What should I expect after a prostate biopsy checking for prostate cancer because of an elevated PSA?
There will blood places and that is normal. Blood at the tip of your penis, blood when you urinate, blood with bowel movements, and blood in your semen if you are sexually active. Blood is expected and rarely a problem and almost always limited in duration. As a rule, don’t worry about the blood. Urology tip: blood at the beginning of the urinary stream and then clears as you void is prostate in origin a rarely associated with complications or difficulty voiding because of clots. Spotting of blood on your underwear or pajamas in the morning when you awake is expected.
If you have trouble voiding to the point that you are uncomfortable, that is something to be concerned about. If you get really full and uncomfortable you need to make your way to an Emergency Room. This usually means you had some underlying early prostate enlargement that has been exacerbated by the biopsy. This is usually a simple matter of placing a foley catheter, starting a med that helps the prostate open and allow the bladder to empty. If a catheter is necessary it is needed for only a few days.
If you develop a fever, now that is a problem. A prostate biopsy is obtained by the needle going through the rectal mucosa and into the prostate. This is associated with about a 3% chance of infection. Difficulty urinating, fever, burning to void, chills are a tip-off and this is a urologic emergency usually requiring I.V. antibiotics depending on the degree of your fever. Chills and fever usually mean there is bacteremia and this is something to call your doctor about or go to the Emergency Room.
About 17% of all biopsies result in the diagnosis of cancer. It is my opinion that a second opinion to review the path report is unnecessary as the diagnosis of prostate cancer is “bread and butter” for the average pathologist and missed diagnosis is rare. There is however an opinion difference between a particular Pathologist and another regarding whether the Gleason’s grade is a 6 or 7, as grading is somewhat subjective.
There is no evidence that biopsies “seed” the tract of the needle with cancer.
There is no evidence that the needle lets “air get to it” and allow for the spread of cancer.
You have to have a biopsy of the prostate to know if you have cancer or not. Once you get the results you and your doctor can gauge the aggressiveness of it by the Gleason’s and volume of disease i.e. how many cores are positive and have cancer in them. Armed with this information you then can make “informed ” decisions about what to do, if anything.
If you had your biopsy done because of an elevated PSA, then if your biopsy is negative (no cancer) then that level of PSA even if elevated becomes your “baseline” and another biopsy is not necessary unless your PSA goes up or your rectal exam changes.