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November 27, 2012

Side effects of having a prostate biopsy

We have been discussing the diagnosis of prostate cancer using transrectal ultrasound (TRUS) guided prostate biopsy. Last time, I explained what the procedure involved. This week, I will look at the side effects of having the procedure done.{{more}}

As we said last week, a biopsy or sample test is done to see if you really have prostate cancer. Normally, we do not start treatment until after we have done a biopsy.

Obviously, there are side effects of having a biopsy. The most common is the immediate effect of the biopsy at the time of having it, namely, pain. Most people imagine that if you are having a sample test that involves a needle that you will have pain, but strangely enough, most men do not complain of pain; however, most say they have some discomfort. This is because we numb the inside of the rectum and the prostate itself, so the only thing the man feels is the discomfort of having the instrument in his rectum. They might also experience this discomfort after the procedure, as soreness, similar to having passed a hard stool after constipation. Usually, all that is needed is one dose of a simple analgesic like Paracetamol or Advil.

Generally, all patients will notice a trace of blood on the first stool they pass after the procedure. This can be considered normal, just like noticing blood on the sponge that is used to stop bleeding after venipuncture. It is self-limiting, i.e. it will stop on its own. Rarely, it occurs after the first stool or occurs heavily at the time of the sample. These are patients who are either on low dose aspirin or another anticoagulant (blood thinner) or may have piles, usually the undiagnosed, internal type. In my 17 years of doing biopsies, I have only had to admit one patient in the hospital overnight because of bleeding from the rectum!

Even less common is blood in the urine, this occurs when you bruise the inside of the bladder on doing the sample. This tends to happen in men with a very small prostate so the needle passes straight through the prostate and “touches” the bladder. Again, it will stop on its own. Sometimes, if the prostate gets infected, then the patient may notice blood in the urine, but not a bright red colour, instead a coke or coffee brown colour. This is usually accompanied by some burning in the urine. This side effect is called a prostatitis and is more likely to occur in patients who are diabetic or who had infection in their prostates before the sample test, or who were on long courses of antibiotics or who had a lot of samples. Some men also complain that after the sample test, they notice that the urine stream slows down for a few days. This is not uncommon and happens because the prostate swells a little. It is more likely to occur in men who already have swollen prostates; in other words the prostate swells a little more. Simple medication given before the procedure will relieve this (most men with swollen prostates are already taking them anyway). Rarely, one of these men will go into a state of “stoppage of the water”. As I said, this is rare. So men do not need to use the possible side effects to avoid having a sample test, as most men will never experience a side effect. If stoppage occurs this can be relieved and treated easily.

The two least common side effects are the two most frightening. The first is blood in the semen. For men who are still sexually active (usually in their 40s to 60s), this may occur if sexual activity takes place within two weeks of the sample test. Fortunately, most men are older and “slowing down” and the others are too worried about the results to indulge in sexual activity before the two weeks (by which time the results will be back). Most of this blood will clear on its own as it is usually due to a small amount of bleeding which occurs at the time of the sample test. Sometimes, like the blood in the urine, it can be due to an infection in the prostate and antibiotics will clear this. All the above side effects settle on their own and are not life threatening. Next week, we will discuss an ever rarer side effect of prostate sampling that may be life-threatening if not detected and treated early.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785
email: deshong@vincysurf.com