Prostate biopsy

Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
Next review due, May 2020

Prostate biopsy is a procedure that’s used to help diagnose prostate cancer. It involves having small samples of your prostate tissue removed, which are then sent to a laboratory for testing.

There are several types of prostate biopsy, but the most commonly performed is called a transrectal ultrasound-guided (TRUS) biopsy. This is what we’ll mainly focus on here.

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

About prostate biopsy

In a prostate biopsy, small samples of tissue are taken from your prostate gland. Your prostate is about the size of a walnut and lies at the base of your bladder. The back of your prostate presses against your rectum (back passage). The front of your prostate surrounds your urethra (the tube that carries urine from your bladder and out through your penis).

There are two main types of prostate biopsy.

  • Transrectal ultrasound-guided (TRUS) biopsy – this is the most commonly used. An ultrasound probe is inserted into your rectum to produce a scan of the prostate. Directed by the scan, your doctor then takes a number of small biopsies through the probe using a needle. They’ll first inject some local anaesthetic to numb the area around the prostate. The procedure usually only takes about 20 minutes and you can go home afterwards.
  • Transperineal biopsy. If your doctor recommends this test they’ll explain why. It may be because you’ve had a negative TRUS biopsy but they think there’s still a chance you have prostate cancer. In this procedure, your doctor will insert biopsy needles through the skin in the area between your testicles and rectum (your perineum). They’ll insert an ultrasound probe into your rectum to help guide them to the right spot. You’ll have either a spinal anaesthetic, so you’ll be numb from the waist down, or a general anaesthetic, so you’ll be asleep. You may be able to go home the same day.

This article focuses on the TRUS biopsy, as this is the type you’re most likely to have. If your doctor recommends you have a transperineal biopsy they’ll be able to answer any questions you have about that procedure. You can also look at the information on the websites of the organisations listed below. See our section ‘other helpful websites’.

Why have a prostate biopsy?

A prostate biopsy will help to find out whether or not you have prostate cancer. It can also help your doctor decide on the best kind of treatment to offer you. Your doctor will probably do two tests before recommending you have a prostate biopsy.

The first of these is a blood test to find out your level of a substance called prostate specific antigen (PSA). PSA is made by both healthy and cancerous cells in your prostate. If you have a high level of PSA, it may indicate that you have prostate cancer. However, a high PSA level doesn’t always mean that you have cancer. Bear in mind that more often it’s caused by other, less serious prostate diseases and infections.

The second test is a digital rectal examination to check the size of your prostate. This involves your doctor inserting a finger into your rectum to feel your prostate through your rectal wall (they will wear gloves). If your doctor thinks it’s harder than usual or knobbly, they may recommend that you have a prostate biopsy. (You can find out about having this examination in our article on prostate problems.)

As well as the results of these tests, your doctor will take into consideration other things that may affect your risk of prostate cancer. These include your age, your ethnicity and whether other close relatives have had prostate cancer.

Ask your doctor about the advantages and disadvantages of having a prostate biopsy in your particular circumstances. You may want to read our FAQ below on the accuracy of prostate biopsy for more information.

Preparing for a prostate biopsy

A transrectal ultrasound-guided (TRUS) prostate biopsy is usually done in hospital or an outpatient clinic as a day-case procedure. This means you have the procedure and go home the same day. You can eat and drink as normal before you have the biopsy.

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

Your doctor will give you antibiotics before the biopsy to help prevent any infection. You may also be prescribed antibiotics to take for a few days after the procedure. 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 doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, your doctor will ask you to sign a consent form.

What are the alternatives to a prostate biopsy?

A prostate biopsy helps your doctor find out if you have prostate cancer. It’s usually recommended if a blood test shows a high PSA level or your prostate feels abnormal when you have a rectal examination. See our section on ‘why have a prostate biopsy?’ above for more information.

The alternative to having a prostate biopsy may be for your doctor to keep an eye on you, and to have repeat blood tests.

Your doctor might also recommend that you have an MRI scan of your prostate. Doctors now think this type of scan may be able to help decide if you have a cancer that needs treating.

Ask your doctor to discuss the pros and cons of having a prostate biopsy in your particular circumstances.

What happens during a prostate biopsy?

You’ll be given a local anaesthetic to ease any discomfort. So you’ll stay awake during the procedure but pain will be blocked from your rectal area.

The procedure usually takes up to 20 minutes.

You’ll need 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 a lubricated ultrasound sensor through your anus and into your rectum. The sensor may be covered with a condom. Let your doctor know beforehand if you’re allergic to latex so they can use an alternative type. The sensor may feel uncomfortable but shouldn’t be painful. Images of your prostate will be displayed on a monitor. Your doctor will use the images as a guide when they take biopsies of your prostate through the wall of your rectum.

Before your doctor takes a biopsy, they’ll give you an injection of local anaesthetic around your prostate. Your doctor will then pass a biopsy needle down the shaft of 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 having the biopsies taken slightly uncomfortable but try to keep still. After the procedure, 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, to make sure you’ve recovered from the anaesthetic.

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

Make sure you arrange for someone to take you home. It’s good to have someone to stay with you for a day or so after the procedure.

Recovering from a prostate biopsy

If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine carefully. If you have any questions, ask your pharmacist for advice.

Take it easy at home for a couple of days and then you should be fine to get back to your usual activities. Drink plenty of fluids during this time – perhaps twice as much as you normally would.

It’s normal to have some blood in your urine, faeces (stool) and semen after this sort of biopsy so don’t be alarmed if you do. This will last from a few days (in your urine) to up to six weeks (in semen).

