How is a prostate puncture done? How is a prostate biopsy performed - types of research and preparation, diet after the procedure Causes of cystic formations of the prostate gland

Diseases of the prostate gland are being diagnosed more often these days, and both young and elderly men are susceptible to them. Usually in people under the age of 40, congestion in the prostate and, as a result, chronic prostatitis are detected. In men over 60 years of age, the risk of developing more serious changes in the gland is much higher. At this age, benign prostate tumors and pathological neoplasms are often found that pose a threat to health.

Puncture of the prostate is an exclusively diagnostic measure.

If the doctor, after examining the patient and receiving the results of the examination, suspects a malignant disease, a puncture of the prostate gland is prescribed, with the help of which a small area of altered tissue is taken for histological examination. This procedure is not difficult due to the high quality of medical devices, and negative consequences after it develop infrequently.

Preparing for a puncture

Preparation for the collection of material does not present any particular difficulties. Sometimes, for prevention purposes, the urologist prescribes antibacterial agents a week before the procedure, which help prevent complications in the form of the development of inflammatory processes.

For patients taking Aspirin cardio or other blood-thinning drugs, the doctor may recommend that they stop taking them a few days before the puncture.

Before the puncture, the patient is asked whether the body is intolerant to any drugs and whether he is taking blood thinners.

If the puncture of the prostate will be performed with the introduction of the device through the perineal site, special preparation is not required. In case of severe anxiety, the patient is advised to take some kind of sedative. In the case of a transrectal biopsy, an enema bowel cleansing is necessary.

Before the procedure, the patient must sign a consent to it.

Informed voluntary consent contains information about the risks and side effects of prostate puncture

Biopsy methods

The sampling of material from the prostate for histology is carried out by three methods:

Possible consequences

It is advisable to ask your doctor in advance about all the consequences that may arise after a prostate puncture. Many patients undergoing the procedure experience some anxiety. In fact, the puncture most often takes place without complications, but the process itself can cause discomfort, most often associated with the moment a spring needle is inserted into the prostate tissue. The patient also experiences insignificant pain at the moment when the ultrasound equipment transducer is inserted into the rectum. On the first day after the puncture, a man should avoid any physical activity.

If possible, it is better to be under medical supervision in the first few hours after the puncture.

Perineal pain is common during this period, and in some patients a small amount of blood is excreted in the urine. Within a few weeks after the procedure, the shade of the semen may change. In some cases, men get blood from the intestines. If the puncture was carried out under general anesthesia, the man is left in the hospital until he feels better.

Despite the insignificance of the intervention, it can be dangerous with the following complications:

inflammation of the prostate due to the penetration of pathogenic flora;
violation of the outflow of urine due to bleeding in the urinary tract;
intestinal bleeding;
allergy to anesthetics.

A sharp increase in body temperature may indicate the development of an inflammatory process.

You should urgently visit a urologist if, after a biopsy, there is an increase in temperature, pain in the perineum, urinary retention, blood flow for several days.

Histological examination, which requires taking material from the tissues of the prostate gland, is prescribed in the following cases:

identifying signs of compaction on palpation of the prostate;
the presence of hyperechoic areas in the gland during ultrasound;
significant excess of the norm of PSA indicators.

Restrictions after puncture

In general, there is no need for special food restrictions after the biopsy.

Eating foods that cause gas in the intestines should be limited

To support the immune system and prevent the occurrence of flatulence and constipation, doctors advise to exclude the intake of spicy and canned food, cabbage, grapes, peas. Drinking strong coffee, alcohol can cause irritation of the intestines. Not indicated after puncture and drinks with gas, a large amount of preservatives.

In the first weeks, it is better to give preference to vegetable stews, fruit salads, fish and white meat. To strengthen the immune system, you should eat nuts, oranges, greens. To avoid overloading the digestive organs, it is necessary to reduce portions, and also drink a sufficient amount of water. It is advisable for an adult man to consume more than one and a half liters of water per day.

You should ask your urologist about the possibility of resuming sexual activity after a puncture. Most often, doctors advise taking a break for 10 days, since during invasive intervention, one way or another, the prostate is injured. After the recommended period of abstinence, intimate life can be resumed. In this case, you should not take stimulants and do not delay ejaculation. If during intercourse pains in the perineum appear, the quality of the seminal fluid has changed, the general condition has deteriorated, you should consult a doctor.

