Prostate biopsy
Prostate gland biopsy; Transrectal prostate biopsy; Fine needle biopsy of the prostate; Core biopsy of the prostate; Targeted prostate biopsy; Prostate biopsy - transrectal ultrasound (TRUS); Stereotactic transperineal prostate biopsy (STPB)
A prostate biopsy is the removal of tiny samples of prostate tissue to examine it for signs of prostate cancer.
The prostate is a small, walnut-sized gland just under the bladder in men. It wraps around the urethra, the tube that carries urine out of the body. The prostate makes semen, the fluid that carries sperm.
The male reproductive structures include the penis, the scrotum, the testes, the epididymis, the seminal vesicles, and the prostate.
How the Test is Performed
There are three main ways to perform a prostate biopsy.
Transrectal -- through the rectum. This is the most common method.
- You will be asked to lie still on your side with your knees bent.
- Your health care provider will insert a finger-sized ultrasound probe into your rectum. You may feel a little discomfort or pressure.
- The ultrasound allows your provider to see images of the prostate. Using these images, your provider will inject a numbing medicine around the prostate.
- Then, using ultrasound to guide the biopsy needle, your provider will insert the needle into the prostate to take a sample. This may cause a brief stinging sensation.
- About 10 to 18 samples will be taken. They will be sent to the lab for examination.
- The entire procedure will take about 10 minutes.
Transperineal -- through the perineum (the skin between the anus and the scrotum), is being used more frequently.
- You will receive medicine to make you sleepy so you do not feel pain.
- Your provider will insert an ultrasound probe into your rectum to image the prostate.
- A needle is inserted into the perineum to collect prostate tissue.
A transperineal biopsy may reduce the risk of infection while maintaining similar cancer detection.
Transurethral -- through the urethra, not used very often.
- You will receive medicine to make you sleepy so you do not feel pain.
- A flexible tube with a camera on the end (cystoscope) is inserted through the opening of the urethra at the tip of the penis.
- Tissue samples are gathered from the prostate through the scope.
How to Prepare for the Test
Your provider will inform you about the risks and benefits of the biopsy. You may have to sign a consent form.
Several days before the biopsy, your provider may tell you to stop taking any:
- Blood thinning medicines (anticoagulants) such as warfarin, (Coumadin, Jantoven), clopidogrel (Plavix), apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), or aspirin
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
- Herbal supplements
- Vitamins
Continue to take any prescription medicines unless your provider tells you not to take them.
Your provider may ask you to:
- Eat only light meals the day before the biopsy.
- Do an enema at home before the procedure to cleanse your rectum.
- Take antibiotics the day before, the day of, and the day after your biopsy.
How the Test will Feel
During the procedure you may feel:
- Mild discomfort while the probe is inserted
- A brief sting when a sample is taken with the biopsy needle
After the procedure, you may have:
- Soreness in your rectum
- Small amounts of blood in your stools, urine, or semen, which may last for days to weeks
- Light bleeding from your rectum
To prevent infection after the biopsy, your provider may prescribe antibiotics to take for several days after the procedure. Be sure you take the full dose as directed.
Why the Test is Performed
A biopsy is done to check for prostate cancer.
Your provider may recommend a prostate biopsy if:
- A blood test shows that you have a higher than normal prostate specific antigen (PSA) level
- Your provider discovers a lump or abnormality in your prostate during a digital rectal exam
As men get older, they have a lot of new worries to deal with, from hair loss, weight gain, perhaps even erectile dysfunction. In addition, cancer is one of the biggest concerns that older men face, especially prostate cancer, which is the leading cause of cancer death in men over 75. Younger men may not be very familiar with their prostate, the walnut-shaped gland that wraps around the urethra, the tube that carries urine out of the body. But as they get older, the prostate can start to cause problems. Men over the age of 60 are at increased risk for prostate cancer, especially if they're of African descent, they have a father or brother with the disease, or they eat a lot of burgers and processed meats in their daily diet. It can be hard to pinpoint prostate cancer symptoms, because they usually start late in the disease and they can mimic symptoms of a benign, enlarged prostate, which is also more common in older men. Symptoms like a slow urine stream, dribbling, blood in the urine, or straining while urinating can be signs of either condition. An enlarged prostate can also confuse the results of a PSA test, which is used to screen for prostate cancer. So, if your doctor thinks you might have prostate cancer, you may need a biopsy, which is a procedure that removes a small piece of prostate tissue and sends it to the lab to check for cancer. Then a scoring system called the Gleason grade is used to tell how fast your cancer might spread. Your Gleason grade will help decide what treatment you get. Early-stage prostate cancers that haven't spread are often removed with surgery, and then treated with radiation therapy to kill any remaining cancer cells. Prostate cancer surgery may affect your ability to have sex and control urine, so talk about these issues with your doctor before you have the procedure. Because prostate cancer tends to grow very slowly, your doctor may want to just monitor you with PSA tests and biopsies, and avoid treatment unless the cancer starts to spread. Prostate cancer that has spread is usually treated with surgery, chemotherapy, or hormone therapy. If your doctor discovers prostate cancer in its early stages, before it spreads, it's pretty easy to treat, and even cure. Treatments can also slow down prostate cancer that's spread, and extend your survival. Before you have to deal with a prostate cancer diagnosis, ask your doctor for ways to prevent and screen for the disease. Eating a healthy, low-fat diet that's high in healthy omega-3 fatty acids might help lower your risk. There are also drugs called finasteride and dutasteride that are used in some men to prevent prostate cancer. Talk with your doctor about the pros and cons of these drugs, as well as the possible benefits and risks of having your PSA levels tested.
Normal Results
Normal results from the biopsy suggest that no cancer cells have been found.
What Abnormal Results Mean
A positive biopsy result means that cancer cells have been found. The lab will give the cells a grade called a Gleason score. This helps predict how fast the cancer will grow. Your provider will talk to you about your treatment options.
The biopsy may also show cells that look abnormal, but may or may not be cancer. Your provider will talk with you about what steps to take. You may need another biopsy.
Risks
A prostate biopsy is generally safe. Risks include:
- Infection or severe infection of the blood (sepsis)
- Trouble passing urine
- Allergic reaction to medicines
- Bleeding or bruising at the biopsy site
References
Babayan RK, Katz MH. Biopsy prophylaxis, technique, complications, and repeat biopsies. In: Mydlo JH, Godec CJ, eds. Prostate Cancer: Science and Clinical Practice. 2nd ed. Waltham, MA: Elsevier; 2016:chap 9.
Trabulsi EJ, Halpern EJ, Gomella LG. Prostate biopsy: techniques and imaging. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 150.
Version Info
Last reviewed on: 10/15/2023
Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
