Introduction

The initial detection of signs that you may have prostate cancer is now most commonly the result of some regular form of check-up carried out by your primary care physician which may include a digital rectal examination (DRE) or a prostate specific antigen (PSA) test. The most common symptom which may make a man go to either his primary care physician or a urologist, is some form of problem with normal urination or sexual abnormality such as incipient impotence. The only way to diagnose prostate cancer in a man without symptoms is through a prostate biopsy. A urologist  sample the gland and a pathologist identifies the presence or absence of malignancy in the specimens. No other clinical test can provide an absolute diagnosis of prostate cancer in asymptomatic men except in the case of a  positive bone scan in the presence of bone pain and an elevated PSA

Indications for a Prostate Biopsy

These are a few basic reasons why your urologist would recommend a prostate biopsy:

Expert urologists now recommend that if any one of these indicators is present, you should have a biopsy even if your ultrasound evaluation is normal.

Prostate Biopsy Procedure

Biopsies of the prostate are normally carried out under ultrasound guidance by taking several samples of tissue from the prostate using a method called systematic sextant biopsy.

The urologist will order a prep a enema prior to carrying out the biopsy, and while there is no need for anesthesia you can ask for medication to ease the stress of the procedure. You will almost certainly be given an antibiotic in order to prevent any possible infection. You will also be asked to stop drugs such as aspirin for one or two weeks prior the scheduled biopsy date in order to minimize the risk of bleeding problems. Be sure to tell the doctor if you are on blood thinning medications.

In carrying out the actual biopsy, using transrectal ultrasound (TRUS) to guide the precise placement of the biopsy needle, the urologist will take six or more samples of tissue from the prostate and then send them to the pathologist for examination. The precise number of samples taken will depend upon what the urologist is able to see using the ultrasound machine. Normally, he or she would expect to take six evenly spaced specimens from different areas of the prostate (called a systematic sextant biopsy), and then additional specimens from any areas which look suspicious according to the ultrasound. In this way the urologist will maximize the chance of finding prostate cancer tissue if it is there in the prostate.

The urologist will send the biopsy specimens (often called "cores") to a pathologist for evaluation. The pathologist will then study these specimens carefully under a microscope, and will send a report back to the urologist which usually includes the following information:

This information is designed to help the urologist (and the patient) make a treatment decision. Because of the subjective nature of the biopsy grading it is sensible to obtain a second opinion from a pathologist specializing in prostate cancer.