To date, many research procedures are known, during which doctors are able to objectively assess the patient's prostate condition and detect tumors - this is ultrasound, CT, and MRI, and scintigraphy. At the same time, none of them is able to give an absolute accuracy an answer to the question of malignancy of neoplasms. To determine the structure of cells, see cancerous changes in the gland tissue and establish an accurate diagnosis, a prostate biopsy will be required.
Brief description of the procedure
Localization of the prostate gland allows for the collection of material in several ways. The prostate is located slightly below the bladder and is closely adjacent to its lower wall. The posterior organ is in contact with the rectum, and the anterior is in contact with the pubic bone. The bottom of the iron is reliably protected by soft tissue of the perineum. Thus, it is easy to guess how a prostate biopsy is taken - through the anus, urethra, or perineum.
This study involves the collection of small particles of the prostate gland using a special needle. The resulting tissue samples are sent to the laboratory to determine the structure and nature of the pathological changes. A prostate biopsy is usually performed when a man is suspected of having a cancerous tumor.
Prostate Access
There are several ways to remove biomaterial from a patient, which differ in penetration options. A biopsy needle can be administered:
- Transperineally, that is, through the perineum. A puncture is carried out between the scrotum and anus.
- Transrectally through the rectum. This technique is widespread, despite the fact that in recent years, surgeons refuse to use it more and more often. The reason is the high risk of transferring intestinal infection to the genitourinary system.
- Transurethrally - by introducing an endoscopic instrument into the prostate through the urethra. A prostate biopsy today is practically not performed by this method, since it is considered uninformative. The thing is that the cancerous lesions are localized mainly along the edge of the organ, and the urethra passes through the center of the prostate.
Who needs to be tested
A prostate biopsy test is shown for every man who is suspected of having cancer. Accordingly, any sign of prostate cancer is a direct indication for diagnosis. The following factors can directly or indirectly talk about a malignant process in the genitourinary system:
- increased prostate-specific antigen ;
- the presence of a neoplasm of an unknown nature detected with transrectal ultrasound;
- history of precancerous condition;
- detection of atypical formation with rectal palpation of the prostate.
Before taking a sample of the gland from the patient, it is carefully examined to determine the cause of the change in the shape of the organ. It is curious that with prostate adenoma a biopsy is not performed. To exclude or confirm the cancer process, they rely on the results of the analysis of prostate-specific antigens, the findings of CT and MRI.
When is a biopsy contraindicated?
If a bacterial infection in the pelvic organs is suspected, the procedure will have to be abandoned so as not to contribute to the spread of inflammation and purulent complications from diseased organs to nearby healthy ones. Among the diseases against which intervention is unacceptable, pyelonephritis, cystitis, urethritis, and prostatitis are most often diagnosed.
It is impossible to carry out manipulation with blood coagulation disorders, since a blood biopsy inevitably leads to tissue injury and minor hemorrhages. With thrombocytopenia, which can be caused, for example, by hemophilia, uncontrolled intake of anticoagulants, a person may develop shock and even death from blood loss.
Arterial hypertension is another contraindication. At high pressure, the risk of bleeding is especially great, so these patients are not allowed to biopsy the prostate. How the procedure itself is carried out, we learn after describing the preparation for it.
Before manipulation
Preparing for a prostate biopsy is a set of diagnostic procedures that help to assess the condition of the man’s body, as well as predict the likelihood of developing complications and learn about contraindications. As soon as the doctor determines the need for a biopsy, the patient will have to be examined for the presence of infections and inflammation of the genitourinary system. Typically, the doctor is alarmed by patient complaints such as:
- pain in the lower abdomen;
- discoloration of urine;
- the occurrence of purulent discharge from the urethra;
- persistent fever;
- frequent urination.
Laboratory diagnostics
In this case, the tendency to allergic reactions in a man or his relatives, especially to medicines, is necessarily taken into account, since the study will inevitably require the introduction of drugs. Biopsies, like any other surgical manipulation, are preceded by a complex of laboratory and instrumental studies.
Mandatory procedures include:
- General blood analysis. It allows to detect latent inflammatory diseases in the body, as evidenced by overestimated leukocytes and lymphocytes, to determine anemia by low hemoglobin, etc.
- Analysis of urine. The objective of this study is to exclude latent bacterial infection of the urinary system. If a biopsy of the prostate is performed against the background of a sluggish current cystitis, urethritis and other diseases, the risk of prostate infection and the development of prostatitis in the patient increases.
- Bacteriological analysis of urine. This is another, more reliable way to verify the sterility of urine and the absence of bacterial infection in it. If the study confirms the presence of pathogenic microflora, the patient is prescribed a course of antibacterial therapy using an antibiotic, to which the bacteria of the identified type are most sensitive.
- Blood chemistry. The procedure is necessary to assess the status and functionality of internal systems.
- Analysis for prostate-specific antigens.
