Diagnosis - Biopsy of the prostate

To confirm the suspicion, and execute the diagnosis of a prostate tumor, a biopsy is performed of the prostate land which makes it possible to determine the type of tumor, its position and know the “state” of the neoplasm, that is determine its extension.

Before being subjected to the biopsy, the patients must abstain for 1 week from the use of aspirin and anti-inflammatory drugs, since they facilitate bleeding. They should only be used if prescribed. An oral anti-biotic is prescribed (usually Ciprofloxacina), to be taken from the day before the biopsy until two days after it.

During the biopsy, the patient must remain lying on his side with the knees held close to the chest, or lying on his back with his legs bent towards the chest. A biopsy needle, similar to those used to take blood or administer injections is introduced into the ultrasound trans-rectal probe, or through the perineum in order to make take the sample of the area suspected of having a tumor. The Ultrasound Trans-rectal Prostate assists the urologist in placing the needle correctly, which is seen on the screen of the echo-graph. A sample of cells is extracted from one or more areas of the tumor. The sample is analyzed by an anatomic pathologist in order to confirm the diagnosis of a tumor or determine the type of histology. The results are obtained in 5 to 10 days.

Gleason Score
The biopsy samples are examined under a microscope to detect the presence of cells or groups of cells that are visibly different from the healthy tissue. The greater the difference between the healthy cells and the malignant, the more probable it is that the tumor is aggressive and can spread (metastasize). The pathologist examines two samples of the tissue taken from different areas of the tumor and assigns to each sample a number from 1 to 5. The more abnormal the tissue, the higher the number. The sum of the numbers of the two samples gives the Gleason Score. A Gleason Score from 2 to 4 indicates the cells are slightly altered compared to the normal ones, and a number from 5 to 7 indicates that the cells are moderately altered; a Gleason Number from 8 to 10 indicates that the cells are very altered and different from the normal ones. The maximum number suggests that the tumor is aggressive.

Complications
After a biopsy, blood may appear in the sperm, (haematospermia), in the urine (haematuria) and in the faeces, which normally disappears in 1 to 2 weeks. Patients can also feel, for several days, pain in the perineum. Patients are recommended to abstain from sexual intercourse for 3 to 5 days. The patient must visit his urologist if he has urination problems, or if clots of blood appear in the urine.