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The prostate sample test or biopsy


Over the last few weeks I have been discussing prostate cancer. The main point about prostate cancer is that there are no specific signs to let you know that you have the cancer. Most of the prostate problems that men complain of have nothing to do with cancer, but just an enlarged prostate. The vast majority of enlarged prostates do not harbour cancer and have nothing to do with cancer. Men who say “the doctor say I have ‘prostate’” think that the doctor means that he has cancer, but usually that is not the case.{{more}} The doctor is just saying that his prostate is enlarged or swollen. A swollen prostate does not cause cancer, but sometimes cancer can develop in a swollen prostate and the best way to find out if your prostate has a cancer is to do the blood test called the PSA or “prostate specific antigen”. The most important point, however, is to remember that there are no signs of prostate cancer; in other words, prostate cancer in the early treatable stage does not cause any problems. When it has gone far and then not treatable, it may cause a few “non-specific” symptoms that may be missed by most doctors. So, it is important to do the blood test. The finger test is also advised, especially in older men with problems peeing or in younger men who have no problems, but who did the blood test and whose test is high or on the border. This week, I am going to discuss the prostate sample test or biopsy.

Some men will be told that they need to have a prostate biopsy or sampling. The usual reason is because the PSA is raised. As I said before, a normal PSA has been selected as any number below 4.0. I advise men to have a biopsy if the PSA is more than 4 in men older than 60 or around 4 in younger men. In both cases, I would have ruled out infection in the urinary passage or prostate. The sample test is an office procedure; in other words you do not need to be admitted to the hospital for it and you do not need a general anaesthesic. It does not involve cutting and the pain is minimal, usually nonexistent. In other words, most men will not have any pain, as the prostate is numbed or anaesthetized before the procedure. The numbing is done first with a jelly, then with a needle. The procedure takes about 30 minutes. The men are instructed to take antibiotics from 1-2 days before the procedure, including the morning of the test. They are advised to bring someone with them when they are coming for the test and they are told they have to pay for the test. The cost of the test varies, depending on the number of samples taken and reflects the increased time to do the test and the increased processing (pathology) costs.

Before the test, the man is asked to empty his bladder, as this reduces the urge to pee during the procedure. He is supposed to have emptied his bowel at home that morning also. The test is done using a transrectal ultrasound (TRUS) probe, placed in the rectum after the first anaesthesic, but before the second one. The ultrasound helps us to “see” the prostate closely and to gauge where in the prostate the samples are being taken. It is also used to get an accurate measurement of the prostate size and in cases where there is a high suspicion of cancer, to “see” if the cancer has started spreading. Just before the sampling test, the prostate is further numbed or anaesthetized, using local anaesthesic liquid with a needle through the ultrasound probe (TRUS guided prostatic block). After the test, the man gets dressed and goes home. There is no admission to the hospital, no pain or bleeding! I emphasize these points because that is what you are asked over and over when this test is discussed. And yes, this is the same way the test is done overseas, no difference. The old way of doing it blindly with a finger is wrought with problems of pain, accuracy, sampling error, false negative samples and injury to the finger of the doctor! Next week, I will discuss the problems that may arise after a prostate sample test.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785