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Oganes E. Dilanyan
Urologist, MD, PhD

Prostate biopsy

In most cases attempting to diagnose cancer without prostate biopsy is pointless. Just think about it,  in the early stages of prostate cancer the only symptom is increased PSA. Prostate cancer is not the only reason for increased PSA, and other reasons include prostatitis and benign prostatic hyperplasia. So, PSA results on their own do not tell us that much. There is only one investigation that allows us to confirm the diagnosis  and this investigation is prostate biopsy during which tissue samples are taken from the prostate and examined under a microscope. This is called histology and today it is the only reliable method of diagnosing prostate cancer.

Pain free prostate biopsy


The words “prostate biopsy” are rather scary in themselves. Everyone knows that this test almost always relates to cancer diagnosis. What is worse is that those people who have been through this procedure swear they are never going through the same again without pain relief. 
So where does all this come from? 
First of all, most hospitals are still using dated methods which are quite painful.
Secondly, hospitals often ignore the need for pain relief with only 5ml of local anaesthetic allowing one to perform prostate biopsy without any discomfort for the patient. So, the patient is presented with a choice: fear of prostate cancer or fear of pain during the procedure.

Prostate biopsy is the only way of diagnosing prostate cancer. This procedure should be done in the presence of increased levels of PSA and palpable thickening in the prostate. The aim of the procedure is to collect tissue samples for histology analysis and diagnosis confirmation. 

Clarification based on personal experience: How prostate biopsy is performed.

— “But my PSA levels are not that high, doctor! Only slightly elevated! And you want to do a prostate biopsy straight away. Maybe we should wait?”- My patient is not happy.
— “Victor, when your PSA levels become considerably high the only aim of the investigation will be to confirm inoperable prostate cancer. And also, to confirm the fact that both you and I have made a big mistake. You by not agreeing to have a 10-minute procedure and ignoring the slight PSA elevation and I by not explaining to you the dangers of this elevation and how paramount the investigation is” 
— But aren’t there any other methods of diagnosis? MRI? CT scans? I am not great with needles and have had a needle phobia since I was a child” – my patient looks embarrassed.
— Look, Victor. In the presence of increased PSA and free to general PSA ratio distortion together with a palpable thickened area in the prostate, the biopsy is necessary. You need to know and understand that this “slight elevation” might be a sign of a very small tumour which has not yet spread beyond the prostate. Sometimes a very small tumour takes up less than 1% of the prostate. 
— Doctor, please understand that I am simply afraid. My brother had the same procedure and he complained a lot about bowel pain. And they never even found any tumour! Only during the repeat procedure 3 months later”. Victor frowns, it is clear these memories are painful for him. “And those three months were crucial…. PSA went up to 90 and my brother was deemed inoperable…It’s terrifying.
— Hang on a minute. When and how was your brother’s biopsy performed? – I am perplexed.
— About nine or ten years ago. As he told me, the surgeon inserted his finger up the back passage and the needle followed the finger. First there was a poke on the right, then on the left” – the patient frowns again.  
—  This method is very dated, Victor, - I say, getting a piece of paper and starting to draw a diagram of the prostate and the biopsy procedure with ultrasound control for him.  Look, a special ultrasound probe is inserted into the rectum. We receive the image of the prostate 2 different perspectives. The probe is biplane which means we can precisely aim at specific areas of the prostate and take 10 to 12 samples which almost always rules out the need for the second biopsy. The needle passes through the probe port thus avoiding the scratches to the colon.
— So, it’s still a needle then? — Victor asks looking rather defeated.
— Well of course it is called a needle. But it is very different from an ordinary needle that penetrates tissue slowly while tearing it. We use a high speed biopsy “gun” and you will not feel the slow penetration of the needle, you will just hear a click. The most unpleasant moment will be the insertion of a tampon with antibacterial cream into the rectum after the procedure, but you will not even feel that either because before the procedure some numbing gel will be administered into your rectum.
— Fine, Victor agrees rather reluctantly, let’s do it! When?
— Are you taking any regular medication? Aspirin, warfarin or cardiomagnyl? - I ask one of the most important questions. 
— No, I am not taking anything, no medication at all. 
— Then we can do it the day after tomorrow.
—  Ok, what do I need to do? 
—  Just a bit of preparation. In the evening before the prostate biopsy you will need to have an enema. In the morning try not to eat anything but you can drink clear fluids such as squash or black tea. You will need to start taking antibiotics in the evening before the procedure.  
— What are the side effects?
—  You may experience a small amount of blood in the urine. After the procedure you will remain in hospital under observation for approximately two hours so that we can monitor the amount of blood on the tampon in the rectum.

Preparing for prostate biopsy

When preparing for prostate biopsy one should

  • Stop taking all blood thinning medications such as aspirin, cardiomagnyl, warfarin etc. a few days before the procedure.
  • Start taking antibacterial medicine 12 to 24 hours before the procedure. This should be prescribed by your doctor! 
  • Have an enema 12 hours before the procedure. 
  • The procedure is carried out under fasting conditions.
After prostate biopsy. True story

2 hours after the procedure.
- How are you feeling Victor? 
-Things are never as bad as they seem, - he smiles. I was imagining all sorts of scary things and just wound myself up for nothing with all this nonsense. When can I go home? 
- As soon as you have urinated.  
- But I already have and no problem.
- Well, in this case you can go home. Please keep in touch and let me know in case you have any fever, problems urinating or bleeding from the rectum. The possibility of these side effects is extremely rare though, less than 0.2%. 
-Ok doctor, when shall we get back in touch?
- In a few days when the histology report is ready. But if anything bothers you before that, do call me. 

Information for foreign patients:

If you require prostate biopsy in Moscow please contact us. We will arrange your admission to hospital on the day you arrive and will carry out the procedure on the same day. You will be able to go home in the evening.

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