Prostate biopsy

Inflammatory complications

Inflammatory complications of prostate biopsy cause the gland to swell, which can grow to the point that normal urine flow is impeded; even in this quite rare circumstance (<1%), it may be necessary to place a catheter to be maintained for a few days. For preventive purposes, especially in the case of a very bulky prostate or a major inflammation of the same, the doctor may decide to apply the bladder catheter immediately after the examination and keep it in place for a few hours.

INFECTIOUS complications

In the presence of infectious complications (cystitis, infectious prostatitis and epididymitis), the difficulty in urinating is typically associated with urethral discharge and more or less high fever, which when it becomes particularly high requires hospitalization; in this case antibiotics come in handy, the use of which will be perpetuated for a few days from the end of the biopsy.

Many of the complications listed in this chapter can be prevented, or at least mitigated, by scrupulously following the instructions provided by the urologist on the methods of preparation for the examination.

Allergic complications

The appearance of allergic reactions to the anesthetic used is quite rare.

Reliability

Is Prostate Biopsy a Reliable Exam?

The number of samples taken during prostate biopsy must be such as to obtain a significant sampling for histological examination.

Given its often small size, in fact, it may happen that samples are not taken in correspondence with the tumor, returning false positives (subjects who, according to the cytological examination, appear healthy when in reality they suffer from prostate cancer). Therefore, even if the results biopsy excludes the presence of a tumor, a new PSA check is usually necessary; in the presence of further clinical suspicions, a new prostate biopsy will therefore be necessary a few months later.

On the other hand, doctors are faced with the important risk of overdiagnosis, that is, of discovering and treating tumors which - if they had not been diagnosed - would not have caused significant problems to the patient and would not have caused his death. The risk, in fact, is that following a positive prostate biopsy the doctor decides to proceed with the surgical removal of the gland, with the relative consequences of incontinence and impotence that often accompany the post-surgery. A particularly difficult choice, therefore, given that, as we have often seen, the removed tumor, with all that it entails on a psychological and physical level, would not have produced any significant damage during the life span of the subject.

Preparation

How do you prepare for a prostate biopsy?

To minimize the risk of complications, it is essential that the preparation for the prostate biopsy is done as prescribed by the doctor. For example, to prevent serious bleeding episodes it is important to stop taking drugs that decrease the blood's clotting capacity, such as warfarin (Coumadin), acenocoumarol (Sintrom) and NSAIDs (Cardioaspirin, Aspirinetta, paracetamol, ibuprofen, etc.). ); the same goes for herbal supplements with the same properties (such as Ginkgo Biloba, ginger and garlic). The suspension period is established by the doctor (it can be up to two weeks), who also establishes the need to undertake any replacement therapies.

To avoid infectious complications, the nurse may inject a vial of antibiotic into the muscle during the biopsy; alternatively, oral or parenteral (injective) antibiotics may be required from one day before the examination up to three days. from the conclusion of the same.

Within four / five hours of the examination, it is necessary to perform a cleaning enema ("pear") (available in a pharmacy according to the doctor's advice); cleaning the rectal mucosa from fecal residues allows the ultrasound probe to better visualize the prostate , guiding the urologist towards a smoother prostate biopsy. Another important recommendation is to come to the exam with a sufficiently full bladder (not too much), while fasting is not normally required.

Due to the use of anesthetics, it is advisable for the patient to come to the appointment for the prostate biopsy accompanied by someone; at the end of the procedure it is in fact not advisable to drive the car. Rather, the patient can be kept under observation for some time; rarely, during the prostate biopsy there is a slight and transient decrease in blood pressure, with the appearance of sweating and sensation To prevent these lipothymic episodes (fainting), a light sedation can be administered, which causes a slowing of reflexes even in the hours following the prostate biopsy, making it dangerous to carry out activities that require coordination and attention such as driving vehicles.