What happens if my PSA and/or DRE are abnormal?

If you  have an abnormal prostate cancer screening the only way to determine if you have, prostate cancer is through a biopsy.  The decision to proceed with a prostate biopsy should be based primarily on PSA and DRE results.  It should also take into account other factors including your family history of prostate cancer, race, any prior biopsy history and other significant health issues youmay have.  A prostate biopsy is best performed under transrectal ultrasound guidance using a spring-loaded biopsy device coupled to the transrectal probe.
Patients are positioned on their side for this procedure and are given an enema and an antibiotic. The lubricated ultrasound probe is inserted into the rectum. The physicians will first us the ultrasound to find the prostate gland particularly focusing on the size and shape and whether or not any other abnormalities.  The most common abnormalities are shadows, which might signify the presence of prostate cancer. However, not all prostate cancers are visible. After the prostate gland has been anesthetized with an injection of a local anesthetic through a long fine needle that is passed through the probe, the physician performs the biopsy. Using the spring-loaded biopsy device attached to the ultrasound probe, the physician removes several pieces of the prostate gland. Generally, 10 to 12 pieces or cores are removed (or more, depending upon the size of the prostate gland and the prior PSA and biopsy history of the patient).  Each core of prostate tissue is approximately 3/4 inch in length and 1/16 inch in width. The entire procedure takes 20 to 30 minutes. The removed tissue is taken and will be examined by a pathologist (a physician who specializes in examining human tissue to determine whether it is normal or diseased). The pathologist will be able to confirm if cancer is present in the biopsy tissue. If cancer is present, the pathologist will also be able to grade the tumor. The grade indicates the tumor's degree of aggressiveness—how quickly it is likely to grow and spread.
There transrectal ultrasound guided prostate biopsy is usually well tolerated.  Using local anesthetics helps to minimize the discomfort associated with the biopsy.  There are some side effects that may result from the biopsy such as, blood in the ejaculate (hematospermia)) and/or blood in the urine (hematuria) however, it should clear up within a few days for the urine and a few weeks for the semen. High fever is rare, occurring in only 1 to 2 percent of patients. The antibiotic is continued for at least 48 hours after the biopsy procedure