Prostate cancer is the most common cancer in men.
It affects one in three American men during their lifetime. By the age of 50, many men start to get screened, usually undergoing a PSA test.
During this screening, if it seems that an individual has the possibility of cancer, a biopsy is recommended.
This is to confirm whether cancer is present, as to make a prostate cancer diagnosis and determine the aggressiveness of the disease.
But, mounting evidence suggests that biopsies have several negative side effects.
This article will discuss the safety of undergoing a prostate biopsy and the 5 side effects that could affect your quality of life.
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What is a prostate biopsy?
A prostate biopsy is a procedure used to detect prostate cancer. Small samples of the prostate are removed and then observed under the microscope.
Doctors usually recommend a biopsy of your prostate gland based on certain findings. One is if your prostate-specific antigen (PSA) blood test results are higher than average for your age.
Another is if your doctor detects signs of a prostate problem during your digital rectal exam (DRE). Although the PSA and DRE or show a possible problem with your prostate, a biopsy is needed to confirm if it’s cancer.
A prostate biopsy involves:
- Collecting minute samples of the prostate gland. The doctor passes a needle through the rectal wall or makes a small cut in the area between the anus and rectum to obtain the samples. A CT or MRI scan is also used to guide them through the procedure.
- A prostate biopsy takes about 10 minutes and is usually done in the doctor’s office. The samples will be sent to a lab and will be looked at under a microscope to see if they contain cancer cells.
- If cancer is detected in the patient, it will also be assigned a grade. The results are available after 1 to 3 days, but it can sometimes take longer.
Side effects of a prostate biopsy
Although one of the most common procedures for detecting prostate cancer, biopsies carry many potential risks and complications which we will discuss below.
Just like any invasive procedure, bleeding will occur. It’s normal to see a small amount of blood in your semen or urine for about two weeks. However, it becomes a significant problem if bleeding takes a long time or if it gets worse.
One study reviewed the safety of transrectal ultrasound-guided needle biopsy. It found that 58 patients (63%) experienced haematuria and experienced rectal bleeding 23 patients (25%).
Severe rectal bleeding is an uncommon complication yet in some instances can be life-threatening. So, both patients and practitioners should be aware of the risks.
After the biopsy, it is highly common for patients to experience discomfort and pain after ejaculating or urinating. This usually only lasts for a few days after the procedure, but the degree of pain will vary for each individual.
While some may find it very painful, other people only report a slight discomfort. This is because of the injury caused by the needle on your prostate cells.
A prospective cohort study measured the short-term outcomes of men undergoing a prostate biopsy. The participants were asked to complete a questionnaire, measuring the frequency and effect of symptoms related to pain, infection, and bleeding.
The results found that pain was reported by 43.6%, fever by 17.5%, haematuria (blood in urine) by 65.8%, hematochezia (anal bleeding) by 36.8%, and haemoejaculate (the presence of blood in a man’s ejaculate) by 92.6%)men during the 35 days after a biopsy.
Although the researchers concluded that most men well tolerate prostate biopsy, it is associated with significant symptoms in the minority and affects attitudes to repeat biopsy.
Pain is a very important symptom to monitor. Worsening and persistent pain may indicate a bigger problem. If this is the case, you need to see your doctor for a follow-up.
A further risk of having a prostate biopsy is an infection. Surgeons will usually prescribe strong antibiotics to reduce the risk of infection. However, infection almost always occurs.
Research indicates that resistance to antibiotics is increasing the likelihood. In some cases, the result of the infection is that there is long-term sexual dysfunction.
Occasionally, these infections can turn into life-threatening sepsis. This is as needles used to detect cancer are passed through the rectum.
As a result, if the needles transport bacteria from the bowel into the prostate, bladder, and the bloodstream, an infection can occur.
A study by John Hopkins researchers was published in The Journal of Urology. It found that men hospitalized as a result of a biopsy-related infection had a 12-fold higher chance of dying than those who did not undergo a biopsy.
4) Acute urine retention
The procedure does injure the prostate gland, causing it to swell. And this makes it hard for you to pass urine.
