are an essential tool for diagnosing prostate cancer, but facing the prospect of undergoing one can be emotionally draining. Many men find themselves grappling with fears about the procedure itself, concerns about the risks, and uncertainties surrounding the results. Understanding both the benefits and potential drawbacks of a prostate biopsy can help ease these anxieties and allow you to make informed decisions about your health.

Golden State Urology in Fremont and Sacramento is committed to helping you navigate this journey by providing you with expert care, advanced diagnostic tools, and a personalized approach to your treatment. In this blog, we’ll explore the truth about prostate biopsy by shedding light on the side effects, risks, accuracy, and alternative options available to patients.

What Is a Prostate Biopsy?

A prostate biopsy involves the removal of small tissue samples from the prostate gland for examination under a microscope to detect the presence of cancerous cells. The procedure is usually recommended when there are elevated Prostate-Specific Antigen (PSA) levels or abnormal findings in a digital rectal exam.

Before the biopsy, patients may be given antibiotics to reduce the risk of infection. The procedure is usually performed in an outpatient setting and involves local anesthesia. A transrectal ultrasound (TRUS) is used to guide a needle through the rectum and into the prostate to retrieve tissue samples. Some urologists may use a transperineal approach, where the needle is inserted through the skin between the scrotum and anus.

Understanding the Test Procedure

There are three main methods for performing a prostate biopsy, each with its own pros and cons. 

Transrectal (through the rectum): This is the most commonly used prostate biopsy method.

• You’ll be asked to lie on your side with your knees bent.
• A healthcare provider will insert an ultrasound probe into your rectum, which may cause some discomfort or pressure.
• The ultrasound provides images of the prostate. Using these images, the provider will inject a numbing agent around the prostate
• A biopsy needle is then guided into the prostate to collect tissue samples. You may feel a brief stinging sensation during this step.
• Between 10 and 18 samples are taken and then sent to a lab for analysis.

Transperineal (through the perineum): This method, where the biopsy is conducted through the skin between the anus and the scrotum, is becoming more common. This method may lower the risk of infection while maintaining cancer detection rates similar to that of the transrectal approach.

• You’ll be sedated to ensure you don’t feel any pain.
• An ultrasound probe is placed in your rectum to provide imaging of the prostate.
• A biopsy needle is inserted through the perineum to collect tissue samples.

Transurethral (through the urethra): This method is the least commonly used method of performing a prostate biopsy.

• You’ll be sedated to help reduce pain.
• A cystoscope, a flexible tube with a camera, is inserted through the urethra at the tip of the penis.
• Tissue samples are then collected from the prostate using the scope.

While the procedure generally takes only about 10-15 minutes, patients should expect some discomfort during and after the biopsy. Recovery typically involves avoiding strenuous activities for a few days, and follow-up care may include additional tests based on biopsy results.

Is Prostate Biopsy Safe?

One of the most common questions patients have when considering a biopsy is: Does a prostate biopsy damage the prostate? 

As with any medical procedure, a prostate biopsy comes with its own set of risks, the most common being hematuria and rectal bleeding, according to academic research studies. However, the procedure is generally considered safe when performed by experienced urologists using advanced imaging technology. Prostate biopsy complications are rare, but it’s important to be aware of the potential risks involved, which we’ll cover in detail below.

Prostate Biopsy Side Effects 

As with any medical procedure, there are some prostate biopsy side effects. Pros and cons should be discussed with your healthcare provider to make an informed decision. Here are some potential side effects to be aware of:

• Blood in urine: It’s common to see blood in the urine for a few days after the procedure.
• Blood in stool: Rectal bleeding may occur due to the transrectal approach.
• Blood in semen: Hematospermia (blood in the semen) can last several weeks.
• Pelvic discomfort: Patients may experience soreness or mild pain in the pelvic region.
• Difficulty urinating: Some men may have trouble urinating after the biopsy.
• Infection: Although rare, infection is a potential risk, primarily if the procedure was performed transrectally.
• Rectal bleeding: Minor bleeding from the rectum may occur, particularly with a transrectal biopsy.
• Fever: A fever is a sign of infection that requires immediate medical attention.
• Urinary retention: Some patients may have temporary difficulty emptying their bladder.
• Erectile dysfunction: Though less common, temporary erectile dysfunction can be a side effect.

Long-term side effects of prostate biopsy are rare and are much less severe than some of the side effects of untreated prostate cancer. If you are concerned about prostate biopsy risks (spreading cancer, inaccurate diagnosis, pain, discomfort, etc.), consult with your healthcare provider, who can discuss how to mitigate them.

How Accurate is a Prostate Biopsy?

While a prostate biopsy is considered the gold standard for diagnosing prostate cancer, it’s not perfect. Several factors can affect the accuracy of the test, leading to either false positives or false negatives.

False Negatives and Missed Cancer

About 75% of prostate biopsies are negative for cancer. However, prostate biopsies can frequently present with false-negative results. A false negative occurs when cancer is present but not detected by the biopsy. This can happen if the cancer is located in an area of the prostate that wasn’t sampled. In such cases, repeat biopsies or additional imaging tests may be necessary to ensure an accurate diagnosis. 

