In general, prostate cancer cannot be diagnosed without a sample of prostate tissue. In prostate biopsy, multiple tiny tissue cores are systematically taken from the prostate. These are then processed and the tissue architecture looked at under the microscope.
There are two possible approaches.
1. Transrectal biopsy
Under a light general anaesthetic, the prostate is visualised with an ultrasound probe to guide the needle biopsies. The main risk of this approach is infection, which will be mitigated with antibiotics.
Preparation: You will be prescribed a Ciprofloxacin 750mg antibiotic tablet, to take one hour before the procedure. If you have been travelling in Asia in the last 18 months, then further preventative antibiotics may be necessary.
2. Transperineal biopsy
Under general anaesthetic, needle biopsies are obtained through the skin of the perineum (beneath the scrotum). In this approach, the risk of infection is extremely low.
By either approach, the procedure will take less than 30 minutes. It will be done as a day case.
After the biopsy
Expect some blood in the urine and in the ejaculate (this may persist for some weeks). If you become unwell with fevers, shakes or nausea then you should go the nearest emergency department. You may need admission for treatment with intravenous antibiotics. There can be some swelling of the prostate, and there is a small risk of having trouble passing urine.
Most men can return to normal activities after 1-2 days. Contact the rooms if you have any concerns.
These will take about 1 week to come back. There are broadly three possible outcomes:
- No prostate cancer
- Prostate cancer present, but of insignificant volume and aggressiveness. Active surveillance may be appropriate.
- Significant prostate cancer. Further staging investigations and active treatment may be recommended.