Introduction
Prostate biopsy is the gold standard diagnostic technique for the detection of prostate cancer. Early detection is crucial to identify the pathology and plan appropriate treatment regimen for the patient.
Definition
Prostate biopsy is a procedure involving insertion of a small hollow needle under ultrasound/MRI guidance to obtain a tissue specimen from the prostate.
Purposes
- To identify malignancy.
- To aid in selecting the therapy.
- To determine the prognosis of the illness.
Types
- Transrectal ultrasound (TRUS)-guided biopsy.
- Prostate fine needle aspiration.
- Transperineal three-dimensional mapping biopsy (3DMB).
- Magnetic resonance imaging (MRI)-TRUS fusion prostate biopsy (it consists of an adjustable clamping system to position probes of various diameters and stabilization bars for easy insertion of Trucut needles for biopsy).
- Contrast-enhanced Doppler ultrasound elastography-targeted biopsy.
Indications
- Abnormal digital rectal findings (palpable lesions with nodularity, asymmetry, or diffuse firmness).
- Increased PSA value >4 ng/mL.
- Concomitant risk factors for prostate cancer.
- Patients with lesions identified on multiparametric MRI (mpMRI).
Contraindications
- Malignant tumors.
- Pregnancy.
- Painful anorectal conditions.
- Immunosuppressive conditions.
- Acute prostatitis.
- Coagulation disorders.
- Uncontrolled hypertension.
Articles
| Articles | Purpose |
| Prostate biopsy tray containing; | |
| Sponge-holding forceps (1) | To prepare the site for biopsy. |
| Artery forceps | To hold the needle. |
| Slit towel (1) | To create sterile field. |
| Sterile gauze | To prepare the site for biopsy. |
| Sterile Trucut needle 15 gauge | To take biopsy tissue. |
| Clean tray containing; | |
| 5-mL syringe (1) | To take anesthetics. |
| Disposable needles 22 gauge (1), 20 gauge (2) | To give local anesthesia. |
| Antiseptic solution | To prepare the site for biopsy. |
| Xylocaine (2%) | Acts as local anesthesia. |
| Sterile gloves (2 pairs) | To prevent transmission of microorganisms. |
| Formalin 10% in small container | To collect tissue biopsy. |
| 0.9% saline | To prepare the site for biopsy. |
| Disposable plastic apron | To protect from infection. |
| Sharps container | To dispose the sharps. |
| Urine specimen container | To check hematuria. |
| Kidney tray | To collect the waste. |
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure and obtain consent. | Promotes patient cooperation and prevents legalities. |
| 2. | Collect patient records and reports, especially bleeding parameters, before the procedure. | Obtains baseline data. |
| 3. | Assemble equipment in treatment room. | Saves time and energy. |
| 4. | Instruct the patient to empty his or her bladder and bowel prior to the procedure and change to the hospital gown. | General preparation for the procedure. |
| 5. | Help the patient to lie in the left lateral decubitus or lithotomy position as per the physician’s advice. | Easy access for the biopsy site. |
| 6. | Assist the physician to locate the prostate under transrectal USG guidance. | Helps in the accuracy of the procedure. |
| 7. | Site is prepared by cleaning with povidone-iodine and 70% alcohol. | Prevents introduction of microorganisms into the body cavity. |
| 8. | Assist in administering local anesthetic drugs. | Numb the biopsy site and reduce pain perception. |
| 9. | Assist in inserting the biopsy device into the anus; a spring-loaded needle is passed through the wall of the rectum under USG guidance in a transrectal biopsy. In transperineal biopsy, a needle is passed through the perineal skin and into the prostate. | To obtain prostate tissue specimen. |
| 10. | Reassure and withdraw the needle immediately and take several tissue samples. | To ensure the adequacy of sample collected. |
| 11. | Help the patient to turn to the supine position slowly for at least 20 minutes and make him or her comfortable. | Provides comfort. |
| 12. | Collect the biopsy specimen in formalin bottle, place label, and send to histopathological lab. | Degradation of biopsy can be minimized and prevents specimen error. |
| 13. | Monitor vital signs. | Provides baseline data for early identification of bleeding and infection. |
| 14. | Observe urine for hematuria for the first 24 hours after the biopsy. | Indicates bleeding. |
| 15. | Wash and replace the equipment. | Articles ready for next use. |
| 16. | Instruct the patient to; Avoid heavy lifting and strenuous activities for 7 days after the biopsy. No cycling, motorcycle riding for 2-3 weeks. Be aware that it is normal to have blood in urine and stool for up to 3 days, and in semen for up to 6 weeks. Take more fluid, 2000-3000 mL, unless contraindicated. Report any signs of excessive blood in urine or stool, sudden onset of weakness, fever, chills, or infection. Not take anticoagulant drugs until allowed by the physician. | Prevents the postprocedural complications and helps to provide intervention immediately. |
| 17. | Document the date and time of biopsy performed, subjective response to the procedure, vital signs, medication administered, education given, and sign of complication. | Serves as a legal evidence and prevents duplication of care. |
Special Consideration
- Prior biopsy showing atypical small acinar proliferation (ASAP) or high-grade prostatic intraepithelial neoplasia (HGPIN)
- Discontinue anticoagulants/antiplatelets (e.g., warfarin, aspirin) several days prior, per protocol
- Administer prophylactic antibiotics (e.g., fluoroquinolones ± gentamicin) to reduce sepsis risk
- Sedation or general anesthesia may be used for transperineal or anxious patients
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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