Transrectal Biopsy

[lwptoc]

Overview

According to the United States National Cancer Institute, a transrectal biopsy is a procedure in which a sample of tissue is removed from the prostate using a thin needle that is inserted through the rectum and into the prostate. Transrectal ultrasound is used to guide the needle. The sample is then examined under a microscope to detect the presence of cancer.

The prostate ultrasound uses a probe that’s about the size of a finger. The probe is inserted a short distance into your rectum. It creates harmless sound waves that can’t be heard but bounces off the surface of your prostate. A machine records the sound waves and gives a visual either as videos or photos of your prostate gland at different angles to help your doctor guess the size of your prostate and spot abnormal growths.

The prostate is the small, walnut-shaped gland in men that sits below the bladder and wraps around the urethral. It is responsible for the production of fluid that nourishes and transports sperm.

Why it may be required

A transrectal biopsy is used to diagnose prostate cancer. It may be recommended for some of the following reasons.

• After conducting a PSA test it shows levels higher than normal for your age.
• Lumps or other abnormalities are found during a digital rectal exam.
• Your previous prostate biopsy was normal, but you still have elevated levels of PSA.
• An earlier biopsy revealed abnormal prostate tissue cells but are not cancerous.
• A man is experiencing certain symptoms such as trouble urination.
• To examine the prostate’s size and shape.
• To diagnose the cause of infertility, such as cysts in a man’s reproductive system.
• It can also be adopted as a treatment model for cancerous and non-cancerous conditions of the prostate or surrounding structures. 

Preparation

You might be wondering if there are any conditions you have to meet or fulfil before carrying out a transrectal biopsy procedure. First of all, have a discussion with your doctor. This will help you prepare better. However, some of the preparations you can make are

• Eat and drink before going for a transrectal biopsy. 
• Take your medications. Except otherwise advised by your doctor.
• You should let the doctor of any existing medical conditions such as heart disease, lungs disease, kidney disease or any other type of disease.
• You should inform the doctor of any history of bleeding disorder and if you are on any medication for it. 
• You should also tell the doctor of any allergy or sensitivity you have to medications.
• You will need to use an enema the night before or the morning of the transrectal biopsy is carried out. This is administered to empty to colon and minimize any risk of infection. 
• Be prepared for a sedative, which may make you feel drowsy.
• You will also have to fill out a consent form authorizing the performance of the transrectal biopsy procedure.

If there are any other things that are required, the doctor will fill you in.

Transrectal biopsy Procedure

The first thing that takes place is proper positioning. You may be asked to lie on your side with your knees pulled up to your chest or to lie on your stomach. Local anaesthesia is then injected into the rectum to numb the area. 

The next thing will be for the do tor to try to feel your prostate by placing his finger on the rectum. Then an iodine-soaked sponge covered with a lubricating gel is inserted into the rectum to clean it. The lubricating gel helps make it easy for the insertion of the probe. 

A thin ultrasound probe is then gently inserted into the rectum, in a controlled manner, with light but slowly increasing the pressure applied against the probe as its tapered end dilates the sphincter during entry. The ultrasound probe using sound waves creates images of the prostate on the ultrasound screen. The images created are used to guide the prostate biopsy needle into place. The insertion of the probe may be discomforting, but should not hurt.

This is when anaesthesia is given to numb the area. Some minutes may be allowed for the anaesthesia to take effect. After which the biopsies are taken with a spring-loaded needle device.

The whole transrectal biopsy procedure normally causes a very brief uncomfortable sensation each time the spring-loaded needle device takes a sample but it is not painful.

Base on discretion, the doctor carrying out the procedure may target a suspicious area to take a biopsy or may take from several places in your prostate. Mostly, 10 to 12 tissue samples are taken, and the entire procedure usually lasts about 10 minutes.

It should also be noted that, the doctor carrying out the procedure remains mindful of the topical anatomy throughout the procedure, just as the laparoscopic surgeon observes the body during instrument entry and exit, and the ultrasonographer also observes the probe to ensure that it points to the direction of the rectal course during placement.

Expectations after the transrectal procedure.

After a transrectal biopsy procedure, there must be enough rest and intake of lots of fluid, water preferably, for the next 24 hours. After which you can then go home. The team will also monitor you for at least 30 minutes afterwards.

It is also likely you will be recommended to do only light activities for 24 to 48 hours after your transrectal biopsy.

Results

The result could be either pleasing or saddening. It could come out all clean. That is, normal and no cancer. In the case of abnormal findings. Some of the possible diagnosis could be

• An enlarged prostate (which is also known as benign prostatic hyperplasia)
• An infected or inflamed prostate (known as prostatitis)
• Prostate cancer

In the case of an abnormal result but no cancer is found, you may need to repeat the transrectal biopsy procedure or try another method of prostate biopsy.  Also, if the PSA level goes up or there were precancerous cells in the first biopsy, it advisable to repeat the test in 6 to12 months’ time.

Possible treatment options

If treatment is necessary, surgery may be considered to remove the prostate and nearby tissue if the cancer hasn’t spread. Other available treatment options are

• Radiation
• Cryotherapy – which involves the use of very cold temperatures to freeze cancer cells
• Hormone therapy
• Chemotherapy

In some cases, what is required might only be active surveillance (also known as watchful waiting). This means doing regular blood tests, rectal exams and possibly biopsies to keep an eye on things. 

What are the likely side effects?

• Urethral bleeding

That is, passing a small amount of blood in the urine or blood leakage from the penis after the procedure. This is an expected incidence after the procedure and should settle within 24-48 hours. Taking lots of fluid will help flush through the blood.

• Rectal Bleeding

That is, passing a small amount of blood in the first one or two bowel motions after the procedure. This is an expected incidence after the procedure and should resolve within 24-48 hours.

• Haematospermia

There could be the presence of blood in the semen or dark staining of the semen, which can persist for up to 3 months after the procedure. This is an expected incidence and should not be of serious concern, as sexual activity can continue as normal.

• Sepsis

Sepsis, otherwise known as blood poisoning is a severe form of infection. However, the incidence rate is low. It occurs in 1 in 100 to 200 patients. The symptoms include fever, chills, shaking, lethargy, warm skin, shortness of breath, rapid heartbeat, drowsiness and a general feeling of being unwell.

• Urinary retention

Though occasionally, some patients may experience difficulty passing urine after the procedure. This happens mostly in older men or men with extremely large prostates. The symptoms consist of difficult urination, abdominal pain, poor flow of urine, or frequent urination.

• Urinary tract infection

An infection of the urinary tract, prostate or testicles may occur after the procedure. It may be accompanied by symptoms such as difficult urination, burning on urination, frequent urination, swollen testicles or fevers.

• Pain or discomfort

Mild pelvic pain or discomfort may be experienced within 24 hours of the biopsy. 

• Erectile difficulties

On rare occasions, they may be a problem of erection after a prostate biopsy. This usually occurs in men who have a positive diagnosis and is often related to anxiety.