Prostate biopsy: preparation, procedure technique, possible complications. How is prostate puncture performed: possible consequences Preparing for a biopsy

This is the most common way to detect tissue changes at the cellular level.

This procedure is the most reliable method of research, which with 100% probability allows you to judge the cellular composition of a particular formation. Using a special prostate biopsy needle, the doctor takes living tissue from the patient, which is then examined under a microscope. The method will accurately confirm whether the patient has cancer.

A biopsy is prescribed if the examination reveals any tissue changes or high rate PSA when taking a blood test.

The patient must understand the need for this procedure. Untimely examination may have consequences in the future dangerous consequences for good health.

The tissue collection procedure can be carried out in outpatient setting or in a hospital.

To avoid infection, a course of antibiotics is prescribed in advance.

Does a prostate biopsy hurt? The procedure for taking prostate tissue is quite painful.

Therefore, before the biopsy begins, the patient is given local anesthesia. Most often, a special gel with lidocaine is administered.

Sometimes, in agreement with the doctor, the patient drinks a painkiller for greater effect.

How is a prostate biopsy done? There are several methods for performing a biopsy:

transrectal;
transureal;
transperineal.

Transrectal prostate biopsy is performed in the following steps:

It is necessary to lie with your legs pulled up to your chest on your left side or stand on your elbows and knees.
To relieve pain, the doctor through anal hole injects lidocaine gel into the prostate.
Allow 10 minutes for the drug to dissolve properly and begin to act.
Next, a sensor is inserted, which has attachments and disposable needles for prostate biopsy.
Using a sensor, areas of the prostate are examined.
To collect living tissue, the doctor immediately marks from 6 to 18 places in the prostate, not only from the diseased area, but also from other areas of healthy tissue according to a special scheme.
How is prostate puncture performed? The doctor performs a puncture of the prostate gland using a biopsy gun, which shoots a hollow needle into the tissue, removing a column about 17 mm long from each targeted point.

Transperial

How is a prostate biopsy taken? Due to the complexity of the procedure, this method is not very popular.

The man lies down in the fetal position and the doctor injects him with an anesthetic injection.
The doctor treats the area between the testicles and the rectal sphincter with an antiseptic drug.
Next, an incision is made in this area and an ultrasound probe or finger is inserted. After examining the collection site, a biopsy needle is inserted.
By moving the needle over the tumor using special manipulations, they take the piece of tissue required for the sample.
The nodule is fixed using a finger located in the anus.
After the cells are collected, the wound is treated.
The procedure takes about 30 minutes.

Transurethral

How is a prostate biopsy (transurethal) performed?

Cells extracted from the prostate as soon as possible sent to the laboratory for examination.

Contraindications

The procedure is prohibited if:

infectious diseases;
if identified;
at in serious condition patient;
in the presence of an inflammatory process in the large intestine;
in acute form;
with blood incoagulability.

Preparation

How to prepare for a prostate biopsy? Regardless of the type of biopsy, the patient should prepare for the procedure in accordance with the precise recommendations of the doctor. Having determined and examined the patient’s condition, the urologist prescribes measures to prepare for a prostate biopsy.

Preparing for a prostate biopsy:

IMPORTANT: Only the doctor determines the need for and frequency of prostate biopsy and decides which method is most appropriate.

Decoding the results

After 10 days, the results of the prostate biopsy will be ready. Degree of availability cancer cells determined in points by . They are assessed by a pathologist, who makes the necessary conclusions.

If the indicator is 2-4 units, then the risk of developing a tumor is insignificant. Cells taken for prostate biopsy analysis are similar in structure to healthy ones.
If the results of the prostate biopsy analysis are from 5 units to 7, we can talk about an average risk of cancer.
An indicator from 8 to 10 units indicates the presence.

If there have been cases of prostate cancer in your family tree, it is important to consult a urologist and take PSA tests from the age of 45.

Code of Conduct

Biopsy is equivalent to the minimum surgical intervention. Therefore it is very important to comply necessary recommendations after the procedure.

IMPORTANT: It is necessary to strictly follow all the urologist’s prescriptions.

