Pro­sta­te bio­p­sy

For a prostate biopsy, the biopsy needle is inserted into the prostate through the rectum or via the perineum under the control of an ultrasound probe.

Tissue sampling is recommended to rule out or detect prostate cancer. As a rule, it is necessary if PSA values (PSA = prostate-specific antigen) are elevated or rising, palpation findings are unclear or magnetic resonance imaging of the prostate is abnormal. The PSA value is a laboratory parameter for the early detection of prostate cancer that can be measured in the blood.

How is a prostate biopsy performed?
Tissue is usually removed using a punch biopsy. To do this, the doctor inserts a thin hollow needle into the prostate either directly through the perineum or via the rectum at various predetermined points. As a rule, 10-16 tissue samples (or more in certain situations) are taken under ultrasound guidance and then analysed in the laboratory.

The biopsy is performed under local anaesthetic. A combined administration of painkillers and sedatives (twilight sleep) is also possible. If twilight sleep is planned for you, you will be informed of this separately.

Depending on the access route, antibiotic shielding may be necessary before the prosate biopsy. You will then receive an antibiotic from the evening before the examination for a period of 2 days (this varies from person to person, we will inform you of this in detail). Medication to thin the blood (e.g. Marcoumar, Xarelto, etc.) must be discontinued due to the risk of bleeding.

For the examination, you only need to remain fasting for a planned twilight sleep. The bowel does not need to be empty before a prostate biopsy. The entire examination takes about 15 minutes. The definitive examination result can be expected after approx. 4 working days.

What does a prostate biopsy reveal?
In most cases, the biopsy can be used to differentiate between benign prostate enlargement, a precancerous stage (PIN or so-called prostatic intraepithelial neoplasia) or prostate cancer. It is important to realise that these are only random samples and it is therefore possible to miss small tumours. In the case of precancerous lesions (PIN) or if PSA values continue to rise, a second or third biopsy may be necessary.

What does the prostate biopsy not reveal?
The ultrasound image cannot be used to differentiate between benign enlargement and prostate cancer. The microscopic evidence of prostate cancer in the biopsy is conclusive.

What will I feel during and after the examination?
During the examination, you will feel the pressure of the ultrasound probe in the rectum - unless twilight sleep is planned for the sample collection. This pressure is comparable to a finger examination to feel the prostate. The tissue is removed under local anaesthetic, so you should only feel a little pain (slight needle pricks at most). The spring-loaded biopsy gun makes a metallic popping noise, which should not frighten you.

After the examination, most patients feel pressure in the perineal and prostate area. After the biopsy, there is often dripping blood from the anus or a red discolouration of the urine. These are temporary (a few days) and harmless changes. Dark traces of old blood in the semen can often be observed for weeks and are no cause for concern.
Inflammation or even abscesses as well as blood poisoning after a prostate biopsy are very rare, although not completely ruled out.

If you develop a fever or chills in the first few hours or days after a prostate biopsy, you should contact us immediately (at night via the emergency ward). The same also applies to unusually heavy bleeding, i.e. a deep red discolouration of the urine ("burgundy wine") or a gush of blood from the anus. In rare cases, the biopsy may also lead to a swelling of the prostate so that you can no longer urinate properly. In this case, you should also contact us immediately.

Arethere alternatives to a prostate biopsy?
A prostate biopsy is by far the most common way of removing tissue. Alternatively, a so-called cytology can be obtained using a fine needle. This involves "extracting" individual cells from the prostate and analysing them under a microscope. However, the informative value of this examination is significantly lower compared to a biopsy.

How can you yourself help to minimise the risk of complications?
After the biopsy, you should not ride a bicycle for 24 hours and avoid heavy physical work. You should also follow the preparation instructions exactly and answer the following questions in full:

• Are you taking anticoagulant medication to thin the blood (e.g. Marcoumar, Xarelto, Aspirin Cardio, Tiatral, Aspegic, Alcacyl, Eliquis, Plavix, etc.)?
• Do you have an increased tendency to bruise (even with minor injuries, e.g. tooth removal)?
• Do you have an allergy to certain medications? If so, which ones?
• Do you suffer from a heart valve defect?
• Do you carry a heart card (red or green)?