With the correct technique, puncture is not a dangerous and traumatic procedure for the prostate. Histological examination is necessary to clarify the nature of the formations in the prostate, which allows the doctor to prescribe an effective treatment.

From the video you will learn about the indications for a puncture (biopsy) of the prostate under ultrasound control:

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

Puncture methods

There are only two ways to perform a prostate puncture: transperineal and transrectal. The transperineal or perineal method involves a 2-3 cm transverse incision just to the left of the midline. When approaching the prostate gland, the surgeon makes its puncture with a special trocar. Then, having obtained some biopsy tissue, the working instrument is removed.

With 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. Having made a puncture, after taking a sample of prostate tissue inside the rectal cavity, the surgeon intentionally leaves a gauze swab for a day. Recently, it is customary to do a puncture with a special thin needle, and examine its contents by a cytological method.

Even a negative result of such a biopsy does not exclude the presence of a tumor in the patient. With single nodules, gland cells unchanged by cancer can enter the material obtained during the biopsy (biopsy). Puncture biopsy often has to be performed several times.

Complications after puncture

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

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

Preparing for a puncture

The day before, the patient is given a water cleansing enema and antibiotic therapy is started. Streptomycin is given up to 1 gram per day or colimycin (neomycin sulfate) 175,000 IU twice a day intramuscularly.
Also, be sure to prescribe drugs that reduce intestinal motility. This treatment continues for three days after the puncture.

Puncture collection technique

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

By inserting the needle into the prostate gland to a depth of 1.5 cm, using the outer cylinder of the needle, the doctor cuts off a piece of tissue. There are special designs of puncture needles that allow tissue to be pumped in and to complete the manipulation by introducing a small dose of alcohol along the trocar sleeve to prevent tumor tissue from entering the puncture canal. Bleeding from the puncture site is stopped by applying finger pressure to the rectum.

It is very difficult to get a man, especially a young man, to go to the doctor. But diagnosing a disease at the earliest stages of its appearance enables the doctor to choose the most effective way to deal with it. This is exactly what happens with prostate cancer.

Prostate biopsy - how to conduct

If the doctor, during a transrectal digital examination or on the basis of an increase in the content of prostate-specific antigen (PSA) in the blood serum, suggested that the patient has a cancerous tumor, then 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 causes the expected discomfort and the expected test results. In addition, the patient is pre-tuned to pain.

The material for diagnosis is taken using an ultrasound probe inserted through the rectum and a special biopsy needle that directly takes the prostate tissue. With the help of ultrasound, the areas of the prostate gland are determined, then through the punctures the needle picks up thread-like pieces of prostate tissue for histological diagnosis. The needle itself is injected in a tenth of a second - the patient usually does not even have time to notice this, the injection will be performed so quickly. There must be at least 12 such injections. Although this procedure is rather unpleasant, it is vital for the patient. Therefore, it is so important to properly prepare a man, not only on the physical, but also on the psychological level.

Indications for prostate puncture

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

- First of all, it is necessary to warn the doctor about diseases associated with a decrease in blood clotting and tell about the anti-inflammatory drugs taken that thin the blood (aspirin, heparin, ibuprofen). Stop taking them a week before the procedure so as not to provoke bleeding.
- Be sure to inform your doctor about your allergic reactions to medications, including anesthetics.
- The doctor will tell you when to stop eating, and before starting the manipulations, he will suggest cleansing the rectum with an enema.
- An important factor is the psychological preparation for a biopsy of the prostate. The day before, it is better to take sedatives, sedatives. All together will weaken the emotional perception.

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

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 what is the cellular composition of a particular formation. With the help of a special needle for a prostate biopsy, 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 study found any changes in the tissue or there was a high PSA value when taking a blood test.

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

The tissue collection procedure can be performed on an outpatient basis or in a hospital.

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

Prostate biopsy - does it hurt? The procedure for taking prostate tissue is quite painful.

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

Sometimes, in consultation with the doctor, the patient drinks an anesthetic drug for greater effect.

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

transrectal;
transureal;
transperineal.

