Today, many research procedures are known, during which doctors manage to objectively assess the condition of the patient's prostate and detect tumors - these are ultrasound, CT, MRI, and scintigraphy. At the same time, none of them is able to answer the question about the malignancy of neoplasms with absolute accuracy. To determine the structure of cells, to see cancerous changes in the tissue of the gland and to establish an accurate diagnosis, a prostate biopsy will be required.
Procedure in brief
Localization of the prostate allows for the collection of material in several ways. The prostate is located slightly below the bladder and closely adjacent to its lower wall. Behind the organ is in contact with the rectum, and in front - with the pubic bone. From below, the iron is reliably protected by the soft tissues of the perineum. Thus, it is easy to guess how a biopsy is takenprostate - through the anus, urethra or perineum.
This study involves the removal of small particles of the prostate using a special needle. The resulting tissue samples are sent to the laboratory to determine the structure and nature of pathological changes. A prostate biopsy is usually performed when a man is suspected of having cancer.
Prostate Access
There are several ways to remove biomaterial from a patient, which differ in penetration options. The biopsy needle can be inserted:
- Transperineally, that is, through the perineum. The puncture is carried out between the scrotum and anus.
- Transrectal - through the rectum. This technique is widely used, despite the fact that in recent years surgeons refuse to use it more and more often. The reason is the high risk of transmission of intestinal infection to the genitourinary system.
- Transurethral - by inserting an endoscopic instrument into the prostate through the urethra. Today, a biopsy of the prostate gland is practically not carried out by this method, since it is considered uninformative. The thing is that cancerous foci are localized mainly along the edge of the organ, and the urethra runs along the center of the prostate.
Who needs to be tested
A prostate biopsy test is indicated for every man suspected of having cancer. Accordingly, any sign of prostate cancer is a direct indication for diagnosis. Talk directly or indirectly aboutmalignant process in the genitourinary system may be the following factors:
- increase in prostate-specific antigen;
- presence of a neoplasm of unknown nature detected by transrectal ultrasound;
- precancerous condition in history;
- Detection of an atypical formation on rectal palpation of the prostate.
Before taking a sample of the gland from the patient, it is carefully examined in order to determine the cause of the change in the shape of the organ. It is curious that a biopsy is not performed for prostate adenoma. To exclude or confirm a cancerous process, they rely on the results of the analysis of prostate-specific antigens, the conclusions of CT and MRI.
When a biopsy is contraindicated
If a bacterial infection in the pelvic organs is suspected, the procedure will have to be abandoned so as not to contribute to the spread of inflammation and purulent complications from diseased organs to nearby he althy ones. Among the diseases against which intervention is unacceptable, pyelonephritis, cystitis, urethritis, prostatitis are most often diagnosed.
It is impossible to carry out manipulation with blood clotting disorders, since a blood biopsy inevitably leads to tissue injury and small hemorrhages. With thrombocytopenia, which can be caused, for example, by hemophilia, uncontrolled intake of anticoagulants, a person may develop shock and even die from blood loss.
Hypertensionis another contraindication. At high pressure, the risk of bleeding is especially high, so these patients are not allowed to biopsy the prostate. How the procedure itself is carried out, we will find out after the description of the preparation for it.
Before manipulation
Preparation for a prostate biopsy is a set of diagnostic procedures that help assess the condition of a man's body, as well as predict the likelihood of complications in him, learn about the presence of contraindications. As soon as the doctor determines the need for a biopsy, the patient will have to be examined for infections and inflammation of the genitourinary system. Usually the doctor is alarmed by such patient complaints as:
- pain in the lower abdomen;
- discoloration of urine;
- appearance of purulent discharge from the urethra;
- persistent fever;
- frequent urination.
Laboratory diagnostics
This necessarily takes into account the tendency to allergic reactions in a man or his relatives, especially to medicines, since the study will inevitably require the introduction of drugs. A biopsy, like any other surgical procedure, is preceded by a complex of laboratory and instrumental studies.
Mandatory procedures include:
- Complete blood count. Allows you to identify latent inflammatory diseases in the body, which are evidenced by elevated levels of leukocytes and lymphocytes, determine anemia by low hemoglobin levels, etc.
- Urine analysis. The purpose of this study is to exclude a latent bacterial infection of the urinary system. If a prostate biopsy is performed against the background of sluggish cystitis, urethritis and other diseases, the risk of infection of the prostate and the development of prostatitis in the patient increases.
- Bacteriological analysis of urine. This is another, more reliable way to make sure that the urine is sterile and free of bacterial infection. If the study confirms the presence of pathogenic microflora, the patient is prescribed a course of antibiotic therapy using an antibiotic to which the bacteria of the identified type show maximum sensitivity.
- Biochemical blood test. The procedure is necessary to assess the condition and functionality of internal systems.
- Prostate-specific antigen test.