Consequences

Consequences of prostate biopsy:

The appearance of discomfort in the rectum.
This is a fairly common complaint that time will pass on one's own. If the discomfort is quite severe, the doctor may prescribe therapy with non-steroidal anti-inflammatory drugs.
Blood mixed.
In 74% of cases after a prostate biopsy, men have blood in their urine, 14% have blood coming out of the rectum, and 1% have blood in their semen. If blood is released for 3-5 days, this is normal phenomenon. It goes away on its own, but if there is prolonged discharge, you need to contact a urologist. In such cases it is indicated bed rest, therapy selected by a specialist and drinking plenty of fluids.
Presence of infection.
Approximately 2% of patients experience prostate infection and genitourinary system. The doctor prescribes a course of antibiotics. There is also pain in the perineum, elevated temperature, dysuria or polyuria. If the patient's condition persists for a long time or worsens over time, hospitalization is necessary.

Urinary retention when urinating

This is a temporary phenomenon that goes away on its own without medical intervention.

If after a prostate biopsy there is blood in the urine or stool for more than 8 hours, if there is no urination during this time, if long time holds on heat- You must urgently seek medical help.

Conclusion

Now you know how a prostate biopsy is performed. Many men are afraid to have a biopsy because painful sensations. But it is this research method that makes it possible to detect the presence of cancer cells and begin timely treatment.

Content

If cancer or other prostate diseases are suspected, the patient is prescribed various tests, including a prostate biopsy. Using this method, a specialist obtains tissues, which are subsequently sent to the laboratory. There is held histological examination, allowing you to determine the type of tumor, its stage and nature of development. Based on the data obtained after the biopsy, treatment tactics are determined. Every representative of the stronger sex needs to know details about this study.

What is a prostate biopsy

This word means invasive medical manipulation. A prostate biopsy is performed as an outpatient procedure to diagnose prostate cancer in men. Using special equipment, fragments of pathological tissue are taken and sent for histology. Previously, a biopsy was performed by palpating the gland. Now it is performed under the control of the apparatus for ultrasound examination, which reduces the risk of complications to a minimum. The biopsy result is guaranteed to be 100% accurate.

Indications

A prostate biopsy is a very accurate test, thanks to which a specialist will be able to understand whether the patient has cancer or some other disease of the prostate gland. It is prescribed in the following cases:

During the initial palpation rectal examination of the prostate gland, the doctor detects lumps, nodes or other abnormalities.
A blood test indicates elevated level prostate-specific antigen (PSA). If it is constantly large or growing, then a biopsy is repeated to clarify the diagnosis. Another indication is a decrease free PSA in relation to the general, which also increases the likelihood of cancer.
While performing TRUS, the doctor discovered areas with suspiciously low echogenicity, which may indicate cancer.
The tumor has been confirmed by other studies, but we need to find out whether it is benign (adenoma) or malignant (cancer). In the second case, the stage is immediately clarified.

Kinds

Biopsy is performed different ways. The doctor must choose which one to use, taking into account the individual characteristics of the patient. There are these types of biopsies:

Transrectal. The equipment is inserted into the anus, while the patient takes a knee-elbow position, lies on his back with an elevated pelvis or on his side. An anesthetic is injected into the prostate area. The examination is performed with a spring needle under TRUS control. A transrectal or multifocal biopsy is done quickly. In this case, several tissue samples are taken from different parts of the organ.
Transurethral biopsy. It is performed in the supine position under general, spinal or local anesthesia. It is performed with a cutting loop for taking material with a cystoscope - a flexible probe with illumination and a video camera. Insertion of equipment into the urethra.
Transperineal biopsy. This access method is used less frequently than others. The patient lies on his back or side, he is injected with general or local anesthesia. An incision is made in the perineal area, into which a biopsy needle is placed and rotated. The doctor inserts a finger into the patient's rectum to secure the prostate gland and stop bleeding after surgery. The sampling is carried out several times from different areas.

How to do a prostate biopsy

The most common is the transrectal puncture approach, so it is worth talking about its stages in more detail. How is a biopsy performed:

The doctor tells the patient how the study is performed and gives consent to it.
The patient takes the position indicated by the doctor on the couch.
The patient is given local anesthesia. Usage general anesthesia inappropriate.
A TRUS sensor is inserted into the patient's rectum. It displays an image of the prostate gland on the monitor.
Using a special device, a needle is inserted 2 cm deep. To take required quantity material, the doctor will make many punctures into the formation itself and the tissues located near it. The patient can go home as soon as he returns to normal condition. The material in different test tubes with formaldehyde in a special container will be sent for histological examination.
If there are any difficulties, a repeat biopsy may be performed after a few months.

