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TURP-Prostate Large biopsy 3-6 cm

Biopsy
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Report in 240Hrs

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At Home

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No Fasting Required

Details

Histology after resection.

₹740₹1,057

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TURP-Prostate Large Biopsy 3-6 cm - Comprehensive Medical Guide

  • Why is it done?
    • Test Purpose: This test obtains tissue samples from the prostate gland using transurethral resection of the prostate (TURP) technique, specifically targeting larger lesions or suspicious areas measuring 3-6 cm in size.
    • Primary Indications: Detection and diagnosis of prostate cancer, evaluation of elevated PSA levels with suspicious imaging findings, assessment of abnormal digital rectal examination (DRE) results, investigation of transitional zone lesions, and histological confirmation of imaging-detected abnormalities.
    • Typical Timing: Performed when imaging studies (MRI, ultrasound) identify significant prostate lesions, PSA levels are significantly elevated (>10 ng/mL) with imaging confirmation, or when there is clinical suspicion of prostate cancer based on symptoms or screening results. Typically scheduled as an outpatient procedure.
    • Clinical Context: This is considered a definitive diagnostic procedure for tissue diagnosis and grading of prostate pathology, providing more extensive sampling than traditional needle biopsies for larger lesions.
  • Normal Range
    • Normal Result: Benign prostate tissue with normal glandular architecture, absence of malignant cells, no evidence of dysplasia, inflammation, or carcinoma.
    • Reference Standard: Histopathological examination reporting: Gleason score 0 (no cancer present), normal prostatic epithelium, benign hyperplasia if present, absence of high-grade prostatic intraepithelial neoplasia (HGPIN).
    • Measurement Units: Histopathological grading using Gleason scoring system (range 1-10), TNM staging for tumors (if present), specimen adequacy assessment, and pathological descriptions.
    • Interpretation Guide: Negative result indicates no malignancy detected; positive result indicates presence of cancer cells with grade and extent documented; borderline findings may require immunohistochemistry or repeat sampling.
    • What Normal Means: No cancer present in sampled tissue, benign pathology such as hyperplasia or chronic inflammation may be noted, no immediate malignant threat requiring active treatment.
    • What Abnormal Means: Presence of malignant cells indicating prostate cancer diagnosis, may include information about aggressiveness (Gleason score), extent of involvement, and grade of differentiation requiring treatment planning.
  • Interpretation
    • Benign Findings: No cancer detected, tissue shows normal glandular epithelium, benign prostatic hyperplasia (BPH), chronic prostatitis, or normal variation. May still require monitoring if PSA remains elevated or imaging abnormalities persist.
    • Gleason Score 6 (3+3): Low-grade prostate cancer, slow growth potential, generally favorable prognosis. May be managed with active surveillance, radiation therapy, or surgery depending on clinical stage and patient factors.
    • Gleason Score 7 (3+4 or 4+3): Intermediate-grade prostate cancer with moderate aggressiveness. 3+4 has better prognosis than 4+3. Typically requires active treatment such as radical prostatectomy, external beam radiation therapy, or combined modality treatment.
    • Gleason Score 8-10: High-grade prostate cancer with aggressive characteristics and poor prognosis. Rapid growth potential, higher risk of metastasis. Requires immediate aggressive treatment including surgery, radiation, or systemic therapy.
    • HGPIN (High-Grade Prostatic Intraepithelial Neoplasia): Precancerous changes in prostate tissue, not cancer but indicates increased cancer risk. May warrant repeat biopsy within 6-12 months or closer surveillance depending on clinical context.
    • Atypical Small Acinar Proliferation (ASAP): Uncertain findings suspicious for cancer but not diagnostic. Typically followed by repeat biopsy or targeted imaging to clarify diagnosis.
    • Factors Affecting Interpretation: Specimen adequacy and number of cores obtained, fixation quality, pathologist expertise, prior biopsies or treatment history, coexisting benign conditions, and clinical correlation with imaging and PSA levels.
    • TNM Staging Component: Biopsy contributes to T-staging (tumor extent) and helps determine overall cancer stage. Results combined with imaging and clinical findings for complete staging and treatment planning.
  • Associated Organs
    • Primary Organ: Prostate gland (male reproductive and urinary system organ). Small gland surrounding the urethra below the bladder, responsible for producing seminal fluid. Approximately 3-4 cm in normal size.
    • Associated System: Genitourinary system including bladder, urethra, seminal vesicles. Endocrine system via androgen-responsive prostate tissue.
    • Diseases Diagnosed: Prostate adenocarcinoma (most common malignancy in men), prostate cancer variants (mucinous, small cell, neuroendocrine), benign prostatic hyperplasia (BPH), prostatitis (bacterial or chronic), squamous metaplasia, and other prostate pathologies.
