For this test, a small probe about the width of a finger is lubricated and placed in your rectum. The probe gives off sound waves that enter the prostate and create echoes. The probe picks up the echoes, and a computer turns them into a black and white image of the prostate. You will feel some pressure when the probe is inserted, but it is usually not painful. The area may be numbed before the procedure. Newer forms of TRUS, such as color Doppler ultrasound, might be even more helpful in some situations.
MRI scans create detailed images of soft tissues in the body using radio waves and strong magnets. MRI scans can give doctors a very clear picture of the prostate and nearby areas. A contrast material called gadolinium may be injected into a vein before the scan to better see details.
To improve the accuracy of the MRI, you might have a probe, called an endorectal coil , placed inside your rectum for the scan. This can be uncomfortable for some men. If needed, you can be given medicine to make you feel sleepy sedation. Multiparametric MRI: This newer MRI technique can be used to help better define possible areas of cancer in the prostate, as well as to get an idea of how quickly a cancer might grow.
It can also help show if the cancer has grown outside the prostate or spread to other parts of the body. The results of the different scans are then compared to help find abnormal areas.
In this system, abnormal areas in the prostate are assigned a category on a scale ranging from PI-RADS 1 very unlikely to be a clinically significant cancer to PI-RADS 5 very likely to be a clinically significant cancer. This can help ensure the doctor gets biopsy samples from any suspicious areas seen on the images. If prostate cancer spreads to distant parts of the body, it often goes to the bones first.
A bone scan can help show if cancer has reached the bones. For this test, you are injected with a small amount of low-level radioactive material, which settles in damaged areas of bone throughout the body. A special camera detects the radioactivity and creates a picture of your skeleton. A bone scan might suggest cancer in the bone, but to make an accurate diagnosis, other tests such as plain x-rays, CT or MRI scans, or even a bone biopsy might be needed. A PET scan is similar to a bone scan, in that a slightly radioactive substance known as a tracer is injected into the blood, which can then be detected with a special camera.
But PET scans use different tracers that collect mainly in cancer cells. However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers. A CT scan uses x-rays to make detailed, cross-sectional images of your body. Still, it can sometimes help tell if prostate cancer has spread into nearby lymph nodes.
If your prostate cancer has come back after treatment, the CT scan can often tell if it is growing into other organs or structures in your pelvis. CT scans are not as useful as magnetic resonance imaging MRI for looking at the prostate gland itself. In a lymph node biopsy, also known as lymph node dissection or lymphadenectomy , one or more lymph nodes are removed to see if they have cancer cells.
If there is more than a very small chance that the cancer might have spread based on factors such as a high PSA level or a high Gleason score , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy see Surgery for Prostate Cancer. The lymph nodes and the prostate are then sent to the lab to be looked at. A prostate biopsy is usually done on an outpatient basis. Procedures may vary depending on your condition and your healthcare provider's practices.
This type of biopsy may be done with a local anesthetic to numb the tissue the needle will pass through. Usually, a transrectal ultrasound TRUS will be used to guide the placement of the biopsy needle. The healthcare provider will use a spring-loaded tool that quickly inserts a needle through the wall of the rectum into the prostate gland. You may feel discomfort or pressure when the needle enters the prostate gland.
The needle is put in several times to take tissue samples from different parts of the gland. You will be positioned on your left side, with your knees bent, or lying on your back with your knees bent and thighs apart.
You will feel a needle stick when the local anesthetic is injected. This may cause a brief stinging sensation. When the area is numb, the healthcare provider may make a tiny incision cut in the skin. The healthcare provider will place a gloved, lubricated finger into your rectum to locate and stabilize the prostate gland.
The biopsy needle will be inserted through the incision and into the prostate several times to get samples from different parts of the gland. The biopsy needle will be removed and firm pressure will be applied to the biopsy site until the bleeding has stopped. Sutures are usually not needed. The procedure may be done under a local or general anesthetic. Local anesthetic means medicines are used to make you numb.
General anesthetic means medicines are used to put you into a deep sleep during the procedure. The healthcare provider will insert a cystoscope a flexible tube and viewing device into the opening at the end of your penis, through the urethra, and up to the prostate gland. The healthcare provider will insert tiny instruments through the cystoscope to take out samples of the prostate gland.
Your recovery process will vary depending on the type of anesthesia that is used. If you were given general anesthesia, you will be taken to a recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If local anesthetic was used, you may go back to your normal activities and diet unless otherwise instructed. You may feel the urge to urinate or have a bowel movement after the biopsy.
This feeling should pass after a few hours. There may be blood in your urine or stool for a few days after the biopsy. This is common. Blood, either red or reddish brown, may also be in your ejaculate for a few weeks after the biopsy. This, too, is normal. The biopsy site may be tender or sore for several days after the biopsy.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Partin AW, et al. Prostate biopsy: Techniques and imaging. In: Campbell-Walsh-Wein Urology. Elsevier; Accessed Jan. Benway BM, et al. Prostate biopsy. Accessed March 15, Prostate biopsy adult. Mayo Clinic; Das CJ, et al. Prostate biopsy: When and how to perform. Clinical Radiology. Prostate cancer diagnosis. Ferri FF. Prostate cancer.
In: Ferri's Clinical Advisor Yang XJ.
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