A DRE is a simple procedure that Dr. Alarcon may use to aid in the early detection of prostate abnormalities, benign prostatic hypertrophy (BPH), prostatitis and/or prostate cancer. Dr. Alarcon may perform a DRE as part of a routine physical examination, as a follow-up for a PSA test, or if a man is experiencing prostate symptoms. For most men, undergoing a DRE involves a little discomfort and perhaps some embarrassment. If the prostate is inflamed or irritated the examination can be just a little more painful. In either case, the whole procedure is over in just a few seconds.
Performing the DRE will require that you remove any clothing below the waist, and wear a gown. Dr. Alarcon will insert a gloved, lubricated finger into the rectum and press on your prostate to feel for any abnormalities.
If your DRE (together with your PSA) indicates an abnormality in your prostate, then Dr. Alarcon may recommend more tests including a transrectal ultrasound, a prostate biopsy and possible an MRI.
Ultrasound is a technique in which sound waves are used to make images of the organs and structures in the pelvic area (see the image to the right). In men, this includes the prostate gland, bladder, and seminal vesicles. A transrectal ultrasound is the most common test used to examine the male pelvic organs. An instrument called a transducer is shaped to fit into the rectum, where it sends reflected sound waves to a computer. In some cases, a biopsy of the prostate is done during a transrectal ultrasound. The images obtained during the transrectal ultrasound give Dr. Alarcon an idea of the size of your prostate as well as any potential abnormalities. The procedure is performed at Dr. Alarcon’s office. It typically only takes just a few minutes and is not painful.
How Is A Prostate Biopsy Performed?
To perform a prostate biopsy, a thin needle is inserted into the prostate to collect tissues samples from specific areas. These tissue samples are then examined for cancer cells or other potential abnormalities. The most common biopsy method is called a transrectal biopsy in which the biopsy needles are passed through the rectum. During the procedure Dr. Alarcon will typically use a transrectal ultrasound (TRUS) to help guide the needle to the correct biopsy location. The prostate biopsy is usually spring-loaded and quickly enters the prostate gland to remove the tissue sample. Between 6 and 12 samples are usually taken from different areas of the prostate. Before your prostate biopsy, you may be given antibiotics to help prevent infection. Most likely you will be asked to take off all of your clothes and put on a gown. A transrectal biopsy takes about 30 minutes.
Prostate Biopsy Risks?
A prostate biopsy has a slight risk of causing problems such as
- Infection. This is more common in men who have undiagnosed prostatitis. Usually, taking antibiotic medication before the biopsy prevents an infection from developing.
- Bleeding into the urethra or bladder. This can cause a blood blister (hematoma), an inability to urinate, or a need to urinate often.
- Bleeding from the rectum. If you have a transrectal biopsy, you may experience a small amount of bleeding from your rectum for 2 to 3 days after the biopsy.
- An allergic reaction to the anesthetic medications used during the biopsy.
A prostate biopsy is a medical procedure in which small samples of tissue are removed from a man’s prostate gland to test for the possibility of prostate cancer or other prostate disorders. A prostate biopsy is typically performed when a man’s prostate-specific antigen (PSA) blood test shows a level of PSA associated with the possible presence of prostate cancer or after a digital rectal examination (DRE) finds an abnormal prostate or a lump on the prostate.
What is a DRE?
A Digital (finger) Rectal Examination may be performed as part of a regular examination or to check on symptoms involving the prostate. During a digital examination, Dr. Alarcon will insert a lubricated, gloved finger into the rectum to check for growth or enlargement of the prostate gland. A tumor in the prostate can often be felt as a hard lump. However, not all problems of the prostate can be felt through the rectum. Likewise, only one side of the prostate can be accessed from the rectum.
Where is a Prostate Biopsy Performed?
Prostate biopsies are usually classified as an outpatient procedure, and are typically performed in Dr. Alarcon’s office. However, the biopsy may also take place in a day surgery clinic, or a hospital operating room.
How is the Prostate Tissue Tested?
After Dr. Alarcon has taken biopsy samples of your prostate tissue, he sends them to a pathology lab. The pathologist looks at the samples under a microscope and grades the tissue on a scale of 1 to 5. Results are usually available within 10 days.
How Does A Prostate Biopsy Feel?
You may feel a slight sting when you receive an injection of medicine to numb your skin. There is typically a slight dull pressure as the biopsy needle is inserted. For a transrectal biopsy, you may feel pressure in the rectum while the ultrasound probe or guiding finger is in place. You also may feel a brief, sharp stick as the biopsy needle is inserted into the prostate gland. Usually several biopsy samples are collected. However, the overall level of pain is fairly minor and most patients report no ongoing pain. About 85% of men who undergo prostate biopsy experienced low level of pain. Dr. Alarcon will typically provide lidocaine gel (for pain) before the biopsy and can also provide light sedation if necessary.
Note: A prostate gland biopsy does not typically cause any long term problems with erections and will not make a man infertile.
An MRI is a noninvasive imaging technique that uses a magnetic field, radio waves, and a computer to produce very clear pictures of internal structures without the use of x-rays (see below). Images from an MRI can provide physicians with information that may not be visualized adequately using ultrasound. The main reason Dr. Alarcon may request an MRI is to evaluate the prostate after a prostate biopsy. The MRI can help to evaluate the prostate and nearby lymph nodes to distinguish between benign and malignant areas. An MRI of the prostate is also sometimes used to evaluate prostatitis or BPH.
An MRI is a painless procedure and typically takes about 45 to 60 minutes, not including preparation time. Most MRI machines are located at a hospital. The procedure requires patients to lie down and be slid into a tube. Men who know they are claustrophobic can request a sedative before the procedure. Some facilities have open MRI machines that are much less confining.
What is PSA?
PSA is a protein that is produced by prostate gland cells. Its normal for PSA to be found in small quantities for men with a healthy prostate. Likewise, its common for PSA levels to increase as a man’s prostate enlarges as he gets older. However, because PSA levels can also increase from inflammation (prostatitis) or from prostate cancer, its important to have Dr. Alarcon perform a prostate exam and a prostate biopsy if the PSA is elevated to levels associated with prostate
cancer or other prostate disorders.