What is a prostate biopsy?

The prostate gland is found only in males. It sits below the bladder and wraps around the tube that carries urine out of the body (urethra). The prostate helps make semen.

A biopsy is a procedure used to remove a small piece of tissue or cells from the body so it can be looked at under a microscope.

In a prostate biopsy, prostate gland tissue is taken out with a biopsy needle. Or it is taken out during surgery. The tissue is checked to see if there are cancer or other abnormal cells in the prostate gland.

A prostate biopsy may be done using the following methods:

• Transrectal method. This is done through the rectum and is the most common.

• Transperineal method. This is done through the skin between the scrotum and the rectum.

Ultrasound is often used to look at the prostate gland and guide the biopsy needle.

Why might I need a prostate biopsy?

A prostate biopsy is done after other tests show that there may be a problem with the prostate gland. It is the best method to diagnose prostate cancer.

There may be other reasons for your healthcare provider to advise a prostate biopsy.

What are the risks of a prostate biopsy?

Some possible complications of a prostate biopsy may include:

• Bruising and mild pain at the biopsy site

• Bleeding

• Infection

• Trouble urinating

You may have other risks, depending on your condition. Discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a prostate biopsy?

Some things you can expect before a prostate biopsy include:

• Your healthcare provider will explain the procedure and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia.

• Make sure your healthcare provider has a list of all medicines you are taking. This includes prescription and over-the-counter medicines, herbs, vitamins, and supplements.

• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.

• Generally, you don't need to fast or have sedation for the transrectal or perineal method. Your healthcare provider will give you specific instructions.

• If your healthcare provider uses the transrectal method, you may need to have an enema the night before or the morning of the biopsy.

• You may get a sedative before the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.

• You may start to take antibiotics the day before the biopsy is done. You will keep taking them for a few days after it. This is to help prevent infection.

• Follow any other instructions your healthcare provider gives you to get ready.

What happens during a prostate biopsy?

A prostate biopsy is often done on an outpatient basis. This means you can go home the same day. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, a prostate biopsy follows one of these processes:

Transrectal method

1. You will remove your clothing and put on a hospital gown.

2. You will be positioned on your left side, with your knees bent.

3. This type of biopsy may be done with a local anesthetic to numb the tissue the needle will pass through. Occasionally, a sedative or light IV sedation can be provided.

4. A transrectal ultrasound (TRUS) will be used to guide the placement of the biopsy needle.

5. The healthcare provider will use a spring-loaded tool that quickly inserts a needle through the wall of the rectum into the prostate gland. You may feel mild pain or pressure when the needle enters the prostate gland.

6. The needle is put in several times to take tissue samples from different parts of the gland.

7. The prostate tissue samples will be sent to the lab to be examined.

Transperineal method

1. You will remove your clothing and put on a hospital gown.

2. You will be positioned on your left side, with your knees bent, or lying on your back with your knees bent and thighs apart.

3. The skin between your scrotum and rectum will be cleaned with an antiseptic solution.

4. You will feel a needle stick when the local anesthetic is injected. (Local anesthetic means medicines are used to make you numb.) This may cause a brief stinging feeling. Occasionally, a sedative or light IV sedation can be provided.

5. When the area is numb, the healthcare provider may make a tiny cut (incision) in the skin.

6. A transrectal ultrasound (TRUS) will be used to guide the placement of the biopsy needle.

7. The healthcare provider will use a spring-loaded tool that quickly inserts a needle through the wall of the perineum into the prostate gland. You may feel mild pain or pressure when the needle enters the prostate gland.

8. The prostate tissue samples will be sent to the lab to be examined.

What happens after a prostate biopsy?

Your recovery process will vary depending on the type of anesthesia that is used. If you were given general anesthesia, you will be taken to a recovery room and closely watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

If local anesthetic was used, you may go back to your normal activities and diet unless otherwise instructed. You may feel the urge to urinate or have a bowel movement after the biopsy. This feeling should pass after a few hours.

You may see blood in your urine or stool for a few days after the biopsy. This is common. You may also have blood in your ejaculate for a few weeks after the biopsy. The blood may be red or reddish brown. This is also normal.

The biopsy site may be tender or sore for several days after the biopsy. Take a pain reliever for soreness as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. So take only advised medicines.

Call your healthcare provider if you have any of these:

• Increase in the amount of blood in your urine or stool

• Belly or pelvic pain

• Trouble urinating

• Changes in the way your urine looks or smells or burning with urination (may be signs of infection)

• Fever or chills

Your healthcare provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure