What is a Prostate Gland?

The prostate gland is one of the three male sex glands and lies just below the urinary bladder, in the area behind the penis and in front of the rectum. It secretes semen. The urethra carries the urine from the urinary bladder and the semen from the sex glands to the outside of the body.

What is Prostate Biopsy?

A prostate biopsy is a surgical procedure in which a small sample of tissue is removed from the prostate gland for examination by a pathologist under a Microscope. 

Why do you need a Prostate Biopsy?

The test is done to determine the presence of Prostate cancer.
To diagnose benign prostatic hyperplasia (enlargement of the prostate)
The prostate biopsy is done following presence of lumps during rectal examination, and increase in PSA (Prostate Specific Antigen) levels in blood. 

How do you prepare for a Prostate biopsy?

Instructed to have enema prior to biopsy to remove feces and gas from the rectum.
Oral antibiotics are taken before and after biopsy to protect against possible infection.
Taking aspirin is stopped seven to ten days before the biopsy to limit the risks of bleeding. 

What are the risks and complications of prostate biopsy?

Avoid strenuous activities for about 4 hours.
It is a normal procedure to have minor bleeding after biopsy due to needle entering the areas that contain small veins. 
Blood occurs in urine, semen and bowel movements for few days to few weeks.
You should consult your doctor 

• If you experience severe and persistent bleeding and infection of the prostate gland or urinary tract. 
  

• You have a fever higher than 100.4 °F (38 °C). 
  

• You are unable to urinate within 8 hours. 

What are the different biopsy procedures?

Trans-Rectal Biopsy: Through the rectum
TRUS is the most commonly used method for obtaining Trans-Rectal Biopsy.
TRUS uses sound waves to create a video image of the prostate gland, using which a biopsy gun. 
Biopsy gun is a hand held device with a spring loaded slender needle. 
Biopsy needle is passed through the wall of the thin rectal wall, the needle can remove slender cylinder of tissues called core. Biopsy needles are tiny, with a sliding sheath which opens once it enters the prostate. 
The biopsy procedure removes a sextant (six-part) biopsy. 
The doctor may inject a local anesthetic around the prostate gland before the biopsy is taken.

Trans-Urethral Biopsy:  

Through the urethra
You may be given a general anesthesia or a local anesthesia to numb your urethra and the area around it. 
Cytoscope (Light fitted scope) is inserted into your urethra, which helps your doctor to view your prostate gland. 
A cutting loop, which can cut small pieces of tissue is inserted into the cytoscope. The loop is rotated to collect the small pieces.

Trans-perineal biopsy (Through the Perineum)
In this procedure, local anesthesia is given around the perineum to numb the area.
An incision is made in the perineum, inside which the doctor inserts a finger into the rectum, and holds the prostate gland. He then inserts the needle through the cut into the prostate gland and turns it and pulls it out. Samples are taken from different areas of the prostate. 
A bandage is placed on the cut after stopping the bleeding by applying pressure. 

What are the disadvantages of Prostate Biopsy test?

The test results are inconclusive if the biopsy sample does not contain enough tissues.
As a biopsy test collects tissue from small areas, chances of missing a cancerous growth are possible.
Normal biopsy results do not rule out cancer, and if the tests are positive for cancer it has to be confirmed with other tests - Prostate Specific Antigen, bone scan, lymph node biopsy, CT scan.

Frequently Asked Questions

Which doctor should I consult for a Prostate Biopsy?

You should consult an Urologist or a General physician.

What is an abnormal test result?

Abnormal test results may indicate:
Prostate cancer - Presence of cancer cells in Microscopic examination of tissue sample.
Abnormal non cancerous enlargement of the prostate gland (benign prostatic hyperplasia).

What is a Robotic Biopsy System?

A robotic system, which can perform accurate biopsy of the prostate, would indeed eliminate many of the existing drawbacks of conventional prostate biopsy procedures. 
The robot's greatest contribution would be accuracy. It would be capable of delivering a biopsy needle to a predefined point in the prostate with an error of less than 1 mm. 
This procedure ensures a uniform standard in prostate biopsy which is independent of the urologist's skills and experience. 
The urologist could plan the trajectory of the needle so that a chosen biopsy protocol is followed closely and consistently. 
The system also allows the ultrasound based 3D model of the prostate to be magnified and rotated to aid in the definition and visualisation of would be biopsy points.

What are the advantages of Robotic biopsy system?

Eliminate the existing drawbacks of conventional prostate biopsy procedures
Accuracy - The system is capable of delivering a biopsy needle to a predefined point in the prostate with an error of less than 1 mm
Multi-core biopsy - Another advantage of Robotic biopsy system is the possibility of performing multiple-core biopsy with just a single puncture point. The possibility of infection with the biopsy needle passing through a non-sterile field increases with every additional puncture, which is reduced by robotic biopsy. 

Glossary:

Prostate Specific Antigen:  
Prostate-specific antigen (PSA) is a 34 kd glycoprotein located in the prostate. A PSA test measures the amount of prostate-specific antigen in the blood. Low amounts of PSA may be found in the blood of healthy men. The amount of PSA in the blood normally increases as a man's prostate enlarges with age. It is also increased by inflammation of the prostate gland and by prostate cancer.

Perineum:  
The region between the thighs, in the female between the vulva and the anus, in males, between the scrotum and the anus

Conventional:  
Traditional or old method