What is a Prostate Biopsy?

A prostate biopsy is a procedure used to obtain tissue samples from the prostate to detect cancer. It is usually done if a prostate-specific antigen (PSA) test or rectal exam suggests an abnormality. A prostate biopsy helps find prostate cancer cells. Prostate cancer begins in the prostate gland.

The prostate is a small gland in men, located below the bladder and in front of the rectum. It is approximately the size and shape of a walnut.

Why Your Doctor Might Recommend a Prostate Biopsy?

Common reasons for a prostate biopsy procedure:

• Rectal exam abnormalities — If your doctor identifies abnormalities, such as a lump, during a rectal exam, you may need a prostate biopsy to determine whether cancer is present.
• Prostate-specific antigen (PSA) test — If your PSA levels are above a certain number, you may need to have a prostate biopsy to identify possible cancer cells.
• Previous biopsy with abnormal cells — Previous biopsies with abnormal but not cancerous cells may indicate the need for another prostate biopsy.
• Family history of prostate cancer — If your brother, father, or son has had prostate cancer, you may be at a higher risk for developing the disease.
• Previous biopsy with elevated PSA levels — If your PSA levels have been elevated, you may need a prostate biopsy to confirm that the elevated numbers are from an infection or inflammation and not from cancer. 

Potential Risks

There are potential risks associated with getting a prostate biopsy.

These risks include:

• Trouble urinating — Urinating may be difficult or painful.
• Bleeding — You may bleed from your biopsy site.
• Blood when you urinate — Seeing some blood in your urine is common.
• Blood when you empty your bowels — It is common to see some blood in your feces.
• Blood when you finish — You may see blood and feel some pain when you finish.
• Infection — In rare cases, you may develop an infection in your prostate or in the tubes that allow urine to flow through your body.

Types of Biopsy Procedures

Your doctor may recommend one of several different types of prostate biopsy. The biopsies differ by site and method. Currently, there are five recognized types of prostate biopsy.

Types of prostate biopsy:

• Random 12-Core Biopsy — In this biopsy, your doctor uses a needle to collect 12 tissue samples from all parts of the prostate gland using a random pattern approach. The randomized collection allows for a more accurate diagnosis of prostate cancer.
• Imaging Guided Biopsies — In this type of biopsy, your doctor uses special imaging, such as magnetic resonance imaging (MRI) or ultrasound, to identify areas of abnormality. Your doctor then guides a needle into the prostate gland where tissue samples are collected.
• Transrectal — In a transrectal prostate biopsy, your doctor inserts a needle directly through the rectum to collect tissue samples from the prostate.
• Transperineal — During a transperineal prostate biopsy, your doctor inserts a needle between the scrotum and anus, to collect tissue samples from the prostate.
• Transurethral — In this type of biopsy, your doctor inserts a needle through the urinary opening to collect tissue samples from the prostate.

Your doctor will decide which type of biopsy is best for you based on your symptoms, age, test results, and other personalized health factors.

How to Prepare for a Prostate Biopsy

Your doctor will let you know how best to prepare for your prostate biopsy.

Prostate biopsy preparation often includes:

• Detailed Explanation — Your doctor will explain the procedure, the benefits, the risks, and what to expect before, during, and after your biopsy.
• Paperwork —You will be asked to sign consent forms for the procedure and explore health insurance authorization.
• Medical Review — Your doctor will review your general health, medical history, and may perform a physical exam.
• Medications — Your doctor will review your current medication use and any history of medications. Inform your doctor of any medication you take, especially blood thinners, as they can affect the procedure. Your doctor may prescribe antibiotics to help prevent infection.
• Enema —Your doctor will usually recommend an enema the night before or the morning of your prostate biopsy to clear your body for the procedure.
• Clear Fluids — Your doctor might also recommend that you drink a lot of water a few hours before your biopsy. A full bladder makes it easier for your doctor to examine your prostate with imaging tools.
• Outfit — You will wear a hospital gown for the procedure. Your doctor may suggest that you bring loose-fitting clothing to wear after your procedure.
• Drive Home — Your doctor will generally ask you to organize a ride home from the hospital after the procedure.

What to Expect During a Prostate Biopsy

A prostate biopsy is generally performed in a hospital and can usually be completed in 15 to 45 minutes. The average timeframe is approximately 20 minutes.

Before the procedure, you will be given a local anesthetic to numb the area where the needle is inserted into your rectum so that you do not feel pain during the biopsy. Some physicians prefer general anesthetics.

You may also receive antibiotics to prevent infection before and after your biopsy.

Depending on the type of prostate biopsy you receive, your doctor may position your body on your side or your stomach. During a prostate biopsy, a urologist inserts a thin needle into your body and may use imaging technology to guide it into your prostate gland.

Once the correct location is reached, the doctor removes tissue from your prostate gland. Generally, the urologist will take several samples from various parts of your prostate. You might feel pressure and mild pain each time a sample is taken.

The tissue can then be examined under a microscope to determine whether cancer cells are present. In most cases, results from the biopsy will help doctors confirm or rule out a diagnosis of prostate cancer.

What To Expect After a Prostate Biopsy

After your prostate biopsy, you may feel groggy from the anesthesia, and you may experience some pain or bleeding. Your doctor will likely release you the same day with instructions on how to care for your insertion site and prostate at home. They will also recommend that you avoid strenuous activity for the next day or two. Otherwise, you could unintentionally injure yourself.

Your doctor might also prescribe an antibiotic to further prevent infection.

Before you leave the hospital, your doctor may give you initial indications of your biopsy results. However, full results can take from a few days up to one or two weeks to come back.

Results and Outcomes

A pathologist will review your tissue samples and create a post-procedure pathology report. A pathologist is a doctor trained to diagnose cancer and other abnormalities.

The report may include:

• Diagnosis — Your doctor will go over the pathologist’s diagnosis with you and if the pathologist recommended additional tests.
• Progression — The report may include a Gleason Score, which is essentially a grade of the aggressiveness of cancer. The score ranges from one to ten. The higher the score, the more aggressive the cancer.
• Description of tissue sample — The report might include a description of the color and consistency of the prostate tissue sample.
• Description of cells — The report will likely include a description of the appearance of your prostate cells as viewed by a microscope.