Other research procedures
In addition to tests, every man needs to undergo instrumental screenings, the results of which will indicate the condition of the lungs, heart, and kidneys. In addition, none of the analyzes will indicate the exact localization of the pathological focus in the prostate for biopsy. The standard list of studies includes:
- X-ray (fluorography) of the chest;
- electrocardiogram;
- Ultrasound of the kidneys;
- TRUS - transrectal ultrasound of the prostate.
If a man has any contraindications to a biopsy, the operation is postponed until the causes are eliminated: cure for infection, recovery of satisfactorycoagulation, blood pressure stabilization, etc.
Principles of operation
The day before the biopsy, the patient must undergo the final stage of preparation. If a man has previously taken medications that prevent blood clotting (Aspirin, Clexane, Heparin, Cardiomagnyl), the medication should be interrupted. But even this question remains at the discretion of the attending physician, who draws a conclusion about the ratio of benefits and risks of their cancellation.
Immediately before the biopsy, the man is given a cleansing enema. For prophylactic purposes, "Ceftriaxone" is prescribed - this is a broad-spectrum antibiotic that prevents infection from entering the internal organs. In order to provide full access to the genitals, the patient shaves off the hair from the pubic region, anus, scrotum and perineum. The choice of the puncture method remains with the surgeon and it usually depends on the number of required samples of the prostate gland. How to do a biopsy of the prostate in different ways, we will tell further.
Transrectal access
Most modern surgeons are of the opinion that there is no need to use anesthetic drugs to take biomaterial. Meanwhile, painkillers significantly improve the patient's well-being, which allows for a better biopsy. Doctors use as local anesthesia:
- painkillers that are injected into the rectum (gels and viscous dosage forms "Instillagel","Lidochlor" and others);
- injection anesthesia of the pelvic plexus, which involves the blockade of several nerve receptors.
After anesthesia, the patient is placed in a position convenient for performing a biopsy - lying on his left side, with his knees brought up to his chest. The doctor examines the rectum with his fingers and inserts an ultrasonic sensor into the anus, which, by transmitting an image to the screen, will help select the puncture point. In total, the biopsy procedure takes no more than 15 minutes.
Transperineal method
In comparison with the previous one, this method of taking samples of prostate tissue is considered more traumatic, but it is more informative and objective, since it allows you to get more biomaterial for research. Anesthesia for transperineal biopsy, which involves the introduction of a needle through the tissues of the perineum, is required. They can be used as general anesthesia, in which the patient's consciousness will be completely depressed, and epidural anesthesia, which involves the introduction of drugs into the spinal column and the preservation of consciousness.
For transperineal access, the patient lies on his back, lifts and spreads his legs to the sides, bent at a right angle. The procedure usually does not last longer than half an hour. Here, too, one cannot do without an ultrasonic sensor, which helps the surgeon navigate the location of the prostate and the tumor.
Transcript of results
Correct interpretation of prostate biopsy results is the ultimatethe purpose of this study. The procedure allows you to learn about the nature of the neoplasm and determine its type. However, this does not mean that all patients who have undergone a prostate biopsy always have cancer. In the conclusion of specialists, the absence of a cancerous process can be noted, while this does not always mean that the patient is completely he althy. In some cases, a false negative result is possible. Also not excluded:
- Atypical small acinar proliferation is a precancerous condition. Sometimes proliferation is considered the beginning of the development of adenocarcinoma.
- Precancerous intraepithelial neoplasia - a change in cells in all layers of the prostate, with the exception of the basal layer. The probability of the appearance of a malignant tumor at the site of foci of intraepithelial neoplasia is 35-40%.
Diagnosing one of these two conditions is a strong indication for repeat biopsy after a few months.
Types of prostate cancer
If a patient has cancer, it is important to determine the stage of the tumor and the degree of its danger in a particular case. Several types of malignant tumors are diagnosed that can occur in the tissues of the prostate gland:
- adenocarcinoma - malignant prostate adenoma, consisting of gland cells that produce the liquid part of the seminal fluid and prostaglandins;
- transitional cell carcinoma - a tumor arises from cells of the urethra passing through the prostate, occurs in 10-15% of cases;
- squamous cell (undifferentiated) cancer is the most dangerous type of tumor, as it is prone to rapid growth, metastasis and germination in neighboring tissues.
Patient feedback on the consequences
If we turn to the comments of men who know firsthand about this procedure, it is easy to guess the high probability of complications. A biopsy of the prostate, according to reviews, can lead to serious consequences. So, for example, the cause of damage to blood vessels is the individual feature of their location. But most often, the unfavorable consequence of a prostate biopsy, according to men, is:
- development of infection and inflammation at the needle entry site;
- purulent discharge from the rectum, impurities of pus and blood in the urine;
- prolonged aching pain in the pubic area;
- frequent urination.
A dangerous complication of such a manipulation is a puncture of the wall of a large artery, which can even end in death with a large blood loss. To avoid such consequences of a prostate biopsy, a man should carefully monitor his condition and consult a doctor if he feels worse.
