Have you also been asked to undergo an MRI Prostate Biopsy? (MRI-Guided Prostate Biopsy) Let's learn about this simply!

Has your doctor suspected a problem with your prostate gland and told you that you need to have a biopsy (a small piece of tissue taken and examined using an MRI scan) to find out for sure? It's normal to feel a little scared and nervous when you hear something like this. But when you know exactly what this test is, how it's done, and how to prepare for it, your fear will go away. Let's talk about this simply.

First, let's see, what is this MRI-guided prostate biopsy?

Simply put, this is a special test to detect prostate cancer, if so, to find out what stage it is, and to plan treatment. This involves taking very small tissue samples from your prostate using MRI and ultrasound technology, which provide very clear images . A pathologist then examines these tissue samples under a microscope to determine whether or not they contain cancer cells.

What is the prostate gland?

Your prostate is part of your male reproductive and urinary system. It's a walnut-sized gland located in front of your bladder. It makes seminal fluid, which is the fluid that mixes with sperm when you ejaculate. This fluid helps keep sperm healthy and helps you conceive.

Your urethra runs through the prostate gland. When you urinate, urine from the bladder comes out through the penis, and when you ejaculate, semen comes out through this tube.

What are the methods for performing this biopsy?

There are two main methods for obtaining tissue samples from the prostate. Your doctor will explain to you which method is best for your situation.

Let's learn about some more advanced technologies.

Nowadays, advanced technologies are used to make this test more accurate.

• Multiparametric MRI (mpMRI): This is a more sensitive and advanced MRI method than a standard MRI. It can detect cancerous changes in the prostate gland much more clearly than a standard MRI. However, mpMRI alone cannot be 100% certain that there is no cancer. Therefore, a biopsy is often necessary.
• Fusion-guided prostate biopsy: This is a very interesting technique. It involves "fusing" MRI images and ultrasound (TRUS - Transrectal Ultrasound) images together to create a single image. You first have an MRI. Then, during the biopsy, the doctor uses special software to combine the MRI images and the ultrasound images taken at the same time. This allows the doctor to precisely target suspicious areas of the prostate and take tissue samples.

Why is it necessary to conduct such a test?

Doctors can confirm several things through this test.

• Accurately diagnose whether or not you have prostate cancer .
• If there is cancer, determine its grade/aggressiveness .
• Check to see if the cancer has recurred after being treated previously.
• Sometimes, other conditions that are similar to cancer symptoms but are not cancer (e.g., enlarged glands, infections) can be identified and ruled out as cancer.

Who usually needs this test?

There are several situations in which your doctor may refer you for this test.

• If the PSA (Prostate-Specific Antigen) level in your blood is higher than normal.
• If the doctor finds a lump or an unusually hard area in the prostate gland during a digital rectal exam (DRE).
• If a previous MRI scan showed anything suspicious .
• If your PSA level continues to rise even though a biopsy performed with a regular ultrasound does not find cancer.
• If you have already been diagnosed with prostate cancer and are under active surveillance without treatment.

How should you prepare before the test?

This is very important. You need to follow the doctor's instructions exactly. Usually, this is what they tell you to do.

What happens during the test?

You will first need to have an MRI scan. You may be given a special liquid (contrast dye) through a vein in your arm to get clearer images.

The biopsy is usually done on an outpatient basis. This means you can go home the same day. A local anesthetic is injected into the area around the prostate gland. This will help you feel less pain. You may also be given a mild sedative to help you relax. So, it's a good idea to have someone drive you home in case something goes wrong.

The doctor usually takes about 12 to 16 tissue samples from different parts of the prostate. You may feel a slight pressure at this time, but you should not feel any significant pain.

What to expect after the test?

You can go home a few hours after the test. These things are normal for the next few days.

• There may be some bleeding and mild pain at the biopsy site.
• You may have a little blood in your urine (hematuria) or semen (hematospermia) for a few days. This is normal, don't worry.
• You need to take the antibiotics prescribed by the doctor as prescribed .

How long does it take to know the results?

The tissue sample taken from you will be sent to a lab. It usually takes about a week , sometimes a little longer, to get the results.

There can be three main types of results:

• Negative: No cancer cells were found. However, very rarely, there can be false-negatives, where the test misses cancer even though it is present. If your PSA level is still high, your doctor may ask you to get tested again in a few months.
• Positive: Cancer cells have been found. This means there is prostate cancer. The doctor will talk to you about next steps, treatment options, or monitoring.
• Suspicious: The results are abnormal, but it is not certain whether cancer is present or not. At this point, further testing or a repeat biopsy in a few months may be recommended.

How is the severity of cancer measured?

If cancer cells are found in the test, the pathologist will give the cells a grade from 1 to 5 based on their appearance. Then, the two most common grades are added together to give a value called the Gleason score (this can range from 6 to 10). Cancers with a high Gleason score (e.g., 8, 9, 10) are more likely to spread (metastasize) than cancers with a low score (e.g., 6). This score can help your doctor choose the best treatment for you.

When you should see a doctor

If you develop signs of infection, such as fever and chills , after the biopsy, you should call your doctor immediately.

Also, if the following symptoms persist or worsen, be sure to seek medical advice.

• Presence of blood in the urine or semen.
• Erectile dysfunction.
• Frequent need to urinate at night (nocturia).
• Pain during urination or ejaculation.
• Difficulty controlling urination, weak or interrupted urine stream.

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