Prostate Biopsy

Some doctors opine that Prostate Cancer begins with a condition called 'prostatic intraepithelial neoplasia' (PIN). Almost 50% of men have PIN by the time they reach the age of 50 years. There occur changes in the microscopic appearance of the prostate gland cells in this condition. These changes can be either normal or abnormal. If a person had an abnormal high-grade PIN, then there is 30 to 50 % of cancer. Men diagnosed with such high-grade PIN are asked to undergo repeated prostate Biopsies. Other reasons for prostate biopsy are:

• An elevated PSA level in a blood test.
  
• Significant change in the standard PSA level over time.
  
• Standard PSA level but a low free/total PSA ratio as indicated by the PSA II test.
  
• Suspicious feeling prostate on digital rectal examination.

Normally for a prostate biopsy, the tissue is taken using a fine needle from ten or more places in the prostate. Nowadays, specialists recommend the biopsies of the prostate to be carried out only under ultrasound guidance. Several samples from the prostate are taken using a method called 'sextant biopsy'. Biopsies are taken using 'Trans-Rectal Ultrasound' (TRUS) to guide the precise placement of the biopsy needle. The patient is administered an enema prior to carrying out the biopsy. There is no need for anesthesia but an antibiotic is given in order to prevent possible infection. The biopsy specimens ('cores') are sent to a pathologist for evaluation.

Enlarged Prostate

Prostate gland enlargement is common in men as they grow older. For men above 50, the most common prostate problem is prostate enlargement. 50% of men by age 60 suffer from this problem and over 90% of men suffer from this problem when they are 80 plus. Enlarged prostate is also known as prostatic hypertrophy, benign prostatic Hyperplasia or prostate gland enlargement.

Enlarged prostate is a benign enlargement and is non- cancerous. This condition often induces urinary problems. If left untreated, the problem can block the flow of urine out of the bladder and cause urinary infection, kidney and bladder problems. The prostate gland is located beneath the bladder; this tube passes through the center of the prostate and transports urine from and out of the penis. Therefore when the prostate is enlarged, it obstructs the flow of urine. With time, the bladder muscles thicken severely and become over sensitive thus forcing the person to urinate frequently as the bladder can't hold even small amount of urine.

Symptoms of prostate gland enlargement

• Increased frequency of urination at night.
  
• Unable to empty the bladder completely
  
• Urinary tract infection
  
• Reduced kidney function
  
• Frequent or urgent need to urinate
  
• Weak urine stream
  
• Strain to urinate
  
• Bladder stone
  
• Difficult to start, stop and restart urination.

Diagnosis includes:

Physical examination and understanding the patient's medical history.
Rectal examination to identify if the prostate is enlarged.
Urine tests.
Urine flow test.
PSA (Prostate Specific Antigen) test in blood.
Trans rectal ultrasound to measure prostate.
Neurological examination to identify reasons other than prostate enlargement for urinary incontinence etc.
Post void residual volume test, to identify if the patient can empty the bladder completely.
Prostate biopsy.
CT urogram to identify blocks in urinary bladder.
Cystoscopy to check bladder and urethra.