Prostate Biopsy Exam
Picture courtesy of the
National Cancer Institute
When it comes to men's health, most men will suffer from prostate problems at some stage in their life. Below middle age (45 to 50) this is most likely to be a case of infection or inflammation, referred to in medical terms as prostatitis. In later years many men will experience the problems of an enlarged prostate, which is often referred to as benign prostatic hyperplasia or BPH. In addition, a significant number of older men will also fall foul of prostate cancer.
One problem with prostate problems is that the symptoms are often very similar for quite different conditions and it is therefore quite possible to, for example, experience the need for frequent and urgent urination as a result of both an infection of the prostate gland and an enlarged prostate. It is also possible to experience no symptoms at all in the early stages of all prostate problems and this is especially a danger in the case of prostate cancer which can develop without you being aware of it at all.
If you are at all concerned therefore you should talk to your doctor or nurse who will begin by asking you a series of questions which will be concerned with urination over the past few weeks. For example, they will need to know whether or not you have noticed an increase in the frequency of urination, in the force of your urine flow, in the ease of starting urination and in whether or not you continue to dribble urine even after visiting the bathroom. Your answers to these and other questions will determine not only whether you appear to have a problem, but what that problem is likely to be and thus the tests which will be necessary to make a diagnosis.
There are a series of different tests which may be carried out and the two most commonly performed tests are a physical examination of the prostate gland, known as a digital rectal exam, and a blood test, known as a prostate specific antigen or PSA test. Depending upon the results of these tests further tests may then be ordered, including a prostate biopsy exam.
Digital Rectal Exam
A digital rectal examination, or DRE, is increasingly being carried out during routine physical examinations for men over the age of 50 and is a short procedure which is perhaps slightly uncomfortable but not painful. The doctor will insert a gloved and lubricated finger into the rectum while you are bending over or lying on your side with your legs drawn up to your chest and feel the prostate gland for any irregularities including bumps, soft spots or hard spots. If your symptoms also indicate the possible presence of an infection the doctor may also massage the prostate to expel a small sample of fluid for microscopic examination.
Prostate Specific Antigen (PSA) Test
The PSA blood test is carried out to indicate the possible presence of cancer and looks for the presence in the blood of a specific protein which is produced by the prostate gland, levels of which tend to rise in the presence of prostate cancer.
Although the PSA test has been approved for use, in conjunction with a DRE, by the Food and Drug Administration (FDA), some concerns have been expressed by the medical profession about the accuracy of the results which the test produces. In simple terms this concerns revolves around the fact that the test produces a high number of false positive results which result in men having unnecessary further testing or treatment which carries both risks and side-effects. Such tests can, for example, lead to bleeding or infection and prostate cancer treatment can produce urinary incontinence, erectile dysfunction or even impotence.
A PSA test will produce a score which tends to rise as cancer develops. It is generally agreed that a score of 4 or below is normal (although some doctors consider a score of 2.5 or below as normal) and that the higher the score is above this threshold level the greater the likelihood of prostate cancer. PSA levels do however vary naturally over time and so it is dangerous to draw conclusions from a single test and it if often wise to repeat testing every few weeks over a period of time before moving on to further testing. This said, if a test returns a very high score (of say greater than 30) then your doctor may recommend further testing without delay.
Prostate Biopsy Exam
If cancer is suspected then the only sure way to arrive at a diagnosis is to carry out a prostate biopsy examination. There are various different ways in which a prostate biopsy can be done including a biopsy using transrectal ultrasound, which is carried out through the rectum using ultrasound to produce a picture of the prostate gland to guide the urologist in collecting samples and a biopsy through the perineum, in which the biopsy needle is inserted through an area of skin between the rectum and the scrotum. In most cases the area the area being investigated will be numbed with local anesthetic and you will feel nothing more than a brief and uncomfortable sensation as each sample is taken. The whole procedure normally takes no more than about 15 minutes and can be carried out in the doctor's office.
For a few days after the biopsy you may experience some soreness and may also notice a small amount of blood in the urine. There may also be some light bleeding seen from the rectum. Finally, it is not uncommon to see small amounts of blood in the semen and this can be noticeable for several weeks.
During the procedure a needle is inserted into various different areas of the prostate gland in order to collect small samples of tissue so that each tissue sample can then be examined under a microscope. The number of samples collected will vary but is typically in the region of about 12. Not only does this allow the doctor to detect the presence of any cancer, but it also gives a good indication of extend of the cancer and of its aggressiveness.
Once a positive result has been returned by a prostate biopsy exam an appropriate course of treatment can then be started.