Transrectal biopsy of the prostate is performed in the following steps:

It is necessary to lie with legs pulled up to the chest on the left side or stand on your elbows and knees.
To relieve pain, the doctor injects lidocaine gel into the prostate through the anus.
It is given 10 minutes for the drug to dissolve qualitatively and begin to act.
Next, a probe is inserted, which has nozzles and disposable needles for prostate biopsy.
With the help of the sensor, a survey of areas of the prostate is carried out.
For the collection of 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 punctures the prostate gland with a biopsy gun, which shoots a hollow needle into the tissue, taking a column about 17 mm long from each target 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.
Next, an incision is made in this area and an ultrasound probe or finger is inserted. After inspecting the collection site, a biopsy needle is inserted.
Driving a needle over the tumor with special manipulations, a piece of tissue necessary for the sample is taken.
The nodule is fixed with a finger, which is located in the anus.
After collecting the cells, the wound is treated.
The procedure takes about 30 minutes.

Transurethral

How is a biopsy of the prostate (transurethral) performed:

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

Contraindications

It is prohibited to carry out the procedure if you have:

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

Preparation

How to Prepare for a Prostate Biopsy? Regardless of the type of biopsy, the patient must prepare for the procedure in accordance with the exact recommendations of the doctor. Having determined and examined the patient's condition, the urologist prescribes measures to prepare for a biopsy of the prostate gland.

Preparing for a prostate biopsy:

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

Decoding the results

After 10 days, the results of the prostate biopsy will be ready. The degree of presence of cancer cells is 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 cells.
If the indicators of the results of the analysis of a biopsy of the prostate gland are from 5 units to 7, we can talk about the average risk of cancer.
An indicator from 8 to 10 points indicates availability.

If there have been cases of prostate cancer along the pedigree, it is important to consult a urologist from the age of 45 and get tested for PSA.

Code of Conduct

A biopsy is equivalent to minimal surgery. Therefore, it is very important to follow the necessary recommendations after the procedure.

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

Effects

Consequences of a prostate biopsy:

Discomfort in the rectum.
This is a fairly common complaint that will go away on its own over time. If the discomfort is rather strong, the doctor may prescribe therapy with non-steroidal anti-inflammatory drugs.
Admixture of blood.
In 74% of cases, after a biopsy of the prostate gland in the urine of men, there is a discharge of blood, 14% - blood comes out of the rectum and 1% is the presence of blood in the semen. If blood is released for 3-5 days, this is normal. It goes away on its own, but if there is a prolonged discharge, it is necessary to consult a urologist. In such cases, bed rest, specialist therapy and plenty of fluids are indicated.
The presence of an infection.
In about 2% of patients, infection of the prostate and genitourinary system is observed. The doctor prescribes a course of antibiotics. Perineal pain, fever, dysuria or polyuria are also observed. If this condition of the patient persists for a long time or worsens over time, hospitalization is necessary.

Retention of urine when urinating

This is a temporary phenomenon that goes away on its own without the intervention of a doctor.

If, after a biopsy of the prostate, blood in the urine or feces is observed for more than 8 hours, if during this time there is no urination, if a high temperature persists for a long time, it is necessary to urgently seek medical help.

Conclusion

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

With an increase in the PSA level in the blood, detection of a tumor with a digital examination of the prostate, a biopsy of the prostate gland is prescribed. During the puncture, small pieces of tissue are taken and sent for histological examination.

A biopsy is an informative and accurate type of diagnosis that helps to determine the nature of the tumor process.

Prostate biopsy - what is it

The definitive diagnosis of prostate cancer is made after a biopsy of the prostate. During the diagnostic procedure, a tissue sample is taken from the patient for analysis. For greater reliability, using a needle, several samples are taken from different parts of the gland, which are subsequently sent for histology.

Clearly distinguishable clinical markers of prostate cancer, as a result of biopsy, help to establish or refute the presence of oncological processes. The advantage of diagnostic research is the ability to simultaneously determine the nature of education and its aggressiveness.

What does a prostate puncture show?

A biopsy is usually prescribed if the results of a clinical blood test for prostate-specific antigen showed a significant excess of the norm. Other diagnostic procedures cannot with a high probability of reliability prove or disprove the presence of oncological processes in the prostate gland.

Biopsy errors in detecting prostate cancer are rare. The reliability of the analysis is at the level of 92-96%.

The biopsy is deciphered by the urologist after receiving the test results. It is not always possible to harvest tissues damaged by oncology during a puncture. There are cases with a false positive result.

