Total and Free PSA Ratio

   When the PSA is borderline, between 4 and 10, a total and free PSA ratio may be obtained.  Like the PSA it is a fuzzy test, revealing the likelihood of cancer being present, but not a definitive answer.  It may help define whether further tests may be needed.  A low ratio, less than 15% suggests that there is a high possibility of cancer, ha high ratio, over 25% suggests a low possibility.  However there may be false positives and false negatives.

    Trans Rectal Ultrasound   (TRUS)

   TRUS is an examination where a finger-like probe is placed in the rectum, and ultrasound pictures are made of the prostate. TRUS is an even more fuzzy test than the PSA.  It is very helpful in directing biopsies to areas of high suspicion, but TRUS is non-diagnostic.  It may give information about prostate size, shape, and significant local spread of prostate cancer, but it cannot make or deny the diagnosis of prostate cancer.  TRUS should never be done as an isolated test, but only when a biopsy is to be done.

Needle Biopsy of the Prostate

   The definitive test to make the diagnosis of prostate cancer is the needle biopsy.  A    thin needle, guided either by ultrasound or a finger, is inserted through the rectum into the prostate, and a small sample of tissue taken.  Usually 6 to 12 samples are taken from nodules, from suspicious areas seen on sonography, or in a pattern sampling the entire prostate.  This test has a better than 90% accuracy in diagnosing prostate cancer, although occasional false negative results occur when a small cancer in the gland is not sampled. The test, while uncomfortable is usually done without anesthesia.

    Small amounts of bleeding in the urine, stool or semen are common after biopsy.  Significant bleeding, or major infection are occasional complications of needle biopsy, rarely requiring hospitalization.

   Preparation includes:

     s stopping blood thinners, (first check with the doctor who has you on this medication). Aspirin should be stopped at least 5 days before, or if that is contraindicated, a baby aspirin may be taken every other day for several days before.

     s Antibiotics are frequently started the night before the procedure, 

     s A cleansing fleet enema should be taken the morning of the test. 

     s If you are having sedation you must not eat or drink after midnight the night before. You may take all your medicines with a sip of water.

    The biopsy results will usually be available within a week. You should call the office and make an appointment to see the doctor at least one week after the biopsy.  We do not give biopsy reports over the phone.

   Occasional false negative results are obtained so even if cancer is not found, follow-up appointments MUST be made and kept. 

What if the biopsy is positive ? 

Stephan Werner, M.D., F.A.C.S.

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