Prostate biopsy

Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
Next review due November 2022

Prostate biopsy is a procedure to remove small samples of your prostate tissue. It’s used to help diagnose prostate cancer. It can also help your doctor decide on the best treatment to offer you if you do have cancer.

Your prostate gland is around the size of a walnut and lies at the base of your bladder. The back of your prostate presses against your back passage (rectum). The front of your prostate surrounds your urethra (the tube that carries urine from your bladder and out through your penis).

An image showing the position of the prostate gland and surrounding structures

Why would I have a prostate biopsy?

A prostate biopsy takes small samples of tissue from your prostate gland. These samples are sent to a laboratory for testing. The procedure can be used to diagnose prostate cancer and some other prostate problems. Your doctor may offer you a prostate biopsy based on the results of previous tests you’ve had. Previous tests might include a PSA test, a digital rectal examination and possibly an MRI scan.

A PSA blood test finds out your level of a substance called prostate specific antigen (PSA). PSA is made by both healthy and cancerous cells in your prostate. If your PSA level is high, this may mean you have prostate cancer or another prostate problem. But your doctor won’t recommend a prostate biopsy just because your PSA level is high. They’ll take into account other things such as the size of your prostate gland and your risk of prostate cancer. They may also suggest what’s called ‘watchful waiting’ which involves monitoring your PSA level over time.

In a digital rectal examination, your doctor will check the size of your prostate gland. They’ll insert a finger into your rectum to feel your prostate gland. If your doctor thinks your prostate is harder than usual or knobbly, they may recommend you have an MRI or prostate biopsy. There are two main types of prostate biopsy.

  • Transrectal ultrasound-guided (TRUS) biopsy. This is the most common type of prostate biopsy. An ultrasound probe is put into your rectum to create a scan (picture) of your prostate. Your doctor takes several small biopsies (tissue samples) using a needle which goes next to the probe. They’ll first inject some local anaesthetic to numb the area around your prostate. The procedure usually takes 20 to 30 minutes and you can go home afterwards.
  • Transperineal biopsy. This type of biopsy is becoming more widely available than it used to be. Your doctor will insert biopsy needles through the skin in the area between your testicles and rectum (this area is called your perineum). They’ll put an ultrasound probe into your rectum to help guide them to the right spot. You’ll have either a general anaesthetic so you’ll be asleep, or a spinal anaesthetic so you’ll be numb from the waist down. Or you may be able to have the procedure under a local anaesthetic, which numbs the area. You may be in hospital for a day.

This article focuses on the transrectal ultrasound-guided (TRUS) biopsy. If your doctor recommends you have a transperineal biopsy, they’ll be able to answer any questions you have about that procedure.

Preparing for a prostate biopsy

You’ll usually have a transrectal ultrasound-guided (TRUS) prostate biopsy as a day-case procedure. This means you have the procedure and go home on the same day. You can eat and drink as normal before you have the biopsy.

You’ll usually be given some special compression stockings to wear during the procedure. Wearing these stockings will help to reduce your chances of getting blood clots in your legs that may travel to your lungs. You may need to wear these stockings for a while when you go home as well – your doctor will discuss this with you. If you’re allergic to latex, tell your doctor before your biopsy because they may need to use some different equipment.

If you take anticoagulant medicines to prevent blood clots (for example, warfarin, aspirin or clopidogrel), you should tell your doctor before your biopsy. You may need to stop taking these medicines before your biopsy because they could increase your risk of bleeding after the procedure. Your doctor will tell you if you should stop your medicines and if so, for how long. Don’t stop taking any medicines without checking with your doctor first. If you’re unsure about taking any of your medicines, contact your hospital.

Your doctor may give you antibiotics before the biopsy to help prevent an infection. You may be prescribed antibiotics to take for a few days after the procedure too. Always read the patient information leaflet that comes with your medicine carefully. If you have any questions about your medicines or how to take them, ask your pharmacist.

Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed, so you are happy to give your consent for the operation to go ahead. You’ll be asked to do this by signing a consent form.

What are the alternatives to a prostate biopsy?

Your doctor will take into account your previous test results and your individual circumstances and risk factors when deciding what to recommend as your next steps. For example, rather than suggesting a prostate biopsy, your doctor may keep an eye on your symptoms and do regular blood tests.

In many hospitals, you may have a special type of magnetic resonance imaging (MRI) scan before or instead of having a prostate biopsy. This is called a multi-parametric MRI (mpMRI) scan. The mpMRI scan may help your doctor decide if you need a prostate biopsy or your cancer needs treating.

What happens during a prostate biopsy?

You’ll be given a local anaesthetic to ease any discomfort. So you’ll stay awake but you won’t feel any pain from the procedure. The procedure usually takes around 20 to 30 minutes.

You’ll be asked to change into a hospital gown that opens at the back. Your doctor will ask you to lie on your left side with your back to them and with your knees drawn up towards your chest.

Your doctor will carefully pass an ultrasound sensor into your rectum. The sensor may be covered with gel to make this more comfortable. You may feel some vibration as the sensor scans your prostate gland. Pictures of your prostate will be shown on a screen. Your doctor will use the pictures as a guide when they take the biopsies (samples).

Before your doctor takes the samples, they’ll give you an injection of local anaesthetic around your prostate. Your doctor will pass a biopsy needle next to the ultrasound sensor and collect several samples of prostate tissue. The biopsy needle is spring-loaded and will make a loud noise each time it’s fired, so you need to be prepared for this. You may find the procedure slightly uncomfortable but try to keep still. Afterwards, your tissue samples will be sent to a laboratory for testing.

