What Is a Prostate Biopsy?

A prostate biopsy is a procedure to remove small samples of tissue from the prostate gland. It’s a method to test for prostate cancer if a prostate-specific antigen (PSA) blood test or digital rectal exam (DRE) shows signs of cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e59762904c7187c-edba-4203-8b89-ee7e4076055b The biopsy can both confirm a prostate cancer diagnosis, and determine how aggressive the cancer is.e60dc2a1-f33c-4a05-9b50-8e3e8e597629457b51dd-e70b-4f00-8475-1ff3f0b73717
Types Types There are two types of prostate biopsy: transrectal and transperineal. Transrectal biopsy is the most common type performed in the United States.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b9049dc4-aca5-4ae1-9934-648c0276a431 Your doctor will recommend the one that is best for your situation. Transrectal Biopsy During this biopsy, the doctor removes prostate tissue samples through the wall of the rectum, the bottom part of the large intestine.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b9049dc4-aca5-4ae1-9934-648c0276a431 Ultrasound or magnetic resonance imaging (MRI) guides the needle to the prostate gland.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295a6341bc-454c-45f4-9b7e-9eb4cf5715fa Transperineal Biopsy This type of prostate biopsy procedure is performed through the perineum — the area of skin between the scrotum and anus. The doctor inserts the ultrasound probe through the rectum and the needle through the skin of the perineum. A transperineal biopsy enables the doctor to remove tissue samples from many parts of the prostate, similar to the transrectal method.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b9049dc4-aca5-4ae1-9934-648c0276a431
Why Is a Prostate Biopsy Done? Why It’s Done A prostate biopsy is done if your doctor suspects prostate cancer. “Urologists perform prostate biopsies most commonly for elevated PSA, which is a blood test,” says Kenneth G. Nepple, MD , a urologist at University of Iowa Health Care in Iowa City. A less common reason to do this test is when the doctor finds a growth or lump during a digital rectal exam.
How Is a Prostate Biopsy Performed? How It’s Performed A prostate biopsy is done in a doctor’s office, clinic, or hospital. “It’s almost always performed by a urologist, although in special situations it might be performed by a radiologist or radiation oncologist,” Dr. Nepple says. After numbing the prostate, the doctor inserts a spring-propelled needle into the gland and removes pieces of tissue. Usually doctors remove multiple samples from different areas of the prostate to ensure no cancer is missed.e60dc2a1-f33c-4a05-9b50-8e3e8e59762978825f29-bea8-4477-825a-bb0bd7b79388
How Do I Prepare for a Prostate Biopsy? How to Prepare Your doctor will ask you to stop taking any medicines that increase the risk for bleeding a few days before the procedure. These include nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, and blood thinners such as warfarin (Coumadin) or apixaban (Eliquis). Ask whether you should also stop taking any herbal supplements or vitamins.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fe64c3f5-f7ab-4615-bdae-e51c6ece484e Your doctor might test your urine for a urinary tract infection (UTI). If you have a UTI, you’ll have to delay the biopsy until antibiotics clear up the infection.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291ce79000-191c-46d1-a1dd-21e1d2d6cb20 Taking antibiotics the day before and the day of the biopsy can help prevent infection from the procedure. Your doctor will ask you to do an enema at home to clean stool out of your rectum. There is usually no need to fast. You can eat a light meal before the test.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fe64c3f5-f7ab-4615-bdae-e51c6ece484e
What Should I Expect During a Prostate Biopsy? What to Expect A prostate biopsy is an outpatient procedure, which means you will go home afterward. You can either be completely awake during the procedure, or get light sedation through an IV or by mouth to help you relax, says Nepple. During the test you’ll lie on your left side with your knees pulled up to your chest. The urologist will clean the skin of your rectum or perineum and apply gel before inserting the ultrasound probe. The doctor will numb your prostate and then insert the needle through the wall of the rectum or perineum.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a755a57b-27c2-421b-91a0-ea5d8ec693b7 You might feel some pressure as the probe goes in, and some discomfort each time the needle removes a tissue sample.e60dc2a1-f33c-4a05-9b50-8e3e8e597629474bf5c9-5595-40de-80ab-d31378779785 A typical prostate biopsy takes 20 to 30 minutes, but it could be longer if the doctor takes additional tissue samples.e60dc2a1-f33c-4a05-9b50-8e3e8e59762931e54bb5-fe31-4955-bf0a-92c20bf4b57c
What Are the Potential Risks Associated With a Prostate Biopsy? Risks Some of the most common risks from a prostate biopsy are:e60dc2a1-f33c-4a05-9b50-8e3e8e5976292063b58e-5b53-4ea8-91be-0c7339a534d9 Bleeding Blood in the urine or semene60dc2a1-f33c-4a05-9b50-8e3e8e5976291037caca-a8c5-4375-8673-a9843cf8fd0d Bruising Mild pain at the biopsy site Infection Trouble urinating These problems can continue for a few days to weeks after the biopsy. Some men continue to have blood in their semen for months afterward.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291a0518f7-c591-4605-a026-b442bc2bbb7e
What Type of Care Is Needed After a Prostate Biopsy? Follow-Up Care Because you may still be in pain and recovering from sedation, ask someone to drive you home, recommends Nepple. Your doctor will tell you how to care for yourself after the biopsy. Avoid intense exercise, heavy lifting, and sexual activity for a day or two. Continue taking antibiotics for as long as your urologist recommends. Drink extra water in the couple days post-biopsy to avoid constipation, and ask about taking a stool softener, if needed.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fc00382c-0f49-4e64-8467-9aaa011edda9e60dc2a1-f33c-4a05-9b50-8e3e8e5976297563eb44-57fb-4a16-8c2c-6ccdb0892218
What Are the Possible Complications and Side Effects of Prostate Biopsy? Complications The main risk from a prostate biopsy is infection, especially a urinary tract infection (UTI) or prostate infection (prostatitis) . Other risks include blood in the urine or stool and prostate swelling that makes it difficult to urinate. Blood with bowel movements almost always improves on its own. “Blood in the urine can, on rare occasions, require a urinary catheter to be placed,” says Nepple. Watch for these signs of infection or other serious complications:e60dc2a1-f33c-4a05-9b50-8e3e8e597629560183ec-02e3-49a4-848d-7fa499304956 A fever of 101 degrees F or higher Shaking chills Bleeding from the rectum that is heavy or that won’t stop Bright red blood or large clots in the urine Inability to urinate Dizziness
What’s Next The tissue samples go to a lab, where a pathologist examines them under a microscope. It takes about a week for the doctor to get the results, but the length of time varies from lab to lab.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a874c607-e569-429e-9bb9-3df99543c8db A negative test result means no cancer is found. A positive test means there is prostate cancer, which can range from low-grade to aggressive.e60dc2a1-f33c-4a05-9b50-8e3e8e59762989fe228a-be0a-4ab4-9e78-51938818fa1d Your doctor will discuss your biopsy results and next steps with you. If the biopsy result is negative, you may just return for annual PSA tests, or other tests, such as a repeat biopsy. If the test shows cancer or abnormal cells, your doctor will help you decide whether to treat it or monitor it over time, which is called active surveillance .e60dc2a1-f33c-4a05-9b50-8e3e8e597629a874c607-e569-429e-9bb9-3df99543c8db
The Takeaway A prostate biopsy is a procedure that removes small samples of tissue so a doctor can check for cancer after an abnormal PSA test or DRE. The test is done as an outpatient procedure and takes 20 to 30 minutes. Although a biopsy may show cancer, this information can be used by your doctor to treat you more effectively.