Prostate biopsy

Description:

The biopsy of a prostate is a method of a research at which the doctor by means of a special needle takes a prostate gland tissue piece for the subsequent its histologic research under a microscope.

The biopsy of a prostate is carried out by a fine tissue extractor through a rectum wall (transrektalno), through an urethra (transuretralno) or through a crotch (area between a scrotum and an anus). Most often the biopsy of a prostate is carried out transrektalno, that is through a rectum. The pieces of fabric taken on a biopsy are investigated on existence of cancer cells (so-called atypical cells).

The biopsy of a prostate can be carried out at good results of blood test on the DOG or at identification of changes during the manual rectal research.

Purposes of performance of a biopsy of a prostate:

The biopsy of a prostate becomes for definition:

- whether the tumor found at a manual rectal research malignant is.
- the reasons of the DOG high level in blood at the patient

How to be prepared for a prostate biopsy:

Before carrying out a biopsy of a prostate it is necessary to tell the doctor about that:

if you have any disturbances of coagulability of blood,
if you have an allergy to any drugs, including anesthetics,
if you regularly accept any drugs. In this case the doctor should report surely what drugs you accept.
if you accept the drugs liquefying blood - warfarin, heparin, эноксапарин, aspirin, an ibuprofen or other non-steroidal anti-inflammatory drugs.
Before carrying out a biopsy of a prostate the patient examines possible complications of the procedure and signs the voluntary informed consent to intervention.

If the biopsy of a prostate is carried out under local anesthesia through a crotch (transperinealno), then no special preparation is required.

When carrying out a biopsy of a prostate through a rectum it is (transrektalno) required to make a cleansing enema previously.

When carrying out a biopsy of a prostate under the general anesthesia, the doctor will tell you is not and not to drink several hours prior to holding a procedure (usually in 6 hours).

During a biopsy of a prostate to the patient the system for intravenous infusion is installed (that is, a dropper) and for an hour to a biopsy soothing drug is given.

Technology of carrying out biopsy of a prostate:

The biopsy of a prostate is usually carried out by the urologist, or in out-patient conditions, or in the conditions of the operating room in clinic.

Before a prostate biopsy the doctor can appoint to you an antibiotic, for prevention of infectious complications. The patient takes off clothes before a biopsy and puts on a special dressing gown.

Leather in the place of an estimated biopsy is processed by an antiseptic agent. The area around area of a biopsy becomes covered with sterile material. The doctor puts on sterile gloves. The patient should not touch area of an estimated biopsy.

Usually transrectal biopsy of a prostate is carried out under control of transrectal ultrasonography (ТрУЗИ).

Transrectal biopsy of a prostate:

The transrectal biopsy of a prostate can be carried out in different positions of the patient - in a genucubital pose, on one side with the knees which are drawn in to a stomach, or on spin with legs on special supports. Before a biopsy the doctor can enter anesthetic into the area around a prostate.

All procedure is carried out under control of transrectal ultrasonography that the needle got precisely into a prostate gland, or its required site. The biopsy of a prostate is usually carried out by a spring needle. The needle quickly enters prostate tissue, the prostate tissue piece fence is carried out, and then the needle also quickly leaves. Everything passes within less than 1 second. Usually thus from 6 to 12 pieces of tissue of prostate from its different areas (bioptat) undertake.

The transrectal biopsy of a prostate can be carried out also by means of a finger of the doctor as the conductor. The doctor a finger gropes a prostate, and on it enters a needle through a rectum wall. The needle is turned in the thickness of a prostate to carry out an intake of fabric and then is taken out.

The transrectal biopsy takes on average up to 30 minutes.

Transurethral biopsy of a prostate:

This type of a biopsy of a prostate is carried out in position of the patient on spin, with legs on special supports. The procedure is carried out under the general, spinal or local anesthesia.

The transurethral biopsy of a prostate is carried out by means of the special cystoscope. It represents the thin flexible probe on which end there are a bulb and a lens of the video camera, and also the tool for capture of a bioptat - a cutting loop.

The transurethral biopsy of a prostate takes on average 30-45 minutes.

Transperineal biopsy of a prostate (through a crotch):

This type of a biopsy is carried out not so often as two previous look. The patient lies on one side or on spin with the knees which are drawn in to a stomach. The procedure is carried out under the general or local anesthesia.

In a crotch the small section is carried out. The doctor enters into a rectum of the patient a finger for fixing of a prostate and enters a fine tissue extractor which in the thickness of tissue of a prostate is accurately turned for capture of a piece of fabric through the made section. Then the needle is taken out. Fabric undertakes from several sites of a prostate. For a bleeding stop the prostate nestles. This type of a biopsy is carried out within 15-30 minutes.

