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TURP-Prostate Medium Biopsy 1-3 cm

Biopsy
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Report in 240Hrs

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No Fasting Required

Details

Histology after resection.

₹444₹634

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TURP-Prostate Medium Biopsy 1-3 cm

  • Why is it done?
    • Detects and diagnoses prostate cancer in tissue samples obtained during transurethral resection of the prostate (TURP) procedure
    • Evaluates medium-sized prostate lesions (1-3 cm in diameter) that are clinically suspicious for malignancy
    • Performs histopathological analysis to determine cancer grade, stage, and aggressiveness using Gleason scoring system
    • Performed in patients with elevated PSA (prostate-specific antigen) levels and abnormal digital rectal examination (DRE) findings
    • Evaluates benign prostatic hyperplasia (BPH) with atypical features or imaging findings suggestive of malignancy
    • Differentiates between benign and malignant prostatic pathology in cases of diagnostic uncertainty
    • Typically performed after TURP procedure for symptomatic outlet obstruction with concurrent tissue analysis
  • Normal Range
    • Negative/Normal Result: No malignant cells present; benign prostatic tissue only (benign glandular epithelium, stroma, or simple hyperplasia without atypia)
    • Gleason Score (if cancer present): Ranges from 2-10, calculated from primary pattern (2-5) + secondary pattern (2-5). Score 6 or below indicates low-grade cancer; 7 indicates intermediate-grade; 8-10 indicates high-grade cancer
    • Tumor Grade: Grade 1 (well-differentiated); Grade 2 (moderately differentiated); Grade 3 (poorly differentiated); Grade 4 (undifferentiated)
    • Specimen Size: 1-3 cm in largest dimension; adequate tissue for diagnostic evaluation
    • Benign Findings (Normal): Benign prostatic hyperplasia (BPH), chronic prostatitis, benign glandular epithelium, normal stroma without atypia
  • Interpretation
    • Adenocarcinoma (Malignant): Presence of malignant glandular epithelial cells with nuclear enlargement, hyperchromasia, and abnormal architecture; requires Gleason grading and clinical correlation for treatment planning
    • Gleason Score 6 (Low-Grade): Well to moderately differentiated cancer with slower growth rate; generally associated with better prognosis; may be eligible for active surveillance in selected patients
    • Gleason Score 7 (Intermediate-Grade): Moderately differentiated cancer with intermediate aggressiveness; typically requires definitive treatment (radiation, surgery, or hormone therapy); further risk stratification warranted
    • Gleason Score 8-10 (High-Grade): Poorly differentiated to undifferentiated cancer with rapid growth and high metastatic potential; associated with poor prognosis; requires aggressive multimodal treatment and close monitoring
    • Atypical Small Acinar Proliferation (ASAP): Suspicious but not diagnostic for malignancy; high likelihood of cancer on repeat biopsy; warrants close follow-up and repeat sampling
    • Prostatic Intraepithelial Neoplasia (PIN): Precancerous lesion; high-grade PIN associated with increased cancer risk and warrants repeat biopsy or enhanced surveillance
    • Benign Prostatic Hyperplasia (BPH): Benign enlargement of prostate glands without malignancy; common finding with increased age; indicates need for management of obstructive symptoms but not malignancy
    • Chronic Prostatitis: Inflammatory changes without malignancy; may be associated with elevated PSA and obstructive symptoms; requires clinical correlation and management of inflammation
    • Factors Affecting Interpretation: Specimen adequacy, tissue fragmentation, crush artifact, immunohistochemical staining (PSA, PSAP, high molecular weight cytokeratin), prior biopsies, patient age, PSA level, clinical presentation, imaging findings
  • Associated Organs
    • Primary Organ: Prostate gland (part of male reproductive system)
    • Prostate Cancer (Adenocarcinoma): Most common malignancy in men; may metastasize to regional lymph nodes, bones (especially spine and pelvis), lungs, and other organs
    • Benign Prostatic Hyperplasia (BPH): Non-malignant enlargement causing lower urinary tract symptoms (LUTS), urinary frequency, urgency, nocturia, weak stream, and urinary retention