Overdiagnosis and Overtreatment

Prostate biopsies can sometimes lead to the diagnosis of slow-growing cancers that may never cause harm. Overdiagnosis can result in overtreatment, subjecting patients to unnecessary interventions that can have long-term consequences, including financial burdens and psychological distress.

A controversial study published in The New England Journal of Medicine highlighted the complexities of prostate cancer screening and its relationship to overdiagnosis. This study questioned the effectiveness of PSA tests in improving mortality rates and underscored the need for a careful, individualized approach to prostate biopsies.

Should You Get a Prostate Biopsy? 

Deciding whether to undergo a prostate biopsy is a significant decision that depends on several personal and medical factors. It is essential to take the time to understand potential prostate biopsy risks as well as the benefits of the procedure while working closely with your healthcare provider to make an informed choice.

Your PSA levels play a crucial role in guiding this decision. Elevated PSA levels can indicate the possibility of prostate cancer, but they may also be linked to other benign conditions like an enlarged prostate or prostatitis. A urologist will look not only at your current PSA level but also at PSA trends over time (referred to as PSA velocity) to determine if further investigation is necessary.

Your age and family history are other important factors to consider. Men with a family history of prostate cancer, especially those with a first-degree relative who has had the disease, are at a higher risk and may be more likely to benefit from a biopsy. Age is another consideration, as prostate cancer is more common in older men, particularly those over 50. However, younger men with other risk factors may also be advised to undergo screening and, potentially, a biopsy.

Overall health also plays a role in the decision. For some men, particularly those with multiple underlying health conditions or limited life expectancy, the risks of a biopsy may outweigh the potential benefits. In such cases, your doctor may discuss whether active surveillance (closely monitoring PSA levels without immediate intervention) or alternative diagnostic tests might be more appropriate.

It’s crucial to have an open and detailed discussion with your urologist to explore all aspects of the decision. Here are some key questions to ask during your consultation:

What are the potential benefits and risks of the biopsy?

Understanding the possible outcomes of a biopsy is essential. While a biopsy can detect prostate cancer early, it also comes with risks such as infection, bleeding, and discomfort. Discussing these risks with your doctor will help you weigh them against the potential benefits, particularly if early detection is a priority.

What will happen if the biopsy results are inconclusive?

Sometimes, a biopsy may not provide clear answers. In such cases, your doctor may recommend additional testing or even another biopsy. Knowing what to expect in the event of inconclusive results can help you prepare mentally and understand the next steps.

Are there alternative tests I should consider?

Alternatives like the 4Kscore blood test, urine tests, or multiparametric MRI may offer valuable information without the need for immediate biopsy. These tests help determine if a biopsy is truly necessary or if you might benefit from further non-invasive screening first.

Additionally, it's worth discussing the emotional and psychological impact of undergoing a biopsy. Waiting for results can cause significant anxiety, and dealing with an uncertain diagnosis can be mentally taxing. Your healthcare provider can offer resources or strategies to help you cope with this stress during the diagnostic process.

Lastly, ask your urologist about the implications of different biopsy results. If cancer is detected, understanding the grade and stage of the cancer is critical for determining the appropriate course of treatment. Conversely, if no cancer is found, your doctor will guide you on whether continued monitoring or further testing is needed.

While a prostate biopsy remains one of the most reliable ways to diagnose prostate cancer, it’s essential to consider your personal health factors, lifestyle, and comfort level with the procedure before moving forward.

Alternative Tests

If you're unsure about undergoing a prostate biopsy, several alternative tests may offer additional information to help guide your decision. These tests, while not replacements for a biopsy, can provide insights into your risk for prostate cancer and help determine whether a biopsy is necessary. Here are some of the most commonly used alternatives.

4Kscore blood test

The 4Kscore test measures four prostate-specific markers in your blood, including PSA, to assess the likelihood of finding aggressive prostate cancer. This test goes beyond traditional PSA testing by incorporating additional data, such as your age, digital rectal exam (DRE) results, and prior biopsy history, to provide a more accurate risk prediction. It helps differentiate between aggressive and non-aggressive forms of prostate cancer, potentially reducing unnecessary biopsies.

Urine sample test

Urine tests, such as the PCA3 test, analyze genetic markers found in urine that are associated with prostate cancer. These tests can offer valuable information about the presence of cancer cells in the prostate, making them helpful in determining the need for a biopsy.

Multiparametric MRI

A multiparametric MRI is a highly advanced imaging test that provides detailed pictures of the prostate. It combines different types of MRI images to detect abnormalities in the prostate that may indicate cancer. This non-invasive test can identify suspicious areas that may require further investigation, such as a targeted biopsy. 

These alternative tests may not replace a biopsy but can provide valuable additional information to help you and your healthcare provider make a more informed decision. By assessing the results of these tests, your doctor can help you weigh the risks and benefits of a biopsy more accurately.

Golden State Urology Can Help You Make an Informed Decision

At Golden State Urology, we understand that deciding whether to undergo a prostate biopsy is a deeply personal choice. Our team is here to provide the expert guidance and advanced diagnostic tools you need to make an informed decision based on your unique situation. With convenient locations in Sacramento and Fremont, CA, we are ready to help you every step of the way.

To learn more about our men's health services, visit Golden State Urology's men's services page or contact us to request an appointment today.