What to expect after a prostate biopsy

After your prostate biopsy, you’ll usually need to stay at the hospital for at least 30 minutes until the anaesthetic wears off. Your doctor may also ask you to wait until you’re able to pee properly. This is because a biopsy can make your prostate gland swell up for a while, which can make it harder to pee.

Your doctor or nurse may give you antibiotics and a date for a follow-up appointment to discuss your results. They should also give you a number to call and information about who to contact if you have problems in the first few days after your biopsy.

You shouldn’t drive straight away after a prostate biopsy, so make sure you arrange for someone to take you home.

Recovering from a prostate biopsy

Your prostate gland may feel a bit bruised after the procedure. If you need pain relief, you can take over-the-counter painkillers such as paracetamol. Always read the patient information that comes with your medicine. If you have any questions, ask your pharmacist for advice.

You should be able to get back to your usual activities almost straight away but take it easy for a couple of days. Drink plenty of fluids – perhaps twice as much as you normally would.

It’s normal to have some blood in your urine, poo and semen after a prostate biopsy so don’t be alarmed if you do.

If you’ve been given antibiotics, it’s important that you complete the full course to help prevent an infection. Contact the hospital (or if out of hours the hospital emergency department) if you have:

  • bad pain or discomfort that doesn’t go away
  • difficulty peeing
  • a burning feeling when you pee
  • smelly urine
  • increasing amounts of blood in your urine or poo

If you get a high temperature, especially with uncontrollable shivers and chills, seek medical advice straight away. This may mean you have an infection and will need stronger antibiotics.

Side-effects of a prostate biopsy

Side-effects are the mostly temporary effects that you may have after a procedure. Everyone responds differently to a prostate biopsy but afterwards you may have:

  • some discomfort or pain around your rectum – if this is very bad or gets worse, contact the hospital
  • a small amount of blood in your urine, poo or semen – this may last from a few days in your pee to up to a couple of months in your semen; if you have a lot of bleeding or you’re passing blood clots, contact the hospital

Complications of a prostate biopsy

A prostate biopsy is usually a safe procedure but sometimes there may be some complications.

  • Your biopsy may need to be repeated. This could be because the original biopsy didn’t get good enough samples to show whether or not you have cancer. It could also be because your prostate specific antigen (PSA) level keeps rising even though your initial biopsy didn’t find any cancer.
  • You may get an infection. Your doctor will prescribe antibiotics to treat the infection. If the infection is very bad, you may need to be admitted to hospital for a while. It’s important to see a doctor or nurse if you get a high temperature, especially with chills and shivers.
  • You may have difficulty peeing. This can happen if you have a blockage in your urethra caused by a blood clot or because your prostate is swollen. If you’re finding it hard to pee after your biopsy, contact a doctor or nurse straight away.
  • You may have problems getting or keeping an erection. Sometimes a biopsy can damage the nerves that control erections. This should get better after a couple of months.

The chance of any of these happening is different for everyone. Ask your doctor to explain how these risks may apply to you.

Frequently asked questions

  • When you have your biopsy, your doctor or nurse will tell you when and how you’ll get the results. Waiting for your results can be worrying, but it takes some time for the laboratory scientists to examine your biopsy samples carefully. This may take up to two weeks.

    Your results will be checked by a team of doctors and other cancer experts at the hospital. A hospital doctor or specialist nurse will discuss your results with you at a follow-up appointment.

    You may wish to take a friend or relative with you when you get your results.

  • No diagnostic test is completely accurate. Doctors usually take several samples of your prostate tissue during the biopsy, which increases the chances of finding any cancer. But sometimes the biopsy still misses cancerous cells. Or sometimes the biopsy will find a very slow-growing cancer that wouldn’t have caused you any problems in your lifetime.

    If the doctors don’t find any cancer in the biopsy samples, this is likely to be reassuring. But your doctor will discuss the results with you as it doesn’t definitely mean that you don’t have prostate cancer. There could be a small cancer that the biopsy needles didn’t reach.

    Your doctor may keep monitoring your prostate with further prostate specific antigen (PSA) tests to see if anything changes in the future. If your PSA continues to rise, your doctor may recommend you have another biopsy or an MRI scan.

  • You can usually have sex straight away after a prostate biopsy, as long as you feel well enough. If you’re unsure, ask your doctor about this when you have your biopsy.

    You may have some blood in your semen for up to six weeks after your biopsy. This won’t harm you or your partner, but you may wish to use condoms until the bleeding stops.

  • Everyone recovers differently from a prostate biopsy. As long as you don’t have any complications, you should be able to get back to your usual activities straight away. But if you have any pain and discomfort around your rectum after the procedure, you may wish to rest for a while afterwards.

    When you have your biopsy, ask your doctor about getting back to exercise and sporting activities. They’ll be able to discuss what’s right for you. If you have more pain or bleeding after exercising, contact the hospital.

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Related information

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    • Prostate biopsy. Prostate Cancer UK., updated January 2019
    • Prostate anatomy. Medscape., updated September 2017
    • Urology. Oxford Handbook of Operative Surgery (online). 3rd ed. Oxford Medicine Online., published online May 2017
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    • Prostate cancer. Patient., last edited March 2019
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  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, November 2019
    Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
    Next review due November 2022