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Prostate Biopsy

Test Overview

A prostate gland biopsy is a test to remove small samples of prostate tissue to be looked at under a microscope. The tissue samples taken are looked at for cancer cells.

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.

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

Why It Is Done

A prostate biopsy is done to find out:

  • If a lump in the prostate gland is cancer.
  • The cause of a high level of PSA in the blood.

How To Prepare

Tell your doctor if you:

  • Take a blood thinner, or if you have had bleeding problems.
  • Are allergic to latex or any medicines, including anesthetics.

Be sure to tell your doctor about all the medicines you take, even over-the-counter ones.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the biopsy. Ask about its risks, how it will be done, and what the results will mean. To help you understand the importance of the biopsy, fill out the medical test information form (What is a PDF document?).

A prostate gland biopsy does not cause problems with erections. It will not make you infertile.

If this test is done under local anesthesia through the area between the anus and scrotum (perineum), you don't have to do anything to prepare.

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

If the biopsy is done under general anesthesia, your doctor will tell you how soon before surgery to stop eating and drinking. Follow the instructions exactly, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of the surgery, please do so using only a sip of water.

Before the biopsy, an intravenous line (IV) is inserted in your arm. You will get a sedative medicine about an hour before the biopsy.

How It Is Done

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

Before your 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.

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 sample is taken.

Transrectal ultrasound is often used to guide the needle to the correct spot. A prostate biopsy is usually done with a spring-loaded needle. The needle quickly enters the prostate gland and removes a tissue sample. Between 6 and 12 samples are taken from different areas of the prostate.

The biopsy can also be done with a needle guide attached to your doctor's finger. He or she inserts the finger into your rectum. Then the needle slides 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.

Through the urethra (transurethral biopsy)

For this method, you will lie on your back. Your feet will rest in stirrups. General, spinal, 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.

This type of biopsy usually takes about 30 to 45 minutes.

Through the perineum (transperineal biopsy)

Transperineal biopsy is not done as often as the other two types. You will lie on an exam table either on your side or on your back with your knees bent. General or local anesthesia may be used.

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

Transrectal ultrasound is generally used to guide the needle to the correct spot.

A small cut is made in your perineum. Your doctor inserts a finger into the rectum to hold the prostate gland. He or she will then insert the needle through the cut 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. A small bandage is placed over the cut. The biopsy usually takes about 15 to 30 minutes.

How It Feels

You may feel a slight sting when you get a shot of medicine to numb your skin. You may feel a dull pressure as the 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 needle is inserted into the prostate gland. Usually several samples are collected.

After the biopsy, you will be asked to avoid activity for about 4 hours. You may have mild pain in your pelvic area and blood in your urine for up to 5 days. Also, you may have a change in color of your semen for up to 1 month after the biopsy. If you had a transrectal biopsy, you may have 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 medicine 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. You may feel tired for the rest of the day.

Risks

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

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

After the biopsy

Call your doctor right away if you:

  • Have heavy bleeding or bleeding that lasts 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.

Results

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

Prostate biopsy

Normal:

The prostate gland tissue samples look normal under the microscope. There are no signs of infection or cancer.

Abnormal:

Cancer cells or signs of infection are found.

There are signs of an abnormal noncancerous enlargement of the prostate gland ( benign prostatic hyperplasia, or BPH), tuberculosis, lymphoma, or rectal or bladder cancer.

Normal prostate biopsy results do not rule out cancer. There's a chance that a cancer may be missed since the biopsy takes a small amount of tissue.

If the test finds prostate cancer cells, a grade (Gleason score) will be given. Your doctor will discuss this with you. The Gleason score is a tool for predicting how fast-growing the cancer is.

What Affects the Test

The results of the test may not be helpful if not enough biopsy tissue was taken to make a diagnosis.

What To Think About

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Loeb S, Carter HB (2012). Early detection, diagnosis, and staging of prostate cancer. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2763-2770. Philadelphia: Saunders.
  • Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
  • Scher HI, et al. (2015). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 932-980. Philadelphia: Walters Kluwer.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Christopher G. Wood, MD, FACS - Urology

Current as ofMarch 28, 2018

Current as of: March 28, 2018

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & Christopher G. Wood, MD, FACS - Urology