Patient education: Prostate biopsy (The Basics)

What is a prostate biopsy? — A prostate biopsy is a procedure to check the prostate for cancer or other problems. The prostate is a gland that surrounds the urethra (the tube that carries urine from the bladder out through the penis) (figure 1). For a biopsy, a doctor takes a small sample of tissue from the prostate.

You might get a prostate biopsy if:

●A blood test shows that your PSA level is high – PSA stands for "prostate-specific antigen." It is a protein made by the prostate. PSA levels usually go up when a person has prostate cancer. But they can also go up for reasons that do not involve cancer. A prostate biopsy can help your doctor figure out the cause of a high PSA.

●Your doctor finds a problem during a "digital rectal exam" – For a digital rectal exam, your doctor puts a gloved finger into your rectum to feel your prostate. If they feel a lump or thickened area during this exam, they might do a prostate biopsy to help figure out the cause.

How do I prepare for prostate biopsy? — Before your procedure, your doctor will do an exam and ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries or biopsies, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk. You might need to stop certain medicines for a time before your biopsy.

The doctor or nurse will tell you if you need to do anything special to prepare. In some cases, the doctor might prescribe a medicine to help you relax during the procedure.

Before the procedure, you might need to:

●Use an enema or suppository to clean out your rectum.

●Get a urine test to check for bacteria.

●Take an antibiotic.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during prostate biopsy? — This depends on:

●If you have had a prostate biopsy before

●If the biopsy is done in a doctor's office or in the hospital

●The type of biopsy

●How many tissue samples the doctor takes

When it is time for the procedure:

●You might get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Sedatives – These are medicines to make you relax and feel sleepy.

●The doctors and nurses will have you lie on your side with your knees and hips bent for the procedure. They will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor might use an imaging test such as an ultrasound, MRI, or CT scan to take pictures of your prostate. The pictures will guide the doctor as they do the biopsy. Sometimes, the imaging test is done before the procedure. Other times, the doctor does the imaging test during the procedure.

●The doctor will take a small amount of tissue from the prostate. This can be done in 1 of 2 ways:

•Transrectal biopsy – The doctor inserts a small ultrasound probe into the rectum. A needle goes through the probe and removes small pieces of tissue.

•Transperineal biopsy – The doctor inserts the needle through the skin between the anus and the scrotum to take the tissue samples.

●The procedure takes about 15 minutes.

What happens after prostate biopsy? — After the procedure, the staff will watch you closely as your anesthesia wears off. Most of the time, you can go home a short time after your biopsy.

As you recover:

●It is common to have a small amount of bright red blood from your rectum. You might also have a small amount of blood in your urine or semen.

●You will get medicine to help with pain, if needed. You can take non-prescription medicines to relieve pain, such as acetaminophen (sample brand name: Tylenol). The doctor might recommend that you avoid ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve) because they can increase your risk of bleeding.

●Apply a cold gel pack, bag of ice, or bag of frozen vegetables to your perineum every 1 to 2 hours, for 15 minutes each time. Put a thin towel between the ice (or other cold object) and your skin. Some people find it helpful to use ice for the first 2 days after their biopsy.

You can go back to your normal activities after the procedure, including having sex. Some people are more comfortable if they avoid activities like riding a bike, motorcycle, or horse for about a week.

Your doctor or nurse will tell you when to expect your results.

What are the risks of prostate biopsy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding from your rectum, or blood in your urine or semen

●Very bad pain

●A tear in the wall of the bladder or rectum

●Trouble urinating

●Trouble getting an erection

When should I call the doctor? — Call for advice if:

●You have a fever of 100.4°F (38°C) or higher, or chills.

●You are not able to urinate, and your bladder feels full.

●You have pain or burning when you urinate that lasts for more than a few days.

●You have large blood clots (the size of a quarter or bigger) in your urine or start seeing more blood in your urine.

●Your urine is thick or cloudy, or has a bad smell.

●You have more bleeding from your rectum.

●You have very bad pain in your belly that is not helped by pain relievers.

More on this topic

Patient education: Benign prostatic hyperplasia (enlarged prostate) (The Basics)
Patient education: Surgery for benign prostatic hyperplasia (The Basics)
Patient education: Prostate cancer (The Basics)
Patient education: Prostate cancer screening (PSA tests) (The Basics)
Patient education: Choosing treatment for low-risk localized prostate cancer (The Basics)
Patient education: Prostate removal surgery (The Basics)

Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics)
Patient education: Prostate cancer screening (Beyond the Basics)
Patient education: Treatment for advanced prostate cancer (Beyond the Basics)