If the prostate is particularly enlarged (>50mL) or the man has pre-existing risk factors, e.g., a poor flow, a high residual volume or previous urinary retention, then the risks of biopsy-induced urinary retention are significant.
Acute urine retention is a medical emergency, and you need to seek help at once. The doctor often inserts a catheter to drain the retained urine, and it will take a few days for you to recover.
5) Sexual problems
Several studies have found that men develop erectile dysfunction after having a prostate biopsy. In 2015, BJUI International published a study involving 220 men who underwent transrectal prostate biopsy.
Overall the researchers reported an increased risk of temporary ED after biopsy of approximately 5%.
While this happens rarely and should improve over time, the study concluded that the effects of TRUS-guided prostate biopsy on ED have probably been underestimated.
It is important to be aware of these side effects so patients can be appropriately counseled. If sexual problems persist, you should consult your doctor.
Types of prostate biopsy
A prostate biopsy may be done in several different ways:
- Transrectal method
At the moment, most biopsies are done using a transrectal ultrasound-guided (TRUS) technique. A TRUS prostate biopsy is where the needle goes through the wall of the back passage (rectum).
- Perineal method
This is done through the skin between the scrotum and the rectum.
- Transurethral method
This is a type of biopsy done through the urethra using a cystoscope (a flexible tube and viewing device).
- Transperineal biopsy
Unlike the TRUS Guided Biopsy, this is where the doctor inserts a needle into the prostate through the skin between the testicles and the anus. This area is called the perineum.
The needle is inserted through a template or grid. This is a targeted biopsy, which can be target a specific area of the prostate using MRI scans. An advantage of the TP biopsy is that it can now be performed under local anesthesia.
Are prostate biopsies safe?
One of the main issues with prostate cancer screening tests is that they can lead to misdiagnosis and as a result, overtreatment.
Even if you take many samples, a biopsy can still sometimes miss cancer. This occurs if none of the biopsy needles pass through the rights areas. Thus, the biopsy will have a false-negative result.
What is the alternative to a prostate biopsy?
But in recent years, doctors have found out that new imaging studies like high-resolution MRI and ultrasound can be alternatives to a prostate biopsy.
They have proven to be very accurate and safe. A multi-parametric MRI or a color Doppler ultrasound has a 95 to 98% chance of determining the location and grade of prostate cancer cells.
According to the Diagnostic Center for Disease, an MRI scan predicts and confirms the presence of prostate cancer more frequently than a biopsy.
A hi-res MRI features the most sensitive and specific imaging modality that allows it to produce a very clear picture of the entire prostate and pelvic region.
Experts claim that this is a quantum leap from the blind biopsy approach. It will minimize the need for biopsies, and could potentially save millions of dollars for the healthcare industry.
An MRI will give you a high resolution 3D image of your prostate and any specialist worth their salt will be able to see if there is growth, or if you’re experiencing the normal indicators of BPH, producing more antigens, therefore raising your PSA.
If you line up an MRI for 90 days time, you will be able to ascertain the rate of growth, if any. That will allow you to act accordingly, as you will have a far better picture than your current ‘snapshot’ and you will still be able to avoid a biopsy. Any specialist will be able to see if there is growth or any progress in the area of suspicion.
The PCA3 test is another alternative. PCA3 stands for “Prostate Cancer gene 3”, a protein that is produced by prostate cancer cells at much higher levels. PCA3 leaks into the urine when the prostate gland is stimulated.
Unlike the PSA test, a high PCA3 test can only result from cancer – not from an enlarged prostate, inflamed prostate or other non-cancerous prostate problem.
For this test, you need to undergo a DRE. This will stimulate PCA3 to leak into the urine.
A urine sample is then collected and sent to the lab. It takes about 1-2 weeks to get the results. The higher the PCA3 score, the more likely you have prostate cancer.
This test is also used to determine the effectiveness of cancer treatment. The higher the score, the more aggressive is prostate cancer.
Before having a biopsy, do your research. Do not blindly agree to a procedure without being aware of the possible life-changing side effects it could have.
There are alternatives to a prostate biopsy, like MRI and the PCA3 test. These methods are non-invasive and accurate.
Plus, they don’t have the negative side effects that result from a prostate biopsy.