What to Expect After a Prostate Biopsy
Prostate Gland Problems
A History of Prostate Gland Problems
Since January of 1999, I have been afflicted with prostate gland problems. After a routine blood test ordered by a family doctor indicated an elevated prostate-specific antigen (PSA) reading, I started seeing urologists in 1999. While under their care, I had a first prostate biopsy performed in Maryland in July of 2000 and a second in Thailand in December of 2003. Following a diagnosis of an enlarged prostate or BPH, I have been advised since the first biopsy to have regular PSA testing and if necessary, additional biopsies.
The prostate-specific antigen (PSA) is a protein produced by normal as well as malignant cells of the prostate gland. A normal PSA reading is 4.0 or lower. If the reading is above 4, there is an indication that the prostate has malignant cells.
After the second prostate biopsy, I had few PSA tests until May of 2015. Since 2015, however, my urologist in Thailand has prescribed a drug for me to take to shrink the prostate. Its growth and condition have been monitored through semi-annual ultrasounds and PSA readings.
In this article, after first stating the function of the male prostate gland and describing BPH, I discuss the need for biopsies. Then, based on personal experiences, I relate what to expect after a prostate biopsy.
The Prostate Gland and Its Function
According to urologyhealth.org, the prostate gland belongs to the male reproductive system. Being the size of a walnut, it weighs approximately one ounce. The prostate is found below the bladder and in front of the rectum. You will also find the prostate going completely around the urethra which carries urine from the bladder out through the penis.
The primary function of the prostate is to make fluid for semen. At the time of ejaculation, sperm made in the testicles moves to the urethra. Concurrently, fluid from the prostate and seminal vesicles also moves into the urethra. This semen mixture passes through the urethra and out of the penis at the time of orgasm.
What Is Benign Prostatic Hyperplasia (BPH)?
In January of 1999, a urologist in Maryland diagnosed me having BPH or Benign Prostatic Hyperplasia. This diagnosis was based on a digital rectal exam and the results of a prostate biopsy.
Based on an article in urologyhealth.org, BPH is an enlarged prostate. As men age, BPH often happens during the second growth state of the prostate which starts at about age 25. The first growth stage occurs early in puberty.
As the prostate gets bigger, it can squeeze down on the urethra. This narrowing of the urethra and accompanying urinary retention cause many of the problems related to BPH. Although BPH is benign, BPH and cancer can occur at the same time. About 50 percent of all men in their 50s have BPH. Over the age of 80, up to 90 percent of men suffer from BPH.
What Is a Prostate Biopsy and Why Is It Necessary?
According to an article from the Mayo Clinic, prostate biopsy tissue samples are usually collected by transrectal or transperineal means.
A transrectal biopsy is the most common way. In this procedure, a needle is passed through the wall of the rectum.
In a transperineal biopsy, a needle is inserted through the skin between the anus and the scrotum. After a small cut is made in the skin area between the anus and scrotum, a biopsy needle is inserted through the cut and into the prostate to get out a sample of tissue. An MRI or CT scan is usually used to guide this procedure.
Urologists generally advise a prostate biopsy when PSA readings over a length of time are high (above 4) and/or a digital rectal exam and ultrasound indicate abnormalities on the prostate. According to doctors, this is the only definite way to diagnose prostate cancer.
What to Expect During Transrectal Prostate Biopsy
In July of 2000, I underwent my first prostate biopsy. It was a transrectal biopsy conducted at my urologist's clinic in Maryland.
Prior to the biopsy, it was necessary to give myself an enema so that my rectum was clean during the procedure. There were no other preparations in that I had to fast or discontinue taking certain medications.
After arriving at the clinic around mid-afternoon, I remember pulling down my pants and leaning over a high table. Following the cleaning of the anal area and application of gel, the urologist gently inserted a thin ultrasound probe into my rectum.
According to the Mayo Clinic, transrectal ultrasonography uses sound waves to produce images of the prostate. These images are used to identify the area that needs to be numbed with an injection to reduce biopsy discomfort. The ultrasound images are also used to guide the prostate needle into place.
After the biopsy device is situated, the doctor retrieves thin sections of tissue with a spring-propelled needle. I noticed sensations each time the urologist took tissue from three or four places in my prostate. The whole biopsy procedure didn't take more than 10-15 minutes.
What to Expect After Transrectal Prostate Biopsy
I remember having no physical limitations after undergoing the biopsy.
While taking an antibiotic for a few days, I noticed the following.
- Blood in my urine for a few days
- A rust-colored tint of my semen
The rust-colored tint was caused by a little amount of blood in the semen. This condition lasted for about a month.
Some people feel slight soreness and have a little bleeding from the rectum. A few persons may have a fever, difficulty urinating, prolonged or heavy bleeding, and worsening pain. If this is the case, they should immediately see their doctor.
Fortunately, the pathology results indicated that I did not have prostate cancer.
What to Expect After Transperineal Prostate Biopsy
In December of 2003, I had a transperineal prostate biopsy at an international hospital in Bangkok, Thailand. The biopsy was ordered by a Thai doctor who had received urology training in England. Because my PSA readings had been consistently high since July of 2000, Dr. Viroj decided to take tissue samples from 15-20 places around my prostate.
During the biopsy procedure, I was knocked out with anesthesia for about 90 minutes. When I came to in the ICU of the hospital, I could not be discharged until after passing urine. When I finally passed urine, it was in spurts and there were blood clots in it. Like a fool, I made the mistake of signing the discharge papers and leaving the hospital with a friend who drove me home.
After returning to my apartment at around 8:30 p.m., the horror story begins. I started to have extreme difficulty passing urine and most of it was clotted blood. Upon returning to the emergency room of the hospital where I had the biopsy, I was seen by a doctor, given medicine, and sent back home.
About an hour and a half later after being back in my apartment, I was in terrible pain because I could not urinate. When I returned to the emergency room, a catheter was inserted into my urethra and I was sent back home.
The catheter did not do much good because I noticed big clots of blood which could not pass through the tube. Since I was in agony not being able to empty my bladder, I returned to the emergency room for a third time at around 4:00 a.m. At this time, my urologist, Dr. Viroj, was notified. I remember staying in the emergency room until around 7:00 when the doctor arrived and I was finally admitted to the hospital.
Upon seeing Dr. Viroj, I learned that the biopsy had brought on excessive bleeding which happens in only seven percent of patients. While in the hospital for two days and two nights, I was given medication intravenously to the stop the bleeding and antibiotics for an infection. In the hospital, I also had occasional great pain trying to empty my bladder until the medication started to work. To me, this experience was worse than death.
The catheter was removed on the morning of the day I was discharged from the hospital. I had no further complications after leaving. As for the good news, the results of the biopsy indicated that I did not have prostate cancer.
Dealing With BPH Since 2003
Based on the experience of 2003, I will never again have a prostate biopsy. Since having my left cancerous kidney removed in April of 2015, the condition of my prostate has been monitored by more PSA tests and semi-annual prostate sonograms. My new urologist has me on the drug Avodart to help shrink the prostate and another, Harnal, which makes it easier for me to urinate during the night.
© 2017 Paul Richard Kuehn