Prostate cancer is the most common cancer in men, affecting one in three American men during their life time. By the age of 50, many men start to get screened, usually undergoing a PSA test. During this screening, if it seems that an individual has even the slight possibility of cancer, it is a common medical practice to recommend a biopsy, to confirm whether or not cancer is present.
However, mounting evidence has suggested that this increasingly routine practice actually has a number of dangerous and unpleasant side effects.
This article will discuss the safety of undergoing a prostate biopsy and the 5 side effects that could affect your quality of life.
Types of Prostate Biopsy
A prostate biopsy may be done in several different ways:
- Transrectal method. This is done through the rectum and is the most common.
- Perineal method. This is done through the skin between the scrotum and the rectum.
- Transurethral method. This is done through the urethra using a cystoscope (a flexible tube and viewing device).
Although one of the most common procedures for detecting prostate cancer, biopsies carry many potential risks and side effects:
Just like any invasive procedure, bleeding will occur. Although it’s normal to see a small amount of blood in your semen or urine for about 2 weeks, it becomes a major problem if bleeding takes a longer time or if it gets worse.
One study reviewed the safety of the transrectal ultrasound guided needle biopsy and found that 58 patients (63%) experienced haematuria and experienced rectal bleeding 23 patients (25%). Severe rectal bleeding is an uncommon complication yet in some instances can be life-threatening, so both patients and practitioners should be aware of the risks.
After the biopsy it is highly common for patients to experience discomfort and pain. This usually only lasts for a few days after the procedure, but the degree of pain will vary for each individual. While some may find it very painful, other people only report a slight discomfort. This is because of the injury caused by the needle on your prostate cells.
A prospective cohort study measured the short-term outcomes of men undergoing a prostate biopsy. The participants were asked to complete a questionnaire, measuring the frequency and effect of symptoms related to pain, infection and bleeding.
The results found that pain was reported by 429/984 (43.6%), fever by 172/985 (17.5%), haematuria (blood in urine) by 642/976 (65.8%), hematochezia (anual bleeding) by 356/967 (36.8%), and haemoejaculate (the presence of blood in a man’s ejaculate) by 605/653 (92.6%) men during the 35 days after biopsy. Although the researchers concluded that prostate biopsy is well tolerated by most men, it is associated with significant symptoms in a minority and affects attitudes to repeat biopsy.
Pain is a very important symptom to monitor. Worsening and persistent pain may indicate a bigger problem. If this is the case, you need to see your doctor for a follow-up.
A further risk of having a prostate biopsy is infection. Surgeons will normally prescribe strong antibiotics before the procedure to reduce the risk of infection. However, infection almost always occurs, and research indicates that resistance to antibiotics is increasing the likelihood. In some cases, the result of the infection is that there is long-term sexual dysfunction.
Occasionally, the infections can turn into life-threatening sepsis. This is as needles used to detect cancer are passed through the rectum. As a result, if the needles transport bacteria from the bowel into the prostate, bladder and the bloodstream, infection can occur.
A study by John Hopkins researchers, published in The Journal of Urology, found that men hospitalized as a result of a biopsy-related infection had a 12-fold greater chance of dying than those who did not undergo a biopsy.
4) Acute Urine Retention
About 1 in 50 men who have undergone prostate biopsy experience acute urine retention. The procedure does injure the prostate gland, causing it to swell. And this makes it hard for you to pass urine.
If the prostate is particularly enlarged (>50mL) or the man has pre‐existing risk factors, e.g. a poor flow, a high residual volume or previous urinary retention, then the risks of biopsy‐induced urinary retention are significant. Acute urine retention is a medical emergency, and you need to seek help at once. The doctor often inserts a catheter to drain the retained urine, and it will take a few days for you to recover.
5) Sexual Problems
Several studies have found that men develop Erectile Dysfunction after having a prostate biopsy. In 2015, BJUI International published a study involving 220 men who underwent transrectal prostate biopsy.
Overall the researchers reported an increased risk of temporary ED after biopsy of approximately 5%. While this happens rarely and should improve over time, the study concluded that the effects of TRUS‐guided prostate biopsy on ED have probably been underestimated.
It is important to be aware of these transient effects so patients can be appropriately counselled. If sexual problems persist, you should consult your doctor so that the problem can be assessed further.
Are Prostate Biopsies Safe?
One of the main issues with prostate cancer screening tests, such as the PSA test, is that they can lead to misdiagnosis and as result, overtreatment. Many men who are recommended a biopsy may not in actual fact require it. Even if you take many samples, biopsies can still sometimes miss a cancer. This occurs if none of the biopsy needles pass through the rights areas. Thus, the biopsy will have a false-negative result. In fact, one study found that biopsies detected only 67.8% of prostate cancers.
Prior to having a biopsy, do your research. Do not blindly agree to a procedure without being aware of the possible life changing side effects it could have. There are alternatives to a prostate biopsy, like MRI and the PCA3 test. These methods are non-invasive and accurate. Plus, they don’t have the negative side effects that result from a prostate biopsy.
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