Indications for prostate biopsy
- PSA level is above 4 ng/ml or its rapid increase (more than 0.75 ng/ml per year);
- low free to total PSA ratio, change in prostate health index (PHI);
- a lump or nodule in the prostate on digital rectal examination;
- suspicious lesion on prostate MRI (PI-RADS 3–5);
- control during active surveillance of already identified low-risk cancer;
- repeat biopsy if suspicion remains after a negative first one.
How is the biopsy performed?
The patient lies on his side with his knees bent. An ultrasound probe is inserted into the rectum, the doctor examines the gland and performs local anesthesia - a blockade of the nerves around the prostate, after which the needle pricks are almost not felt. Then, in a fraction of a second, thin columns of tissue 15-20 mm long are taken with a biopsy gun: standardly 12 points from the peripheral zone of both lobes, if necessary - up to 16-18, and if MRI is available - additionally targeted from the suspicious area. Each column is marked by zone and sent to the histology laboratory.
The procedure takes 15–30 minutes, after which the patient remains under observation for 30–60 minutes and goes home. If anxiety is severe, intravenous sedation is possible.
Preparation
Before the biopsy, the urologist evaluates PSA, TRUS and, if possible, MRI of the prostate - it allows you to make a targeted biopsy and increase accuracy. Among the tests, a general blood test, coagulogram, general analysis and urine culture are needed (in case of infection, the procedure is postponed). Blood thinners should be discontinued 5-7 days in advance in consultation with the doctor. A cleansing enema is performed the evening before and in the morning, and a prescribed antibiotic is taken to prevent infection the day before the procedure and on the day of the biopsy. There is no need to fast unless sedation is planned.
After biopsy and results
For the first 2–3 days, slight discomfort in the perineum and blood in the urine and feces are possible; blood in semen can persist for up to 3-4 weeks - this is normal. Continue the antibiotic for 3-5 days, drink more water, avoid exercise, cycling and sex for 5-7 days. Temperature above 38 °C, chills, inability to urinate - a reason to urgently go to the clinic.
The histology result is ready in 7–10 days. If cancer is not detected, the urologist prescribes observation with PSA monitoring. If a tumor is detected, the report indicates the Gleason score and ISUP group, the volume of the lesion - from this the urologist oncologist determines the stage and tactics: active surveillance, radical prostatectomy, radiation or hormonal therapy.
Prostate biopsy in Tashkent: where to do it
In the clinics below, prostate biopsy is performed under TRUS control with local anesthesia, histological examination is included in the price; when cancer is detected, MSCT, consultation with a urologist, and radical prostatectomy are available in the same clinics. Make an appointment for a consultation with your PSA result - the urologist will determine the indications and set a date.
