Prostate biopsy

The first thing I have to point out is that each urologist’s routine may be slightly different. Different does not mean wrong. Most of the information I will present here is based on how I, personally, perform a prostate biopsy.

The reason we do a prostate biopsy is to evaluate the prostate for prostate cancer cells. We also get to look at the shape, contour, and size of the prostate using the ultrasound machine. This can be helpful when looking down the road at treatment options.

Your doctor will provide antibiotics for you to take before the procedure. You will also perform and enema before coming to the office. You will be instructed to stop all blood thinning medications. Typically, there is no need to fast prior to the procedure.

Once in the room you will undress from the waist down and lie on the exam table on your side facing away from the doctor. Your bottom will hang off the side of the table and you’ll bring your knees up toward your chest. Basically, you’ll be in a fetal position. In my office the procedure can be done with nitrous oxide medication to make you more comfortable. This is laughing gas at a low dose that you control to make yourself comfortable. It doesn’t knock you out, just takes the edge off.

The doctor will then perform a rectal exam and then insert the ultrasound probe into your anus. This will make you feel like you need to poop, which is a normal sensation. This can be painful for men with hemorrhoids, but is otherwise painless.

The next step is to numb the prostate. This is done by injecting a numbing medication, such as Marcaine, around the nerves of the prostate. During this portion you’ll feel a poke and some burning and pressure from the injection. This is similar to what you would experience with a dentist working on your tooth. Once this part is done, the rest is typically pain-free.

Next the doctor will take some pictures and some measurements of the prostate, looking for any suspicious areas.

The biopsies are then done in specific areas of the prostate, as well as any areas that looked abnormal on the ultrasound. Each time a biopsy is taken you will hear a loud clicking noise of the biopsy device. You should not feel any pain, but may feel some pressure.

After the biopsies are done the ultrasound is removed and the procedure is all done.

You should expect to have some blood in the urine, stool, and semen for a couple of days, though it can last up to a couple of weeks. If you experience high fevers, chills, nausea, vomiting, or an inability to urinate you should call your doctor immediately.

Your doctor should get results within about a week.

There should be no lasting side effects from the procedure. It does not cause impotence or problems with erections. It does not spread cancer. It does not cause cancer. I hope this information has been useful to you and helped to prepare you for your prostate biopsy if you are having one.

You can make an appointment to see me here.

What is PSA?

PSA is one half of prostate cancer screening, which should be performed annually in all men from age 50 to 70. In some men it should be started earlier if they have a strong family history of prostate cancer.

PSA stands for prostate specific antigen. It is an enzyme produced by the prostate tissue cells that is important in making semen less thick and gel-like.

When we talk about PSA for men we’re really referring to a blood test that measures the level of this enzyme floating around in your blood. The reason this test is important is that it can give us a clue as to your prostate health. Having a low PSA is never a bad thing, but having a high PSA could signal a problem.

There are several conditions that could cause your PSA to be high. The most important, of course, is prostate cancer. This is the whole reason we perform the test in the first place. We’re trying to detect prostate cancer early to make it more curable.

Prostate cancer isn’t the only issue that can cause a high PSA, though. Prostate inflammation or infection, which often has no symptoms, can cause an elevation. So can simply having a large prostate. Other things can also do it, such as a recent urine infection, urinary catheter, urinary retention, or camera exam of the bladder. If you ejaculate within 24 hours to the blood test, this can also cause a slight elevation of the PSA.

One of the things I mentioned that can increase your PSA is having a big prostate. This is important because as men age, their prostates grow. So it is normal and natural to see your PSA increase as you age. This is why what’s considered a “normal” PSA changes as you get older.

For a male in his 50s the PSA should be less than 2.5. In your 60s it should be less than 4.5. Once you’re in your 70s it should be less than 10.

It’s also important to keep an eye on the rate of change of the PSA as well. What I mean by this is that if you’re 60 and your PSA is 0.5, but next year it’s 1.2, and the following year it’s 3.5, that could be a problem. Even though that 3.5 is less than 4.5, the rapid increase in the PSA can hint at a problem.

When the PSA is high or is changing rapidly your doctor should refer you to a urologist. Your urologist will then suggest some additional testing. This could include some more specialized blood tests, such as a prostate health index score, a 4kscore, or free PSA percentage. Alternatively, a prostate MRI, a type of imaging scan, could be useful in select cases. Most commonly, though, the next step is a prostate biopsy, a test that samples the prostate tissue for cancer cells.

The most important thing to understand about PSA is that it isn’t a perfect test. A high PSA doesn’t mean there is cancer. Don’t panic if your PSA is high, but definitely see a urologist.

I hope that this information on PSA has been helpful and allows you to better understand your blood. If you’re ever unsure of what your next step should be, see a urologist for more information. It’s better to be safe than sorry.

You can make an appointment to see me here.

Prostate Cancer Screening

In 2020, approximately 170,000 men will be diagnosed with prostate cancer in the United States. We’ve gotten better at detecting it and treating it, but prostate cancer still accounts for nearly 5% of all cancer deaths. Screening may help to address this problem.

To start off I should explain what screening means. Screening is testing to detect a possible health problem before someone has signs or symptoms. For example, when you turn 50 you should have a screening colonoscopy to look for colon cancer. If someone has blood in their stool the colonoscopy is no longer a screening test, but a diagnostic test. The difference is having symptoms vs no symptoms. Prostate cancer rarely has symptoms, but sometime will have back pain, bone pain, blood in the urine, or difficulty with urination.

When it comes to screening for prostate cancer the key concept is called “shared decision-making.” The doctor should explain why you might consider doing screening or skipping screening. Basically, you should understand the plusses and minuses of screening and you can then decide if it sounds right for you or not.

Prostate cancer screening involves two simple tests. The first is a digital rectal exam where the doctor puts one finger in your rectum to feel the prostate. The exam checks for any lumps or bumps called nodules that may be present. The second test is a PSA blood test. PSA is a protein that is made by normal prostate cells. When prostate cancer is present the number of prostate cells increases rapidly. More cells means a higher PSA value. However, a PSA rise can also happen normally. As a man ages, the PSA value will naturally rise as the prostate gets bigger, so it’s important to understand that there are normal ranges of PSA based on age. For men if their 50s the PSA should be less than 2.5. In their 60s it should be less than 4.5. And in their 70s it should be less than 10.

If either of these tests is abnormal then you should be referred to a urologist for further evaluation.

Now let’s talk about who should be screened for prostate cancer. The American Urologic Association, the biggest influencer on urologic care recommends screening in men aged 55 to 70. Most doctors start at age 50, which is reasonable since that’s also the age several other screening tests start. There are some special cases to consider though.

Men whose prostate cancer risk is above average may consider beginning screening at an earlier age. These risk factors including being black, having a family history of prostate cancer at an early age, or certain other cancers in first-degree relatives that developed at a young age. Men over 70 in excellent health may consider continued screening. Any men who have an estimated lifespan less than 10 years should not be screened. The reason for this is that these men are more likely to die from their other medical problems than from prostate cancer.

To summarize, you should consider prostate cancer screening if you are healthy between the ages of 50 and 70. Testing will include a rectal exam and a blood test. If either of these is abnormal you should see a urologist.

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