Mild discomfort may come with prostate biopsy

DEAR DOCTOR K: I recently had a PSA test and my levels came back elevated. I’m scheduled to have a prostate biopsy. What can I expect?

DEAR READER: The prostate-specific antigen (PSA) blood test is a screening test designed to detect prostate cancer before symptoms develop. An elevated PSA value can suggest that cancer may be present. But only a prostate biopsy can confirm the actual presence of cancer.

A prostate biopsy involves removing snippets of tissue from the prostate and checking them for cancerous cells under a microscope.

During the biopsy, your doctor will insert an ultrasound probe into your rectum. The ultrasound probe sends out sound waves that travel into the prostate and bounce back like an echo. When they bounce back, they create a picture of your prostate gland.

Guided by the ultrasound picture, the doctor uses a spring-loaded “biopsy gun” that directs a needle into the part of the prostate that looks cancerous. The device quickly sends a needle through your rectal wall and into the prostate. The needle removes small tissue samples – a typical biopsy removes 10 to 12 samples.

You may feel a slight pinch as the needle punches into the prostate gland and takes the sample. Most men feel only mild to moderate discomfort.

If your biopsy result is positive, that means it has confirmed the presence of cancer in your prostate. If the biopsy specimen shows cancer, it’s cancer. But some prostate cancers just sit there for the rest of your life and never cause trouble, whereas others do cause problems. If no cancerous cells are found in the samples, that’s a good sign. But there’s still some room for doubt. About 10 percent of biopsies are “false negatives.” This means they have missed existing cancer.

Yes, the prostate biopsy can have side effects and can sometimes miss cancer. But the development of ultrasound pictures and biopsy guns and needles has made the diagnosis of prostate cancer much more accurate and has saved many lives.