Other research procedures
In addition to tests, every man needs to undergo instrumental screenings, the results of which will indicate the condition of the lungs, heart, and kidneys. In addition, none of the tests will indicate the exact localization of the pathological lesion in the prostate for biopsy. The standard list of studies includes:
- chest x-ray (fluorography);
- electrocardiogram;
- Ultrasound of the kidneys;
- TRUSES - transrectal ultrasound examination of the prostate gland.
If a man reveals any contraindications for biopsy, the operation is postponed until the reasons are eliminated: cure for infection, restore satisfactory coagulation, stabilize blood pressure, etc.
Operation Principles
The day before the biopsy, the patient must go through the final stage of preparation. If a man previously took medications that prevent blood coagulation (Aspirin, Kleksan, Heparin, Cardiomagnyl), the medication should be interrupted. But even this question remains at the discretion of the attending physician, who concludes on the ratio of the benefits and risks of their cancellation.
Immediately on the eve of a biopsy, a man is given a cleansing enema. For prophylactic purposes, Ceftriaxone is prescribed - it is a broad-spectrum antibiotic that prevents infection in the internal organs. In order to provide full access to the genitals, the patient is shaved off the hair from the pubic area, anus, scrotum and perineum. The choice of the method of puncture remains with the surgeon and it usually depends on the number of necessary samples of the prostate gland. We will talk about how a prostate biopsy is done in different ways.
Transrectal access
Most modern surgeons are of the opinion that there is no need to use anesthetic drugs to take biomaterial. Meanwhile, painkillers significantly improve the well-being of the patient, which allows for a better biopsy. As a local anesthetic, doctors use:
- painkillers that are injected into the rectum (gels and viscous dosage forms "Instillagel", "Lidochlor" and others);
- pelvic plexus injection anesthesia, which involves blocking several nerve receptors.
After anesthesia, the patient is placed in a position convenient for performing the biopsy - lying on the left side, with the knees brought to the chest. The doctor examines the rectum with your fingers and inserts an ultrasound probe into the anus, which, by transmitting the image on the screen, will help you choose the puncture point. In total, the biopsy procedure takes no more than 15 minutes.
Transperineal method
Compared with the previous one, this method of taking tissue samples of the prostate gland is considered more traumatic, but it is more informative and objective, since it allows you to get more biomaterial for research. Anesthesia with a transperineal biopsy, which involves the introduction of a needle through the tissues of the perineum, is required. They can use both general anesthesia, in which the patient’s consciousness will be completely inhibited, and epidural anesthesia, which involves the introduction of the drug into the spinal column and preservation of consciousness.
For transperineal access, the patient lies on his back, raises and legs apart, bent at a right angle. The procedure usually does not last longer than half an hour. Here, too, you can not do without an ultrasound sensor, which helps the surgeon to navigate the location of the prostate and tumor.
Deciphering the results
The correct interpretation of prostate biopsy results is the ultimate goal of this study. The procedure allows you to learn about the nature of the neoplasm and determine its type. However, this does not mean that all patients who underwent a biopsy of the prostate gland always have cancer. In the conclusion of specialists, the absence of a cancerous process can be noted, and this does not always mean that the patient is completely healthy. In some cases, a false negative result is possible. It is also possible:
- Atypical small acinar proliferation is a precancerous condition. Sometimes proliferation is considered the beginning of the development of adenocarcinoma.
- Precancerous intraepithelial neoplasia is a change in cells in all layers of the prostate, with the exception of the basal layer. The probability of a malignant tumor at the site of foci of intraepithelial neoplasia is 35-40%.
Diagnosing one of these two conditions is a strict indication for a second biopsy a few months later.
Types of malignant formations of the prostate
If the patient has cancer, it is important to determine the stage of the tumor and the degree of its danger in a particular case. Diagnosed are several types of malignant tumors that can occur in the tissues of the prostate gland:
- adenocarcinoma - a malignant prostate adenoma, consisting of gland cells that produce the liquid part of seminal fluid and prostaglandins;
- transitional cell carcinoma - a tumor arises from the cells of the urethra passing through the prostate, occurs in 10-15% of cases;
- squamous (undifferentiated) cancer is the most dangerous type of tumor, as it is prone to rapid growth, metastasis and germination in neighboring tissues.
Patient feedback on the effects
If we turn to the comments of men who know firsthand about this procedure, it is easy to guess the high likelihood of complications. A prostate biopsy, according to reviews, can lead to serious consequences. So, for example, the cause of damage to blood vessels is an individual feature of their location. But most often, the unfavorable consequence of a prostate biopsy, according to men, is:
- the development of infection and inflammation at the point of entry of the needle;
- purulent discharge from the rectum, impurities of pus and blood in the urine;
- prolonged aching pain in the pubic area;
- frequent urination.
A dangerous complication of such a manipulation is a puncture of the wall of a large artery, which can even result in death with large blood loss. To avoid such consequences of a prostate biopsy, a man should carefully monitor his condition and consult a doctor if his condition worsens.