Analysis results

Processing of the material takes up to two weeks. After analyzing the tissue, a specialist can make one of the following conclusions:

benign education;
acute inflammation(no malignant cells, glandular structures are damaged);
chronic granulomatous inflammation;
adenosis or atypical adenomatous hyperplasia;
low grade prostatic intraepithelial neoplasia (PIN);
PIN high degree;
High-grade PIN with atypical glands (suspicion of adenocarcinoma);
focus of atypical glands;
a node with suspected adenocarcinoma (repeat biopsy required);
adenocarcinoma.

To get the result, laboratory specialists use the Gleason scale. It determines the stage of adenocarcinoma and the degree of aggressiveness of malignancy. Each column of collected gland material is assessed on a five-point scale. Indicator 1 means that the aggressiveness of the tumor is minimal, 5 means maximum. The scores obtained from the analysis of the two most common changes in tissue fragments by volume are summed up. In this case, the first indicator is assigned to the tissue column in which more than half of the cells are changed, and the second to the one in which less than 50% are affected.

Characteristics of the tumor according to the Gleason index:

2-6. The tumor grows slowly, is well differentiated, and is not prone to early metastasis.
7. moderately differentiated adenocarcinoma.
8-10. Poorly differentiated tumor. It grows quickly and metastasizes.

Preparation

Before the biopsy, you must follow certain rules. Then its quality and efficiency will be as high as possible. How to prepare for a prostate biopsy:

A week before the test, you must stop taking medications that affect blood clotting.
Antibiotic therapy begins 3-5 days before the biopsy. This is necessary to avoid infectious complications.
A week before the biopsy, you should give up alcohol.
The night before and a couple of hours before the test, you need to do a cleansing enema.
You cannot eat on the day of the biopsy.
You should make sure there are no contraindications and consult an anesthesiologist.

Diet after prostate biopsy

To avoid constipation after the study, you need to plan your diet taking into account certain rules. The menu should include:

cereals;
berries;
greenery;
nuts;
legumes;
dried fruits;
vegetables;
fruits.

Products that should be limited:

peas;
alcohol (exclude completely for a month);
black bread;
grape;
sauerkraut;
kvass.

Consequences

Some complications can occur even if the prostate adenoma biopsy was performed completely correctly. Possible consequences:

infectious-inflammatory process in urinary tract;
rise in body temperature;
severe pain in the perineum and anus, discomfort;
Availability small quantity blood in urine (macrohematuria), semen, feces;
bruises in the urethral area;
massive bleeding (extremely rare);
urinary retention or increased frequency;
acute prostatitis;
inflammation of the testicles or appendages.

Prostate biopsy price

The cost of performing the study will depend on many factors. Level matters medical institution, in which the service will be provided, and its reputation, reviews, qualifications of the specialist and support staff. The price is influenced by how the biopsy will be performed and how many puncture points will be made. An important factor in cost formation is the speed at which the laboratory performs analysis and provides results. Taking into account all the above points, the price of the procedure can vary from 6,000 to 70,000 rubles.

Video: how to take a prostate biopsy

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make treatment recommendations based on individual characteristics specific patient.

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It is very difficult to force a man, especially a young one, to go to the doctor. But diagnosing the disease at the most early stages appearance allows the doctor to select the most effective method fight him. This is exactly what happens with prostate cancer.

Prostate biopsy - how to do it

If the doctor, during a transrectal digital examination or on the basis of an increase in the level of prostate-specific antigen (PSA) in the blood serum, suggests that the patient has cancerous tumor, then in this case a puncture (biopsy) of the prostate is necessary, which will either confirm or refute the preliminary diagnosis. This procedure is more unpleasant than painful, but stress is caused by the expected discomfort and the expected results of the analysis. In addition, the patient is prepared in advance for pain.

Material for diagnostics is collected using an ultrasound probe inserted through the rectum and a special biopsy needle that directly removes prostate tissue. Using ultrasound, areas of the prostate gland are determined, then, through punctures, a needle takes thread-like pieces of prostate tissue for histological diagnosis. The needle insertion itself is performed in a tenth of a second - the patient usually does not even have time to notice this, the injection is performed so quickly. At least 12 such injections must be done. Although this procedure is quite unpleasant, it is vital for the patient. Therefore, it is so important to properly prepare a man not only on a physical, but also on a psychological level.

