Prostate Biopsy

A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope. See an illustration of the prostate gland.

For a prostate biopsy, a thin needle is inserted through the rectum (transrectal biopsy), through the urethra, or through the area between the anus and scrotum (perineum). A transrectal biopsy is the most common method used. The tissue samples taken during the biopsy are examined for cancer cells.

A biopsy may be done when a blood test shows a high level of prostate-specific antigen (PSA) or after a digital rectal examination finds an abnormal prostate or a lump.

A prostate biopsy is done to determine:

• If a lump found in the prostate gland is cancer.
• The cause of a high level of prostate-specific antigen (PSA) in the blood.

Tell your doctor if you:

• Have had any bleeding problems.
• Are allergic to any medications, including anesthetics.
• Take any medications regularly. Be sure your doctor knows the names and doses of all your medications.
• Are taking any blood-thinning medications, such as warfarin (Coumadin), heparin, enoxaparin (Lovenox), aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).

You will need to sign a consent form that says you understand the risks of a prostate biopsy and agree to have the biopsy done. Talk to your health professional about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will indicate. To help you understand the importance of the biopsy, fill out the medical test information form(What is a PDF document?).

If a prostate biopsy is done under local anesthesia through the area between the anus and scrotum (perineum), no other special preparation is needed.

If the biopsy is done through the rectum, you may need to have an enema before the biopsy.

If the biopsy is done under general anesthesia, do not eat or drink anything for 8 to 12 hours before the biopsy. During preparation for the biopsy, an intravenous line (IV) is inserted in your arm, and a sedative medication is given about an hour before the biopsy.

This biopsy is done by a doctor who specializes in men's genital and urinary problems (urologist) in the doctor's office, a day surgery clinic, or a hospital operating room.

Before your prostate biopsy, you may be given antibiotics to prevent infection. You may be asked to take off all of your clothes and put on a hospital gown.

Your skin at the biopsy site is cleaned with an antiseptic solution, and the area around it is covered with sterile cloth. Your doctor will wear sterile gloves. It is very important that you do not touch this sterile area.

Transrectal ultrasound (TRUS) is commonly used to guide the placement of the needle during a prostate biopsy.

Through the rectum (transrectal biopsy)

Several positions are possible for this method. You may be asked to kneel, lie on your side, or lie on your back with your feet resting in stirrups. Your doctor may inject a local anesthetic around the prostate gland before the biopsy is taken.

Transrectal ultrasound (TRUS) is generally used to guide the needle to the correct biopsy location. A prostate biopsy is usually done with a spring-loaded needle. The needle quickly enters the prostate gland and removes a tissue sample.

The biopsy can also be done with a needle guide attached to your doctor's finger. He or she inserts the finger into the rectum. Then the needle is slid along the guide, through the wall of the rectum, and into the prostate gland. The needle is turned to collect a tissue sample and then pulled out.

A transrectal biopsy takes about 30 minutes. See an illustration of transrectal prostate biopsy.

Through the urethra (transurethral biopsy)

For this method, you will lie on your back with your feet resting in stirrups. General or local anesthesia may be used.

A lighted scope (cystoscope) is inserted into your urethra. It allows your doctor to look directly at the prostate gland. A cutting loop is passed through the cystoscope to remove small pieces of prostate tissue.

A transurethral biopsy usually takes about 30 to 45 minutes.

Through the perineum (transperineal biopsy)

Transperineal biopsy is not done as commonly as transrectal or transurethral biopsy. You will lie on an examining table either on your side or on your back with your knees bent. General or local anesthesia may be used.

A small incision is made in your perineum. Your doctor inserts a finger into the rectum to hold the prostate gland and then inserts the needle through the incision and into the prostate gland. To collect a sample of tissue, the needle is gently turned and then pulled out. Biopsy samples may be taken from several areas of the prostate. Pressure is applied to stop the bleeding, and a small bandage is placed over the cut. The biopsy usually takes about 15 to 30 minutes.

You may feel a slight sting when you receive an injection of medication to numb your skin. You may feel a dull pressure as the biopsy needle is inserted. For a transrectal biopsy, you may feel pressure in the rectum while the ultrasound probe or guiding finger is in place. You also may feel a brief, sharp pain as the biopsy needle is inserted into the prostate gland. Usually several biopsy samples are collected.

Following the biopsy, you will be asked to avoid strenuous activities for about 4 hours. You may have mild pain in the pelvic area and blood in your urine for up to 5 days. Also, you may have some discoloration of your semen for up to one month after the biopsy. If you had a transrectal biopsy, you may experience a small amount of bleeding from your rectum for 2 to 3 days after the biopsy.

If you have a transurethral biopsy, you may have a urinary catheter in place for a few hours after the biopsy. You also may need to take an antibiotic medication for several days after the biopsy.

If you have a general anesthetic, you will be in a recovery room for a few hours after the biopsy. You will need someone to drive you home when you are released. When you get home, your muscles may ache and you may feel tired for the rest of the day.

A prostate biopsy has a slight risk of causing problems such as:

• Infection. This is more common in men who have undiagnosed prostatitis. Usually, taking antibiotic medication before the biopsy prevents an infection from developing.
• Bleeding into the urethra or bladder. This can cause a blood blister (hematoma), an inability to urinate, or a need to urinate often.
• Bleeding from the rectum. If you have a transrectal biopsy, you may experience a small amount of bleeding from your rectum for 2 to 3 days after the biopsy.
• An allergic reaction to the anesthetic medications used during the biopsy.

After the biopsy

Call your doctor immediately if you:

• Have heavy bleeding or bleeding continues longer than 2 to 3 days.
• Have increased pain.
• Have a fever.
• Are unable to urinate within 8 hours or have blood in the urine for longer than 2 to 3 days.

A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope. Results are usually available within 10 days.

If cancer cells are present, a grade (Gleason score) will be given, which your doctor will discuss with you. The Gleason score is considered a tool for predicting how aggressive the cancer is.

Factors that can interfere with your test or the accuracy of the results include:

• The biopsy may not contain enough tissue to make a diagnosis.
• A chance that a cancer may be missed since the biopsy takes a small amount of tissue.

• Normal prostate biopsy results do not rule out cancer.
• If the prostate biopsy results show cancer, other tests may be needed to determine the spread of the cancer. These tests may include a blood test (prostate-specific antigen), bone scan, lymph node biopsy, or computed tomography (CT) scan. For more information, see the medical tests Prostate-Specific Antigen (PSA), Bone Scan, Lymph Node Biopsy, and Computed Tomography (CT) Scan.
• Not all types of prostate cancer are treated. There are many factors to consider when deciding on a treatment plan. For more information, see the topic Prostate Cancer.
• A prostate gland biopsy does not cause problems with erections and will not make a man infertile.

Other Works Consulted

• Carter HB, Partin AW (2002). Diagnosis and staging of prostate cancer. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 4, pp. 3055–3079. Philadelphia: W.B. Saunders.

• Scher HI, et al. (2005). Cancer of the prostate. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1192–1259. Philadelphia: Lippincott Williams and Wilkins.