Feelings when carrying out a biopsy of a prostate:

When carrying out anesthesia the small prick is felt. During introduction to a prostate of a tissue extractor some feeling of discomfort can be felt. At a transrectal biopsy some pressure sense in a rectum at introduction to it of the ultrasonic sensor or a finger of the doctor can be felt. At introduction of the needle to prostate tissue some pain can be also felt. Usually several samples of fabric undertake during a biopsy.

After a biopsy usually of the patient ask to avoid exercise stresses within 4 hours. Besides, the patient can feel slight pain in the field of a basin, and in urine within several days blood can be noted. Some discoloration of sperm can be noted within a month after a biopsy and if you had a transrectal biopsy, then within 2-3 days after it the small proctorrhagia can be noted.

After a transurethral biopsy at several o'clock the uric catheter can be established. Besides, within several days after a biopsy antibiotics can be appointed.

If the biopsy was carried out under the general anesthesia, then after it you will lie several hours in postoperative chamber. Upon return home during the day you will feel fatigue.

Complications after a prostate biopsy:

The biopsy of a prostate is characterized, as well as all other invasive interventions, risk of complications:

1. Infections. Most often this complication occurs at men with undetected prostatitis. As a rule, prescription of antibiotics to a biopsy helps to warn this complication.
2. Bleeding in an urethra or a bladder. It leads to a hematoma and disturbance of an urination, or on the contrary, to the speeded-up urination.
3. Proctorrhagia. If to you carried out a transrectal biopsy, at you within 2-3 days the proctorrhagia can be noted.
4. Allergic reaction to anesthetic.

It is necessary to see urgently a doctor in a case:

1. The expressed bleeding or bleeding which lasts more than 2-3 days.
2. The expressed pains.
3. At fever.
4. Impossibility to urinate within 8 hours after a biopsy or bleeding after a biopsy which lasts for 2-3 days.

Results of a biopsy of a prostate:

The biopsy of a prostate is a method of a research of a prostate at which the piece of its fabric is studied under a microscope. Results of a biopsy of a prostate are usually ready within 10 days. In the presence of cancer cells their degree (Gleason's indicator) is defined. The system of assessment of Gleason headed by Donald Gleason through Veterans Administration Cooperative Urological Research Group is accepted and confirmed by World Health Organization as system of assessment in the United States and around the world everywhere. The system gives Gleason's estimates a histologic template from 1 to 5 based on the level of an architectural differentiation of glands of cancer, with 1 being high-differentiated and 5 low-differentiated. On Gleason's classification degree of a differentiation of a tumor is divided into five gradation:

gradation 1: the tumor consists of small homogeneous glands with the minimum changes of kernels;
gradation 2: the tumor consists of accumulations of the glands which are still divided by a stroma, but located more closely to each other;
gradation 3: the tumor consists of glands of various size and a structure and as a rule, infiltrirut a stroma and surrounding fabrics;
gradation 4: the tumor consists of obviously atypical cells and infiltrirut surrounding fabrics;
gradation 5: the tumor represents layers of undifferentiated atypical cells.
With rare exception, the prostate cancer has heterogeneous structure. Therefore to count Gleason's indicator, sum up two most often found gradation. For example, at a research comes to light that the tumor which consists of atypical cells and infiltrirut surrounding fabrics that corresponds to gradation 4 most often meets. Besides, the tumor consisting of accumulation of the glands which are still divided by a stroma, but located more closely to each other that corresponds to gradation 2 also often meets.

Gleason's indicator:

Gleason's indicator - only a part of information which is used by the doctor. The result of a biopsy usually includes number of bioptat, percent of cancer cells in everyone and in what shares of a prostate cancer is revealed. Than further cancer cells extend, the risk of the neblagoprtyatny forecast is more there. Issloyedovateli was developed by different tools which allow the doctor to predict aggression of a course of cancer.

In addition to classification of cancer by Gleason, it is applied as well cancer stages which are based on as far as the cancer tumor extends. A stage I, also called T1, - tumor cells are found in less than 5% of tissue of prostate. A stage of II (T2) - more aggressive cancer cells, than at the first stage. At a stage of III, or T3, a tumor sprouts the prostate capsule. On stages of IV (T4), cancer extends to other bodies (lungs, bones, etc.).

What type of treatment would not be chosen by your doctor - surgical, radiation therapy or waiting tactics - the doctor most likely will recommend you control researches, including retest of blood on the DOG and a repeated biopsy. It is also necessary to give the fact that carrying out a biopsy of a prostate leads to increase in the DOG level in blood that it is important to consider.

These methods of a research are applied to control of a course of a cancer disease. The longer you note lack of symptoms of cancer, the repeated methods of a research will be required less often.