Indications for prostate puncture

If a biopsy is prescribed, then it is necessary to prepare for it. In most cases, it is performed on an outpatient basis, only sometimes the patient is hospitalized for 1-2 days.

- First of all, you need to warn your doctor about diseases associated with decreased blood clotting and tell about the anti-inflammatory drugs you are taking that thin the blood (aspirin, heparin, ibuprofen). A week before the procedure, their use must be stopped so as not to provoke bleeding.
- You should definitely tell your doctor about your allergic reactions for medications, including anesthetics.
- The doctor will tell you when you should stop eating, and before starting the manipulations, he will suggest using an enema to cleanse the rectum.
- An important factor is psychological preparation for a prostate biopsy. It is better to take sedatives the day before, sedatives. All together will weaken emotional perception.

After taking a prostate puncture, you must refrain from active physical exercise, spend one day at home. Small traces of blood in the urine and stool will be observed for some time, the analysis will be ready in 5-6 days. Even if the diagnosis of prostate cancer is confirmed, you should not despair, but direct all efforts towards a complete cure. This will be easier to do the sooner the patient sees a doctor.

Prostate puncture (or puncture biopsy) is medical procedure, allowing you to diagnose cancer or refute suspicions of the malignant nature of the neoplasm. The very concept of “puncture” is translated as “injection”. When carrying out diagnostics, special needles are used and tissue is collected for examination. In addition to establishing the correct diagnosis, prostate puncture allows you to evaluate the effectiveness of the prescribed therapy.

Indications and contraindications

A biopsy is often confused with transurethral resection of the prostate, but these procedures have different techniques. A puncture is prescribed if the patient complains of characteristic symptoms and based on research results. Symptoms that may warrant testing:

a feeling of pain, tightness and discomfort in the pelvic area - especially after physical activity;
erection problems due to pain;
spasms and burning during urination, sensation incomplete emptying Bladder;
general weakness, increased fatigue, weight loss, hair loss;
availability of diagnosed venereal diseases or surgical trauma to the prostate, which often results in inflammation.

The cause of these conditions can be growing prostate tissue, i.e. the appearance of a neoplasm. Puncture of prostate adenoma is prescribed after the following studies:

palpation examination of the prostate;
determining the level of prostate specific antigen.

The main indicator for testing is the excess level of PSA in the blood. Prostate specific antigen is a protein compound found in prostate tissue. The level of this protein is unstable throughout life. One of the reasons why PSA values increase sharply is the malignant nature of the tumor.

In addition, the reason for puncture may be the detection of compactions during palpation. If the results of an ultrasound examination reveal the presence of echogenic areas, a puncture may also be prescribed. List of indications for which puncture is performed:

benign nature of the neoplasm (adenoma);
suspicion of a malignant tumor;
to identify the stage and severity of the disease.

The diagnostic procedure may be performed more than once. Repeated tests prescribed if the collected material was not enough; based on the results of the first puncture, it is necessary to conduct more in-depth studies, as well as to control the course of the disease.

The puncture has a number of contraindications. It is undesirable to carry it out under the following conditions:

for prostatitis in acute or chronic form;
for hemorrhoids;
with low blood clotting that cannot be controlled;
at infectious pathology urinary system;
with inflammatory processes in the rectum.

The reason for refusal is bad feeling patient on the day of surgery. If there are complaints of dizziness, weakness, interruptions heart rate, then the puncture is postponed to another day.

Preparation for the procedure

First, the doctor introduces the patient to a list of necessary conditions that must be met during preparation. Explains their importance, warns about possible risks. List of requirements:

7 days before the puncture, stop taking it medicines, which thin the blood and reduce its clotting;
It is prohibited to take medications whose action is aimed at relieving inflammation (especially non-steroidal ones);
the day before the procedure, take an antibacterial medicine, which is selected by the doctor;
you need to do a cleansing enema twice - the night before and early in the morning on the day on which the puncture is scheduled;
The deadline for eating is the day before the procedure.

After the intervention, any physical exercise and excessive activity within 24 hours. To prevent bleeding, the next day the tampon that was inserted there after the biopsy is removed from the rectum. For 3–5 days the patient should take antibacterial drugs prescribed by a doctor. This is necessary for prevention and prevention inflammatory processes in the area of the prostate and rectum.

