A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. The prostate is a small, walnut-shaped gland in men that produces fluid that nourishes and transports sperm.
During a prostate biopsy, also called a core needle biopsy, a fine needle is used to collect a number of tissue samples from your prostate gland. A prostate biopsy is done by a urologist, a doctor who specializes in the urinary system and men’s sex organs. Your urologist may recommend a prostate biopsy if results from initial tests, such as a prostate-specific antigen (PSA) blood test or digital rectal exam (DRE), suggest you may have prostate cancer.
Following a prostate biopsy, tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly it’s likely to grow and spread, and to determine your best treatment options.
Why is it Done?
A prostate biopsy is used to detect prostate cancer. Your doctor may recommend a prostate biopsy if:
Results of a prostate-specific antigen (PSA) test are higher than normal for your age
Your doctor found lumps or other abnormalities during a digital rectal exam
You’ve had a previous biopsy that was normal, but you still have elevated PSA levels
A previous biopsy revealed prostate tissue cells that were abnormal but not cancerous.
Infection. The most common risk associated with a prostate biopsy is infection. Rarely, men who have a prostate biopsy develop an infection of the urinary tract or prostate that requires treatment with antibiotics.
Bleeding at the biopsy site. Bleeding is common after a prostate biopsy. Don’t start taking any blood-thinning medications after your biopsy until your doctor says it’s OK.
Blood in your semen. It’s common to notice red or rust coloring in your semen after a prostate biopsy. This indicates blood, and it’s not a cause for concern. Blood in your semen may persist for four to six weeks after the biopsy.
Difficulty urinating. In some men prostate biopsy can cause difficulty passing urine after the procedure. Rarely, a temporary urinary catheter must be inserted.
How You Prepare
To prepare you for your prostate biopsy, your urologist may have you:
Stop taking medication that can increase the risk of bleeding, such as warfarin (Coumadin), nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), and certain herbal supplements for several days before the procedure
Do a cleansing enema at home before your biopsy appointment
Take antibiotics 30 to 60 minutes before your prostate biopsy, to help prevent infection.
What You Can Expect
Types of prostate biopsy procedures
Prostate biopsy samples can be collected in different ways. Your prostate biopsy may involve:
Passing the needle through the wall of the rectum. This is called a transrectal biopsy, and it is the most common way of performing a prostate biopsy.
Collecting a tissue sample through the tip of the penis. This way of performing a prostate biopsy is called a transurethral biopsy. A long, thin tube equipped with a camera is passed through the opening (urethra) at the tip of the penis in order to access the prostate.
Inserting the needle through the area of skin between the anus and scrotum. This type of prostate biopsy involves making a small cut in the area of skin (perineum) between the anus and the scrotum. The doctor inserts the biopsy needle through the cut and into the prostate to draw out a sample of tissue.
What to expect during transrectal prostate biopsy
In most cases, the urologist performs a transrectal prostate biopsy. For this procedure, your doctor will start by having you lie on your side, with your knees pulled up to your chest. In some cases, you may be asked to lie on your stomach.
After cleaning the area and applying gel, your doctor will gently insert a thin ultrasound probe into your rectum. Transrectal ultrasonography is used to create images of your prostate using sound waves. Your doctor will use the images to identify the area that needs to be numbed with an anesthetic injection, if one is used. The ultrasound images are also used to guide the prostate biopsy needle into place.
In most cases, an injection of a numbing medication is used to reduce the discomfort associated with the prostate biopsy. A needle is used to inject the anesthetic at various points near the base of the prostate.
Once the biopsy device is situated, your doctor will retrieve thin, cylindrical sections of tissue with a hollow, spring-propelled needle. The procedure typically causes a very brief, uncomfortable sensation each time the spring-loaded needle takes a sample. Your doctor may target a suspicious area to biopsy or may take samples from several places in your prostate. In most cases, doctors will take 10 to 12 tissue samples. The entire procedure usually takes about five to 10 minutes.
After the procedure
After a prostate biopsy, you’ll probably need to take an antibiotic for a few days. You may feel slight soreness and have some light bleeding from your rectum. You may have blood in your urine or stools for a few days. You may also notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen. This can last for several weeks.
Call your doctor if you have:
Prolonged or heavy bleeding
Pain that gets worse
Swelling near the biopsy area
In rare cases, a prostate biopsy can lead to infection. If you have any signs of infection, call your doctor. Signs and symptoms of infection include:
Pain when urinating
A doctor who specializes in diagnosing cancer and other tissue abnormalities will evaluate the prostate biopsy samples. This doctor (a pathologist) can tell if the tissue removed is cancerous and, if cancer is present, estimate how aggressive it is. The pathologist compiles the laboratory findings in a pathology report that’s given to your doctor. Your doctor will explain the findings to you and, if you like, you can ask for a copy of your pathology report for future reference.
Your pathology report may include:
Information about your medical history. A pathology report may include a discussion of your medical history and any other tests that prompted your doctor to recommend a prostate biopsy.
A description of the biopsy sample. This section of the pathology report, sometimes called the gross description, describes the biopsy sample in general. For instance, it may describe the color and consistency of the prostate tissue collected by the needle biopsy procedure. Or it may say how many samples were submitted for laboratory analysis.
A description of the cells. This section of the pathology report describes how the cells appear under a microscope. Prostate cancer cells may be referred to as adenocarcinoma in a pathology report. Sometimes the pathologist finds cells that appear abnormal but aren’t cancerous. Words used in pathology reports to describe these noncancerous conditions include prostatic intraepithelial neoplasia and atypical small acinar proliferation.
If the pathologist finds cancer, it’s graded on a scale called the Gleason score. This scale rates how different the cancer cells are from normal tissue. The lowest rating is 2 and the highest is 10. Cancers with a high Gleason score are the most abnormal and are more likely to grow and spread quickly.
The pathologist’s diagnosis. This section of the pathology report lists the pathologist’s diagnosis. It may also include comments, such as whether other tests are recommended.