If all other diagnostic procedures and clinical studies indicate oncology, a second biopsy is performed, usually no earlier than a month and a half later. It is optimal to withstand a period of 4 months before taking a second tissue sample for histology.

The research results will be ready in 6-8 days. In some cases, you will have to wait up to 14 days. On the histological examination, the conclusion of the urologist is made. The diagnosis can be clarified after consulting an oncologist.

Who is biopsy contraindicated?

The main contraindications to prostate biopsy are associated with general depletion of the patient's body, the presence of infectious inflammatory processes - everything that can prevent the site of tissue sampling from healing quickly and lead to complications.

Obtaining samples for histology is prohibited in the following cases:

Severe condition of the patient.
Blood clotting disorders.
Inflammation of the rectum, especially against the background of developing hemorrhoids.
The presence of acute infectious diseases.

In general, biopsy is a safe diagnostic research method that is highly accurate and informative. The procedure is minimally invasive and does not require hospitalization of the patient.

Prostate biopsy techniques

To obtain samples of the prostate gland, several biopsy techniques are used, differing in the method of conducting, the number of sites from which tissue is collected for analysis. There are several types of tissue harvesting equipment used.

The choice of a diagnostic study method depends on the patient's condition, the required accuracy of the studies, the presence of concomitant diseases that make it impossible to use any of the techniques, as well as the probable complications after puncture.

In order not to get confused in complex medical terms, the most common types of diagnostic procedures can be divided into several classes:

If prostate cancer is suspected, transrectal ultrasound-guided prostate biopsy is the preferred method. The doctor conducts tissue sampling not blindly, but under visual control. The prostate gland is minimally injured.

A comparative assessment of various techniques (reliability / harm to the body) allows us to conclude that the transurethral puncture method remains the best among the existing studies.

The results of the biopsy are influenced by the human factor. During a puncture, the surgeon may not get into the damaged area of the gland and make a sampling of healthy tissue. For this reason, polyfocal and multifocal (extended) prostate biopsies are performed. Each diagnostic method has its own characteristics:

Polyfocal biopsy - performed under the supervision of an ultrasound machine. For research, take up to 12 different samples of the gland.
Saturation biopsy is currently one of the most accurate and informative methods. The tissue is taken from 24 points of the gland. Extended biopsy, unlike other methods, allows you to identify oncology at the initial stages.

By its structure, a biopsy needle resembles a drill (trephine). As it enters the fabric, the drill rotates and cuts out a portion of the fabric. It takes a few milliseconds to take one sample for a trephine biopsy.

Performing a biopsy of the prostate

Before prescribing a biopsy, the attending physician determines whether there are absolute indications for its conduct. Even before the diagnostic procedure, TRUS, clinical, must be prescribed. Only after receiving all the research results and determining that a biopsy is really necessary, the urologist decides on the procedure for the puncture.

Immediately after making a decision, the doctor conducts a conversation with the patient, prepares him for the procedure. At this stage, the type of anesthesia and the method of tissue collection are selected.

How to prepare for a prostate puncture

Preparation for a prostate biopsy is carried out in several stages:

Taking anamnesis - it is up to the attending physician to determine the presence of factors that can cause complications and make it impossible to perform a diagnostic study. Any disorders in blood clotting, the presence of inflammatory processes are direct contraindications to biopsy.
At least a week before the procedure, stop taking any blood thinning drugs. Heparin, Aspirin, Warfarin, Enoxparin are banned.
Prescribing antibacterial prophylaxis - in order to prevent infection, a number of antibiotics are prescribed several days before the biopsy, aimed at suppressing the infectious agent. After the puncture, antibiotic therapy continues for 4-6 days.
Hemostatic drugs are prescribed after the procedure. According to individual indicators, the patient can be prescribed medication 7-10 days before the puncture.
Cleansing enema - performed immediately before the transrectal biopsy. The rectum is cleared of fecal masses that prevent the insertion of the TRUS transducer and the introduction of instruments.
Psychological assistance - before the puncture, the attending physician explains in detail how the manipulations will take place, what the patient will feel and what complications the procedure will face.

There are some guidelines to make the test results more reliable. The patient is advised to refrain from any physical activity before the biopsy, to refuse the morning meal.