Process

Ultrasound-guided prostate biopsy is performed in the following stages:

Local anesthesia.
Insertion of an ultrasound guidance probe into the rectum.
A prostate examination, during which the doctor identifies suspicious areas.
Next, a piece of prostate tissue is taken through a probe using a needle. It fires instantly from a special pistol. Everything takes a split second.
Analysis of tissue taken, called a prostate biopsy or core.
After the procedure, the patient can go home.

It is worth noting that one injection is not enough to conduct a reliable analysis. A man gets up to 12 fences. This is enough to make a diagnosis. Sometimes, because the tumor is too small, the doctor is unable to identify the suspicious area during an ultrasound. In this case, the patient is prescribed a repeat biopsy.

Complications and risks

In most cases, prostate puncture is well tolerated by patients. An increased risk of infection is observed in men with diabetes mellitus or have a weak immune system.

Most often, those who have undergone a prostate biopsy complain of discomfort in the rectum. This is a normal phenomenon that goes away after a few days. Get rid of discomfort possible with the help of non-steroidal anti-inflammatory drugs.

Another common consequence is bleeding from the rectum, finding blood in the urine and semen. This phenomenon also goes away on its own, but with prolonged or heavy bleeding you should consult a doctor.

Infection is a more serious complication after a biopsy. It occurs in 2–3%. For treatment, the man is prescribed antibiotics before the procedure. Rarely, consequences such as bacterial prostatitis, urinary retention, absence of urination for more than 8 hours, and increased body temperature are encountered.

Despite the risks and complications, a man must understand that prostate puncture is the only way to determine the presence of cancer. If the attending physician prescribes a procedure, you cannot refuse. It can be carried out as in private clinic for a high price, and for free under the policy.

A puncture biopsy of the prostate gland is used to diagnose cancer or severe chronic inflammatory processes of an unknown nature. Prostate biopsy helps make a morphological diagnosis malignant tumor, establish the stage and degree of its malignancy, as well as its hormonal stability.

Methods of puncture

There are only two ways to perform prostate puncture: transperineal and transrectal. The transperineal or perineal method involves a transverse incision 2-3 cm slightly to the left midline. When approaching the prostate gland, the surgeon punctures it with a special trocar. Then, after obtaining some tissue for biopsy, the working instrument is removed.

During transrectal instrumental puncture, a gloved finger is inserted into the rectum, then a trocar is brought along it to the area of interest of the prostate gland. After performing a puncture, after taking a sample of prostate tissue inside the rectal cavity, the surgeon intentionally leaves a gauze swab for a day. IN Lately It is customary to make a puncture with a special thin needle, and its contents are examined using a cytological method.

Even a negative result of such a biopsy does not exclude the presence of a tumor in the patient. In case of single nodes, the material obtained during the biopsy (biopsy) may contain gland cells unchanged by cancer. A puncture biopsy often has to be performed several times.

Complications after puncture

During tissue collection for puncture, damage to the vessels of the rectum and pelvis is possible, accompanied by bleeding and hematoma formation. There is a risk of tumor implantation, embolism (air entry) of the pulmonary artery.

Sometimes it is necessary to carry out a parallel puncture of the bones to identify metastases in them, because the prostate tumor gives its first metastases precisely in the pelvic bones and in the spine. Puncture of the sternum and iliac crest is also performed.

Preparation for puncture

The day before, the patient is given a water cleansing enema and begins antibacterial therapy. Streptomycin is given up to 1 gram per day or colymycin (neomycin sulfate) 175,000 units twice a day intramuscularly.
It is also necessary to prescribe medications that reduce intestinal motility. This treatment continues for three days after the puncture.

Puncture collection technique

The technique for performing a prostate biopsy is simple. The patient is placed on the operating table with his legs slightly elevated and spread apart. During puncture, local novocaine anesthesia is used, and in patients with special excitability, short-term anesthesia is possible. The skin of the perineum is pierced with the thinnest trocar needle. Then, through the wall of the rectum, the surgeon controls the insertion of the needle with his finger, bringing it to the desired area of the prostate. The puncture needle is equipped with a special safety device to prevent its too deep insertion and damage to the bladder or perforation of the urethra.

Having inserted a needle into the prostate gland to a depth of 1.5 cm, the doctor uses the outer cylinder of the needle to cut off a piece of tissue. There are special designs of needles for puncture that allow you to pump tissue and complete the manipulation by introducing a small dose of alcohol along the trocar coupling to prevent tumor tissue from entering the puncture channel. Bleeding from the puncture site is stopped by applying finger pressure to the rectum.