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Prostate Biopsy - XL

Biopsy
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Report in 288Hrs

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No Fasting Required

Details

Tissue biopsy of prostate.

₹888₹1,269

30% OFF

Prostate Biopsy - XL (Extended Biopsy)

  • Why is it done?
    • Definitive diagnosis of prostate cancer when PSA is elevated or imaging shows abnormalities
    • Determines presence, location, and extent of malignant cells in prostate tissue
    • Assesses tumor grade (Gleason score) for prognosis and treatment planning
    • Performed when PSA levels persistently elevated (>4.0 ng/mL) or abnormal DRE findings
    • Extended biopsy (XL) involves 12 or more tissue cores sampled across entire prostate for improved cancer detection
    • Used in cases of prior negative biopsy with continued clinical suspicion or elevated PSA density
  • Normal Range
    • Negative/Normal Result: No malignant cells detected in biopsied tissue samples; benign prostatic tissue only
    • Normal Findings Include: Benign hyperplasia, chronic inflammation, or normal prostate glandular tissue
    • Positive/Abnormal Result: Malignant cells (adenocarcinoma) identified in one or more tissue cores
    • Gleason Score (Primary Grading System): Range 6-10 (most common 6-7); sum of two microscopic patterns (each 1-5 scale)
    • Grade Group Classification: Grade 1 (Gleason 6) through Grade 5 (Gleason 9-10); helps predict aggressiveness
    • Atypical Small Acinar Proliferation (ASAP): Suspicious but not definitively cancer; 40-50% risk of finding cancer on repeat biopsy
  • Interpretation
    • Negative Biopsy: No cancer detected; however, does not completely exclude cancer (sensitivity 85-90%). May require follow-up based on PSA trends and clinical judgment
    • Gleason Score 6 (Grade 1): Low-grade cancer; generally slow-growing, favorable prognosis; may be managed conservatively with active surveillance
    • Gleason Score 7 (Grade 2-3): Intermediate-grade cancer; intermediate aggressiveness; typically warrants definitive treatment (surgery/radiation)
    • Gleason Score 8-10 (Grade 4-5): High-grade cancer; aggressive growth pattern; requires prompt treatment planning; may require systemic therapy
    • Number of Positive Cores: Higher number indicates more extensive disease; 1-2 positive cores out of 12 suggests localized cancer; 6+ positive cores suggests more advanced disease
    • Percentage of Cancer in Cores: Reported for each core; higher percentages indicate more extensive involvement; <5% may suggest clinically insignificant cancer
    • Factors Affecting Interpretation: PSA level, PSA velocity/density, age, prostate size, prior biopsy results, digital rectal exam findings, MRI findings
  • Associated Organs
    • Primary Organ: Prostate gland (male reproductive system); walnut-sized organ surrounding urethra
    • Related Structures: Seminal vesicles, urethra, rectum; cancer may metastasize to regional lymph nodes and distant sites
    • Diseases Diagnosed: Prostate adenocarcinoma (various grades), prostate cancer metastases assessment, differentiation from benign hyperplasia
    • Potential Complications of Abnormal Results: Cancer progression, metastatic spread to bone/lymph nodes/liver/lungs, urinary obstruction, erectile dysfunction, local invasion of seminal vesicles
    • Biopsy-Related Risks/Complications: Infection (prostatitis), hematuria (blood in urine), hematochezia (blood in stool), urinary retention, rectal perforation (<0.5%), bleeding, transient fever
  • Follow-up Tests
    • If cancer diagnosed: Staging imaging (CT pelvis/abdomen, bone scan, MRI prostate) to assess extent of disease
    • PSA monitoring: Continue regular PSA testing; frequency depends on Gleason score and treatment choice
    • Repeat biopsy: Recommended if ASAP result, continued PSA elevation despite negative biopsy, or rising PSA velocity
    • Genomic testing: FoundationOne, Prolaris, OncotypeDx for prognostication and treatment planning in intermediate/high-risk disease
    • Urinalysis and urine culture: If post-biopsy symptoms develop (dysuria, frequency) to rule out infection
    • Active surveillance protocol: For low-grade cancer: PSA every 3-6 months, DRE annually, repeat biopsy at 12-24 months
    • Negative biopsy with continued suspicion: Repeat biopsy in 4-6 weeks or MRI-guided biopsy; consider PSA velocity trend analysis
    • Testosterone level: Consider if hormonal therapy being planned for advanced disease
  • Fasting Required?
    • Fasting: No, fasting is not required for prostate biopsy
    • Pre-Procedure Preparation: Clean out bowel with enema morning of procedure or evening before; wear comfortable, loose-fitting clothing
    • Medications to Discontinue: Aspirin, NSAIDs (ibuprofen, naproxen) - discontinue 5-7 days before; anticoagulants (warfarin, apixaban, rivaroxaban) - consult physician; continue other medications as usual
    • Prophylactic Antibiotics: Usually prescribed (fluoroquinolone) to take before and after procedure; may take with light meal
    • Other Preparations: Empty bladder before procedure; provide list of all medications and allergies; arrange transportation (light sedation may be used)
    • Post-Procedure Care: Drink extra fluids for several days; mild discomfort, hematuria/hematochezia normal for 2-3 weeks; report fever >101°F, inability to urinate, heavy bleeding

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