    • Associated Medical Conditions: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), prostatitis (bacterial), urinary tract infections (UTIs), erectile dysfunction (ED), decreased libido
    • Secondary Organs Affected by Cancer: Lymph nodes (pelvic, retroperitoneal), bone (osteoblastic metastases), lungs, liver, adrenal glands; higher Gleason scores associated with greater risk of metastatic spread
    • Potential Complications from Abnormal Results: Cancer progression and metastasis, obstructive uropathy, renal insufficiency, bone pain and pathological fractures, spinal cord compression, hormone-resistant disease, treatment morbidity (urinary incontinence, erectile dysfunction)
    • Procedure-Related Risks: Hematuria, infection/sepsis, urinary retention, dysuria, rectal perforation, transurethral resection syndrome (TURS), hemorrhage, sexual dysfunction
  • Follow-up Tests
    • If Cancer is Diagnosed (Gleason 7-10): PSA level monitoring every 1-3 months; Staging CT or MRI pelvis to evaluate for lymph node involvement; Bone scan or PET-CT for metastatic disease assessment; Ultrasound-guided needle biopsy of additional sites if clinically indicated
    • If Gleason Score 6 (Low-Grade): PSA testing every 6-12 months; Digital rectal examination (DRE) annually; Repeat biopsy in 1-2 years if clinically indicated; Baseline staging imaging if treatment planned
    • If ASAP or PIN Findings: Repeat biopsy in 4-6 weeks; Enhanced PSA monitoring; Enhanced imaging (ultrasound or MRI) of suspicious areas; Close clinical follow-up
    • If Benign Findings Only: PSA monitoring based on baseline level and risk factors; Annual DRE if PSA persistently elevated; Repeat biopsy if clinical suspicion remains high; Symptom management for BPH if present
    • Complementary Tests: Serum PSA (follow-up levels); Prostate-specific membrane antigen (PSMA) PET/CT for high-risk disease; Multiparametric MRI (mpMRI) of prostate; Immunohistochemistry (IHC) markers (p53, Ki-67) for grade assessment; Genomic testing (Oncotype DX Prostate, Prolaris, Decipher) for risk stratification
    • Specialist Consultation: Urology referral for treatment planning if cancer diagnosed; Oncology consultation for systemic therapy if needed; Radiation oncology for radiotherapy options; Pathology consultation for complex or unusual findings
    • Monitoring Frequency: High-grade cancer (8-10): Every 1-3 months; Intermediate-grade (7): Every 2-3 months; Low-grade (6): Every 6-12 months; After treatment completion: Quarterly for 2 years, then semi-annually based on treatment response and PSA nadir
  • Fasting Required?
    • Fasting Required: No
    • Pre-Procedure Preparation: Bowel preparation: Enema or laxative the evening before procedure to clear rectum; May eat and drink normally unless general anesthesia planned (then NPO after midnight)
    • Medication Instructions: Stop anticoagulants (warfarin, apixaban, dabigatran, rivaroxaban) 3-5 days before procedure; Stop antiplatelet agents (aspirin, clopidogrel) as directed by physician (typically 5-7 days); Stop NSAIDs 1 week before; Continue essential medications with small sip of water; Antibiotics may be prescribed for 2-5 days post-procedure
    • Pre-Biopsy Testing: Urinalysis or urine culture to rule out active infection; Coagulation studies (PT/INR, aPTT) if on anticoagulation; Complete blood count (CBC) to assess hemoglobin/platelet levels; Renal function tests (BUN, creatinine) for safety assessment
    • Day of Procedure Instructions: Wear comfortable, loose-fitting clothing; Remove jewelry, dentures, contact lenses; Arrange for responsible adult to drive home; Void before procedure; Arrive 30-60 minutes early for consent and monitoring setup
    • Post-Procedure Care: Rest and avoid strenuous activity for 3-5 days; Drink plenty of fluids to promote urinary output; Use prophylactic antibiotics as prescribed (typically fluoroquinolone); Expect hematuria, blood in semen, or mild dysuria for several days; Monitor for fever, severe pain, inability to void, or heavy bleeding; Sexual abstinence for 2-3 weeks post-procedure
    • Special Considerations: Patients with urinary tract infections should be treated before procedure; Those with severe immunosuppression may require enhanced antibiotic prophylaxis; Patients with bleeding disorders require special precautions; Informed consent discussing risks, benefits, and alternatives required before procedure

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