Prostate Cancer Screening, Part 2: What Happens After My Screening?

Following your prostate screening, it’s important to know what comes next. Our team at CIVCO is dedicated to providing you with the guidance you need. 
 
After your doctor has analyzed the PSA test and DRE from your prostate screening, you’ll receive one of two results: normal or abnormal. Let’s walk through what happens for each.

Prostate Cancer Screening: Your Results: 

Normal Result

If your PSA levels are normal and your provider doesn’t find any irregularities during the DRE, you’re good to go! Though you should continue to monitor your prostate health and have regular conversations with your doctor, you don’t need to take any immediate next steps. ¹

Abnormal Result

If your blood PSA levels are elevated, you might feel some anxiety about what comes next. Keep in mind, though, that only about 25% of people with elevated blood PSA levels are found to have prostate cancer via a biopsy. ²
 
After an abnormal screening result, there are a few paths your doctor might take:

1. Suggest additional screening. To ensure that the first PSA test was accurate, your doctor might order another one — or continue to monitor your health with blood tests and DREs. (This approach is sometimes referred to as “observation” or “watchful waiting.”) ²
2. Order advanced imaging tests. Another tool that can help your doctor get to the root of the problem is an imaging test like an MRI or ultrasound. ³
3. Recommend a prostate biopsy. A biopsy is often the quickest way to diagnose prostate cancer. In the next section, we’ll walk you through the two main types of prostate biopsies: transrectal and transperineal.

How To Prepare for a Prostate Biopsy

During a prostate biopsy, your provider will insert a small, hollow needle into your prostate and remove samples of cells to be examined for signs of cancer. ⁴
 
Though a prostate biopsy might sound daunting, it’s a very common procedure: According to the NCBI, about one million prostate biopsies are performed each year in the United States alone. ⁵ We’re here to help you understand the two options and, in discussion with your doctor, choose the one that’s right for you.

Transrectal Biopsy 

Traditionally, doctors have used the transrectal approach, in which your provider passes a thin needle through the rectal wall to obtain samples of tissue. ⁶ Here’s a look at the main pros and cons of the transrectal path.

• PRO: Accessibility and convenience. A transrectal biopsy can be performed on an outpatient basis, with a relatively quick recovery time for patients. 

• PRO: Rapid results. Usually, transrectal biopsy samples are processed quickly, allowing you to start any necessary treatment faster.

• CON: Likelihood of infection. Because these biopsies pass through the rectal wall, they can introduce fecal matter into your bloodstream, potentially leading to infection by antibiotic-resistant bacteria. ⁷

Transperineal Biopsy

The transperineal approach is becoming increasingly popular for biopsies. 
Using this technique, your physician doesn’t have to puncture the rectal wall, instead passing the needle through the perineum, which offers a number of crucial advantages. ⁷

• PRO: Increased safety. The risk of sepsis following a transperineal biopsy is approximately 5x lower than its transrectal counterpart. ⁶ The rate of sepsis after a transperineal biopsy is nearly 0%. ⁷

• PRO: Minimized rectal bleeding. Because the needle doesn’t pass through the rectal wall, transperineal biopsies rarely result in rectal bleeding. ⁸

• PRO: Equal — or greater — effectiveness. A transperineal approach allows your doctor to target certain hard-to-reach areas in the prostate, which can improve the effectiveness of the procedure. ⁹

For all of these reasons, transperineal biopsies offer significant clinical benefits to patients.

Questions To Ask Your Doctor

Before you head in for your prostate biopsy, it’s never a bad idea to jot down a few questions to ask your healthcare team. Our team at CIVCO has gathered a few below that might be beneficial for you to ask, both before and after your biopsy.

Before Your Biopsy

• What should I expect from my biopsy?
• Are there any steps we can take to reduce the risk of infection?
• Which biopsy method do you recommend and why?
• How accurate are biopsy results?

