Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Prostate Biopsy

(Transrectal Biopsy; Transurethral Biopsy; Transperineal Biopsy)
by Michelle Badash, MS
Definition

A prostate biopsy is the removal of a small amount of tissue from the prostate gland. The tissue is examined to determine whether there is cancer .

Reasons for Procedure

This is usually done as a result of an abnormality found by:

  • Prostate specific antigen blood test
  • Digital rectal exam

A prostate biopsy is the only way to determine the presence of cancer cells.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a prostate biopsy, your doctor will review a list of possible complications, which may include:

  • Bruising or prolonged bleeding from the rectum or in urine or semen
  • Difficulty urinating
  • Infection

Factors that may increase the risk of complications include:

  • History of bleeding disorders or easy bruising
  • Sensitivity or allergy to latex, medicines, or anesthesia
  • Use of any prescriptions, over-the-counter medicines, or herbal supplements

Be sure to discuss these risks with your doctor before the procedure.

What to Expect
Prior to Procedure

You may be asked to do the following:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • Begin taking an antibiotic if advised by your doctor.
  • If you will be getting general anesthesia, do not eat or drink anything after midnight.
  • Use an enema several hours before the procedure.
Anesthesia

This depends on the method that your doctor uses:

  • Transurethral biopsy and perineal biopsy:
    • General anesthesia —blocks pain and keeps you asleep through the surgery, given through an IV in your hand or arm
    • Local anesthesia—just the area that is being operated on is numbed, given as an injection and may also be given with a sedative
  • Transrectal prostate biopsy—local anesthesia
Description of the Procedure

Your doctor will use one of the following methods to do the biopsy:

  • Perineal biopsy—Your doctor will make a small incision in the perineum. The perineum is the area between the scrotum and the rectum. The doctor will insert a small needle into the prostate gland to get the biopsy.
  • Transrectal biopsy (most common method)—Your doctor will insert a small ultrasound device into the rectum. This device will emit sound waves to produce an image of the prostate. These images will help guide placement of the needle. Your doctor will then insert the needle through the wall of your rectum and into the prostate gland.
  • Transurethral biopsy—Your doctor will insert a lighted flexible tube through the penis into the urethra. The urethra carries urine from the bladder. Your doctor will get the biopsy with a cutting loop that is passed through the flexible tube.
How Long Will It Take?

About 30 minutes

Will It Hurt?

You may have discomfort and soreness at the biopsy site.

Postoperative Care

When you return home after the procedure, do the following to help ensure a smooth recovery:

  • Be sure to follow your doctor's instructions .
  • Ask your doctor when you can resume taking your blood-thinning medicine.
  • Avoid strenuous activity the day and evening of the procedure.
  • Keep in mind that you may see blood in your urine, stool, or ejaculate for several days.
  • Stay hydrated. Drink plenty of fluids for the next few days.

Once the sample is taken, it will be sent to a pathologist. This doctor will analyze the sample for cancer. If cancer is present, your doctor will work with you to develop a treatment plan.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs: In case of an emergency, CALL 911 .

  • Blood in the urine more than 2-3 days post-biopsy
  • Cough, shortness of breath, or chest pain
  • Inability to urinate
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency, or frequency of urination
  • Persistent rectal bleeding or scant rectal bleeding that lasts more than 2-3 days after the biopsy
  • Signs of infection, including fever and chills

Last reviewed: November 2009 by Adrienne Carmack, MD .

RESOURCES:
CANADIAN RESOURCES:
References:
  • Causes, Natural History & Diagnosis of Prostate Cancer. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=09&topic=39 . Accessed November 10, 2009.
  • How is prostate cancer diagnosed? American Cancer Society website. Available at: http://www.cancer.org/ . Updated July 2009. Accessed November 10, 2009.
  • Prostate cancer: diagnosis. The Urology Channel website. Available at: http://www.urologychannel.com/prostatecancer/diagnosis.shtml . Accessed November 10, 2009.
  • Rodriguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol . 1998;160(6-I):2115-2120.
  • Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis . 2007;10(2):127-36. Epub 2007 Jan 9.
  • Understanding prostate changes: a health guide for men. National Cancer Institute, National Institutes of Health website. Available at: http://www.cancer.gov/PDF/4dba13db-81fb-4d8d-9c2d-d0c00a048f57/prostate_booklet.pdf . Published August 2004. Accessed September 22, 2009.