Biopsy anesthesia

Modern methods of biopsy are completely painless for the patient. An anesthetic gel is used for transurethral diagnosis. Unpleasant sensations come down to: a slight pain syndrome, in intensity reminiscent of an injection during an injection.

A stronger pain reliever can be used. If necessary, the puncture is performed under general anesthesia. In most cases, a lidocaine gel is prescribed. According to individual indications, injections are prescribed into the neurovascular bundle located near the prostate gland.

How is prostate puncture performed?

Modern diagnostic methods have significantly improved the information content and accuracy of prostate puncture. Tissue sampling began to be performed using a biopsy gun, a method characterized by low trauma and minimization of side effects and complications.

The procedure is performed as follows:

The patient, when performing a biopsy of the prostate gland, is in a supine position, on his back. The legs are bent at the knees.
An automatic prostate biopsy device is inserted into the rectum. First, a TRUS transducer is inserted, after which a gun is inserted to inject the anesthetic and take tissue.
The doctor locates the tissue to be harvested and makes several "shots" with the needle using the biopsy device.
Samples are marked and sent for further histological and cytological examination.

The cost of a biopsy depends a lot on how many samples will be taken for analysis. The patient pays for anesthesia and all tests necessary to determine the appropriateness of the diagnosis. You will have to buy needles for the fence. The total cost, depending on the clinic, will range from 4500-6000 rubles.

The price of an automatic prostate biopsy device is not high enough to make it unaffordable for any clinic or medical center. The use of transurethral diagnostics is the most sparing and most informative method.

Classification of biopsy results

Tissue samples undergo cytological and histological examination. The interpretation of the results is left to the attending physician performing the puncture. After the procedure, it takes from 6 to 14 days to obtain an opinion.

Histological examination of biopsy material may show:

IDU - detection of prostatic intraepithelial neoplasia (precancerous condition) indicates a significant likelihood of developing oncology. A high rate indicates the possibility of detecting cancer with repeated puncture, after six months. A low IDU precedes the oncology of oncology in 3-5 years.
Malignant formation - tissue samples can show the presence of oncological processes. More Gleason studies will be needed to determine the prognosis of therapy and the degree of cancer development.
The biopsy confidence is about 80%. If cancer is detected, additional tests may be needed. After biopsy, repeat puncture to help clarify the diagnosis.
Benign education - in this case, drug therapy is recommended. There is no need for repeated sampling and examination of a biopsy, except in cases when other tests and the patient's well-being showed a deterioration in the functioning of the gland (an increase in PSA, the appearance of hematuria, etc.).

The timing of biopsy readiness for cancer is influenced by the number of samples collected for analysis, the need for cytology and histology at the same time. As a rule, the results come to the attending physician in 1-2 weeks.

To reduce the time of the diagnostic study of the results of the biopsy, there is no sequence of examinations for cytology and histology. In the laboratory, tissue sections are made and sent for examination at the same time.

For taking a second biopsy, at least 4-6 months must pass. During this period, the tissues heal completely and the likelihood of complications after the procedure, due to trauma to the gland, can be minimized. In exceptional cases, it is allowed to take a biopsy 45 days after the first diagnostic procedure.

Consequences and complications after prostate puncture

There is no ideal diagnostic method that can determine the presence of cancer. There is a likelihood of complications after a puncture of the gland. Before agreeing to the procedure, each patient is informed about the possible side effects of the biopsy:

Sepsis - an infection is indicated by a temperature after a biopsy that lasts more than 2 days, accompanied by chills or fever. The likelihood of inflammatory and infectious complications is quite high, therefore, before the appointment of a puncture, antibacterial prophylaxis is mandatory.
Urinary problems - Potential complications are associated with swelling of the injured prostate tissue. With severe edema, urinary retention is observed. The symptom is temporary and usually resolves on its own.
Hematuria and hemospermia - blood in the urine appears due to slight bleeding from trauma to the tissues of the gland. The symptom does not pose a threat if it passes within 1-2 days. If hematuria lasts longer than this period, you should inform your doctor.
The blood in the semen should also alert. Sex after a biopsy of the prostate is possible only after 7-10 days. Hemospermia indicates internal bleeding that has not stopped.
Intensive development of oncology - theoretically, damaged cancer cells are actively regenerating and growing. But biopsy is a gentle method. The risk of developing oncology due to the taken puncture is so insignificant that the procedure is recommended for all patients with suspected cancer.