After You Receive Your Biopsy Results

• What steps should I take now that I have my results?
• If my results are negative but my PSA levels are still high, what should I do?
• Can I get a second opinion on my results?
• If I have prostate cancer, what stage is it? 
• Do I need treatment right away?

Key Takeaways from CIVCO

If you’ve stuck with us to this point, you’re already a budding expert on the topic of prostate cancer screening — but a quick review couldn’t hurt! Before you go, here are the key points to bring with you:

• After a prostate screening, you may need an advanced imaging test or prostate biopsy to help with diagnosis
• During your prostate biopsy, your provider will insert a small, hollow needle into your prostate and remove samples of cells to be examined for signs of cancer
• The transperineal biopsy is associated with a signficantly lower risk of infectious complications, including a risk of sepsis that is approximately 5x lower than its transrectal counterpart ⁶ (in fact, the rate of sepsis after a transperineal biopsy is nearly 0%). ⁷

Now that you know what to expect from your prostate cancer screening — and have some great questions to run by your physician — we hope you’re feeling ready to take the next step.

Introducing TP Pivot Pro: 

When preparing for your prostate cancer screening, it's important to consider all of your options and ask your clinician what prostate biopsy method they utilize. CIVCO's TP Pivot Pro's disposable needle guides are designed to make your biopsy as safe as possible, reducing the number of puncture sites required through the perineum while also helping to lower the risk of infection. 
The transperineal approach is shown to improve access to all zones of the prostate, giving you peace of mind with better detection of clinically significant disease and anterior tumours. With reduced risk of rectal bleeding and infection, and potential elimination of antibiotics together, consider ​asking your provider if they offer the transperineal approach as a standard biopsy method in their practice. ^{11 12}

To discover more about how the transperineal ​approach, when coupled with CIVCO's TP Pivot Pro disposable needle guides, can make a difference in your prostate cancer screening, ​check out our website, and be sure to ask your provider for more information. 

References:

1. Cancer.Net: Digital Rectal Exam: https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/digital-rectal-exam-dre
2. National Cancer Institute: “Watchful Waiting” Definition: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/watchful-waiting
3. Inside View: I Have High PSA Levels: How Do I Find Out if I Have Prostate Cancer: https://blog.radiology.virginia.edu/high-psa/
4. Saint Luke’s: Prostate Needle Biopsy: https://www.saintlukeskc.org/health-library/prostate-needle-biopsy
5. Therapeutic Advances in Urology: Hundred Years of Transperineal Prostate Biopsy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128053/
6. Mayo Clinic: Ultrasound-guided transperineal prostate biopsy: https://www.mayoclinic.org/medical-professionals/news/ultrasound-guided-transperineal-prostate-biopsy/mac-20473283#:~:text=In%20the%20transrectal%20approach%2C%20the,prostate%20biopsies%20are%20conducted%20transrectally.
7. Focal Healthcare: Transrectal vs. Transpinereal Approach for Prostate Biopsy: https://focalhealthcare.com/transperineal-vs-transrectal-approach-for-prostate-biopsy/#:~:text=Compared%20to%20transrectal%2C%20transperineal%20biopsies,the%20need%20for%20fluoroquinolone%20prophylactics.&text=1-,The%20rate%20of%20sepsis%20post%2Dtransperineal%20biopsy%20is%20nearly%200,less%20than%20that%20of%20transrectal
8. World Journal of Surgical Oncology: Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375152/
9. Prostate Matters: Prostate Cancer Diagnosis – TransPerineal Biopsy: https://prostatematters.co.nz/prostate-cancer/prostate-cancer-diagnosis-template-guided-biopsy-tgb-the-gold-standard/#:~:text=TPB%20is%20especially%20useful%20for,of%20recovery%20for%20the%20patient.
10. Yale School of Medicine: Transperineal Prostate Biopsy: Is This the New Gold Standard?”: https://medicine.yale.edu/media-player/transperineal-prostate-biopsy-is-this-the-new-gold-standard-with-jay-amin/

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