If you’ve been given them, it’s important that you complete your course of antibiotics – usually three days – to help prevent an infection.

Contact your GP, or the hospital (or if out of hours the hospital emergency department) if you have:

  • severe pain or pain that lasts for more than two days
  • difficulty going to the toilet (urinating)
  • a burning sensation when you go to the toilet, or if your urine starts to smell
  • increasing amounts of blood in your urine or faeces
  • a high temperature

If you get a high temperature, and especially if it comes with uncontrollable shivers and chills, seek urgent medical attention. You may have an infection and need stronger antibiotics.

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Common side-effects of a transrectal ultrasound-guided prostate biopsy include:

  • some discomfort or pain in your rectal area. If the pain is severe or gets worse contact your GP or the hospital.
  • a small amount of blood in your urine, faeces or semen. This may last a few days in your urine. It may take weeks for blood to disappear from your semen. If you have severe bleeding or are passing clots contact your GP or the hospital.

Complications of a prostate biopsy

As with every procedure, there are some risks associated with transrectal ultrasound-guided (TRUS) prostate biopsy. Complications are when problems occur during or after the procedure, and include the following.

  • Your biopsy may need to be repeated. This could be because the original biopsy didn’t provide good enough samples to show if you have cancer or not. It could also be because your prostate specific antigen (PSA) level continues to rise even though your initial biopsy shows no cancer.
  • An infection. Your doctor will prescribe you antibiotics to treat the infection. If left untreated it can become severe and you’ll need to be admitted to hospital. So it’s important to seek medical attention if you get a high temperature, especially with chills and shivers.
  • Difficulty urinating. This can happen if you have a blockage in your urethra caused by a blood clot or because your prostate is swollen. If you have difficulty urinating after your biopsy, make sure you get medical attention straight away.

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 will get the results. We know that waiting for your results can be worrying, but it takes some time for the laboratory scientists to examine your biopsy samples carefully. Your results should be ready within about two to three weeks and will usually be sent to the doctor who requested your biopsy. If necessary, your results will be discussed by a team of doctors and other cancer experts at the hospital (the multidisciplinary team, MDT).

    Your doctor will go through the results with you at your follow-up appointment, answer any questions you have and discuss with you what happens next.

  • A transrectal ultrasound-guided (TRUS) prostate biopsy is used to detect prostate cancer. But no diagnostic test is ideal. There are two main issues to think about with a prostate biopsy. Sometimes the biopsy will miss cancers in your prostate gland. And sometimes the biopsy will find a cancer, but it’s one that wouldn’t have actually caused you any problems in your lifetime.

    Your doctor will take 10 to 18 samples to see if you have cancer. But the biopsy can only show if there’s cancer in the tissue samples taken. If no cancer is found in the samples (a ‘negative’ result) it doesn’t definitely mean that no cancer is present at all. There could be a small cancer that the needles didn’t reach. As many as one in five prostate tumours may be missed by a TRUS prostate biopsy.

    If your biopsy doesn’t find a cancer, your doctor may continue to monitor your prostate with further prostate specific antigen (PSA) tests. If your PSA continues to rise, your doctor may recommend you have another biopsy to see if a cancer was missed the first time. Alternatively (or as well as), you may be offered an MRI scan.

    Just because you have cancer in your prostate doesn’t mean it will always cause problems in your lifetime. You may have a slow growing or non-aggressive cancer. Prostate biopsy may find one of these cancers. Finding out that you have this type of prostate cancer may not be the best thing for you. You may have treatment, and that can have side-effects. These side-effects may, for some men, be worse than the effects of the cancer itself.

    Taking all this into account, it’s your decision whether to go ahead and have a biopsy done. Ask your doctor to explain the pros and cons of having a prostate biopsy in your particular circumstances.

  • This is something that you should ask your doctor when you have your biopsy. They may advise you to wait for a few days before you have sex. There are no hard and fast rules.

    You may have some blood in your semen for up to six weeks after your biopsy. This won’t cause any harm to you or your partner.

  • You may have a little pain and discomfort in your rectal area after having a prostate biopsy. So it’s best to sit quietly at home for the first two days afterwards. As long as you don’t have complications you should be able to resume your usual activities then.

    When you have your biopsy, ask your doctor about resuming your exercise and sporting activities. They’ll be able to discuss with you what’s best in your particular circumstances. If you have more pain or bleeding after exercising, contact your GP.

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Related information

    • Prostate cancer. BMJ Best Practice., last updated 23 February 2017
    • Prostate Biopsy Technique. Medscape., updated 25 April 2016
    • Prostate anatomy. Medscape., updated 16 September 2013
    • Map of Medicine. Prostate Cancer. International View. London: Map of Medicine; 2017 (Issue 1)
    • Transrectal prostatic ultrasound and biopsy. The British Association of Urological Surgeons., published March 2016
    • Transperineal biopsy of the prostate. The British Association of Urological Surgeons., published March 2016
    • Prostate biopsy. Prostate Cancer UK., updated July 2016
    • The PSA test. Prostate Cancer UK., updated November 2016
    • Digital rectal examination (DRE). Prostate Cancer UK., updated November 2016
    • Ultrasound guided prostate biopsy. Royal Australian and New Zealand College of Radiologists., page last modified 26 September 2016
    • Ahmed H, El-Shater Bosally A, Brown, L, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017; 389:815–22. doi:10.1016/S0140-6736(16)32401-1
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, May 2017
    Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
    Next review due, May 2020

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