    • Conditions Associated with Abnormal Results: Elevated PSA (prostate-specific antigen), abnormal DRE findings, imaging abnormalities on MRI or ultrasound, urinary symptoms, obstructive voiding dysfunction, hematuria, and family history of prostate cancer.
    • Potential Complications: Positive diagnosis may lead to anxiety and requires treatment decisions; untreated prostate cancer can spread to bones, lymph nodes, and other organs resulting in metastatic disease; local extension may cause obstruction or sexual dysfunction.
    • Procedure-Related Risks: Hematuria (blood in urine), hematospermia (blood in semen), urinary retention, infection/prostatitis, rectal perforation, urethral stricture, and transient dysuria. Most complications are minor and self-limiting.
    • Prognostic Impact: Gleason score and cancer extent determined by this biopsy are critical prognostic indicators affecting survival rates, treatment selection, and long-term outcomes. Higher grades associated with poorer prognosis.
  • Follow-up Tests
    • If Cancer Diagnosed: Pelvic MRI for local staging, bone scan or PET-CT for metastatic workup, PSA level confirmation, testosterone/androgen levels, chest imaging if indicated by stage. Results guide treatment modality selection.
    • If Benign Results: Repeat PSA testing in 4-6 weeks, follow-up imaging study to reassess lesion if clinically indicated, consideration of repeat biopsy in 6-12 months if PSA remains elevated or imaging abnormalities persist.
    • Immunohistochemistry (IHC): Performed on tissue samples for biomarker analysis including p63, AMACR, PSA, and other markers to confirm diagnosis, grade tumors, and predict treatment response. May include molecular testing for genomic features.
    • Genomic/Molecular Testing: Genomic Risk Score (Oncotype DX, Prolaris, Decipher) on tissue samples to assess cancer aggressiveness and predict treatment response, especially important for intermediate-risk disease. Guides active surveillance vs. treatment decisions.
    • PSA Monitoring: Serial PSA measurements every 3-6 months initially, then annually. PSA velocity (rate of change) provides prognostic information. Elevation suggests cancer progression or recurrence post-treatment.
    • Imaging Follow-up: Baseline staging imaging at diagnosis (pelvic MRI, bone scan, or PET-CT), surveillance imaging post-treatment typically at 6 months then annually, restaging if PSA elevation suggests recurrence.
    • Repeat Biopsy: Recommended within 6-12 months if initial biopsy shows HGPIN, ASAP, or atypical findings. May be needed to upgrade or clarify diagnosis. Sampling of different prostate regions if first biopsy was non-diagnostic.
    • Supportive Testing: Complete metabolic panel, renal function tests if considering treatment options, bone density studies if hormone therapy considered. Baseline health assessment before treatment initiation.
    • Monitoring Frequency: Active surveillance: every 3-6 months initially. Post-treatment: every 6 months first 2 years, then annually. Advanced disease: based on treatment response and clinical status. Frequency adjusted based on Gleason score and clinical course.
  • Fasting Required?
    • Fasting Status: NO fasting required for this procedure.
    • Pre-Procedure Preparation: NPO (nothing by mouth) typically 4-6 hours before procedure if spinal anesthesia or sedation used. For local anesthesia only, regular diet and medications may continue. Confirm timing with surgical team.
    • Bowel Preparation: Fleet enema or bowel prep solution evening before procedure to clear rectum. Some facilities recommend prophylactic bowel prep; verify with surgical center specific protocols.
    • Anticoagulation Management: HOLD aspirin 5-7 days before procedure. HOLD warfarin 3-5 days before or as directed by anticoagulation specialist. HOLD clopidogrel, dabigatran 3-5 days before. May continue low-dose aspirin if high thrombotic risk; discuss with cardiologist and urologist.
    • Antibiotic Prophylaxis: Pre-procedure antibiotics given typically 1 hour before (fluoroquinolone or cephalosporin IV). Continue oral antibiotics post-procedure typically for 3-5 days to prevent infection. Amoxicillin-clavulanate or fluoroquinolone commonly used.
    • Medications to HOLD: Anticoagulants (warfarin, dabigatran, apixaban), antiplatelet agents (aspirin, clopidogrel, prasugrel). Continue: antihypertensives, diabetes medications morning of procedure with small sip of water unless NPO required.
    • Medications to CONTINUE: Beta-blockers, ACE inhibitors, calcium channel blockers, alpha-blockers (if for BPH), statins. Antidiabetic medications as directed. Confirm with anesthesia and surgical team.
    • Day of Procedure Requirements: Arrive 1-2 hours early for registration and pre-operative assessment. Void completely before pre-op medications. Wear clean, loose-fitting clothing. Remove dentures, glasses, hearing aids before entering OR. Arrange transportation as cannot drive same day.
    • Post-Procedure Care: Pain management as prescribed, urinary catheter care if placed, increased fluid intake to promote clear urine, avoid strenuous activity/lifting for 3-5 days. Mild hematuria/hematospermia expected for several days. Report fever >101°F, inability to void, severe pain, or persistent bleeding.
    • Return to Activities: Light activity resumable in 1 week. Return to normal activity after 2-3 weeks based on recovery. Resume sexual activity after 4 weeks. Follow specific guidelines provided by surgical team.

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