Prostate cancer is the fourth most common male malignancy worldwide. Incidence and death rates vary tremendously among countries, however in the Philippines, more and more cases are being seen every year. The primary screening test for the detection of prostate cancer is the Prostate Specific Antigen or PSA test. This test should be taken once a year for all men at least 50 years of age. If elevated, then there is a suspicion for prostate cancer.

As in all forms of cancers, verification is through the examination of a sample of the cancer tissue. This is called a “biopsy”. In the past, the prostate was a very inaccessible organ for biopsy, however recent advances in technology and knowledge of the pelvic anatomy have allowed your Urologist to visualize and access the prostate with minimal discomfort, side-effects, and complication.

If I have a high PSA, does it automatically mean I have cancer of the prostate?

Usually the higher your PSA, the more likely it is to be cancer. However, not all elevated PSA’s connote cancer. An elevated PSA just means you have “prostate disease”. This can be benign or malignant. It can also be due to infection, as in prostatitis. A significant number of patients with elevated PSA’s may be attributed to Chronic Prostatitis which can usually be treated with antibiotics. However a PSA that is significantly elevated must be biopsied for confirmation.

How do I prepare myself for the procedure?

Unlike other ultrasound procedures, the TRUS with prostate biopsy, requires a much more meticulous preparation. Although the specific method used, varies between Urologists, usually they are comprised of a combination of oral antibiotics take for 3 days prior to the procedure and a laxative the night before. NPO (Nothing Per Orem) or nothing by mouth for a minimum of 6 hours before the biopsy. Frequently, patients also need basic laboratory tests, such as complete blood counts, clotting function tests, blood chemistries, chest x-rays, and electrocardiograms, most of which depend on the age and other associated pre-existing conditions in the patient.

How is the procedure done?

The procedure is usually done as out-patient although this depends on the preference of your Urologist. Mild intra-venous anesthesia may be used for better tolerance.

The patient will be asked to lie on his left side then the ultrasound probe will enter his anus. Guided by the ultrasound, the Urologist will get minute samples (a minimum of 12) from the prostate.

These samples are then sent for pathological diagnosis. The results will usually be available in 5 days.

What are the chances of someone being biopsied to have a postitive result for cancer?

In most Prostate Centers where many biopsies are made based on an elevated PSA, about 25% of patients positive for cancer.

What are the side effects?

There are important side effects of the biopsy that you should know about. Once you go home you may see blood in your urine, or in your bowel motions for up to two weeks. You may find blood in your semen for up to two months. This can clear up quickly, or go on for some weeks. If it takes longer to clear up than you expect or gets worse after a period of recovery do return to your Urologist for further advice.

If you get a temperature, pain, or a burning sensation when you pass urine soon after the biopsy you may have a urine infection, in spite of the antibiotics. Contact your Urologist. You will probably need more antibiotics.

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