Prostate Biopsy

Prostate biopsy at a glance

  • A prostate biopsy is the removal of tissue samples from the male prostate gland so a laboratory can examine the tissue for the presence of prostate cancer.
  • A biopsy is generally recommended when a prostate-specific antigen (PSA) screening, a digital rectal exam or an imaging test indicate a suspicious area that requires further examination.
  • We will discuss our findings with the patient and the prospect of conducting a prostate biopsy to learn more.
  • Urologists perform the removal of the tissue in our offices using transrectal ultrasound (TRUS) and a small needle to obtain cell samples from the prostate for a biopsy.
  • The biopsies are sent to the pathology lab where they are stained and reviewed by a pathologist, with results typically available within one week of the biopsy.
  • Prostate biopsy is the only method of definitively diagnosing prostate cancer.

What is a prostate biopsy?

A prostate biopsy can determine if a man has prostate cancer by collecting tissue samples from the prostate gland and having them examined under a microscope in a lab. Prostate biopsy is the only way to definitely diagnose prostate cancer.

The prostate gland is located in front of the rectum at the base of the urinary bladder. It’s normally the size of a walnut and surrounds the urethra tube that carries urine and semen out through the penis. The gland produces fluid that makes up semen, to which sperm is added during ejaculation.

We generally screen for prostate cancer in two ways. First, a doctor can feel for a nodule or other suspicious area on the prostate in a digital rectal exam (DRE), using a gloved and lubricated finger. Second, some abnormalities in the gland will cause an elevated level of the prostate-specific antigen (PSA), which will show up in a blood test.

Doctors may recommend men have a prostate biopsy when one or both of these tests indicates concern about prostate cancer. The DRE or PSA evaluations can suggest the presence of prostate cancer, and they can also indicate noncancerous tumors, infection or just the normal signs of aging, which can result in enlarged prostate, or benign prostatic hyperplasia (BPH). In such cases a biopsy may be necessary to clarify the exact issue.

Our doctors thoroughly discuss the reasons for a prostate biopsy with each patient and review the reasons why they think a biopsy is the best measure to take. We will explain the benefits of a prostate biopsy, as well as the infrequent risks, for the individual man and will answer all his questions.

Haven’t been screened for prostate cancer lately? Don’t wait, please make an appointment.

The prostate biopsy procedure

A urologist safely performs prostate biopsies in the Urology Associates office using local anesthesia. We use a special needle in a prostate needle biopsy (PNBx), approaching the prostate through the rectum wall. The urologist employs ultrasound imaging to inspect the prostate and to precisely guide the needle that takes the biopsy sample. This is known as transrectal ultrasound (TRUS) biopsy.

A tiny bit of the prostate gland is withdrawn through the needle. We will typically withdraw about 12 core samples from different parts of the prostate in order to map multiple areas. This gives us a more complete picture of the gland and possible issues.

We then send these biopsy samples to a pathology lab. We will get the results back in about one week after the biopsy. The urologist will share this information with the patient, including a clear explanation of the pathology report. These results will help us determine with the patient the proper course of action.

Preparing for a prostate biopsy

  • Do not take medications containing aspirin or ibuprofen for 10 days prior to the prostate biopsy. These brand name medications include Plavix, Advil, Motrin, Aleve and Naprosyn. Tylenol is allowed. Patients can continue their medications with aspirin and ibuprofen after the biopsy.
  • Patients should stop taking Coumadin, Pradaxa, Effient, Eliquis or Xarelto 5 days before their prostate biopsy, unless otherwise directed by their urologist.
    • Patients may need a consultation with their primary care provider, cardiologist or hematologist to consider bridge steps between stopping their blood thinner medications and the prostate biopsy. They will be counseled on how to start back on those medications after the biopsy.
  • Biopsy patients should eat before arriving for their procedure.
  • Patients need a Fleets Enema 2 hours before their prostate biopsy.
  • We will give patients a prescription for antibiotics with instructions on when to begin taking the medication before their scheduled biopsy.

What to expect in a prostate biopsy

Our urologists usually take around 10 minutes to complete the prostate biopsy. The man will remain awake during the procedure, and may receive a mild sedative to help him remain calm. We will also give him antibiotics to prevent possible infection. The man may experience some discomfort during the procedure.

Possible complications and considerations

There are rarely any severe after effects of a prostate biopsy. Men can usually go on about their normal activities, and we will discuss this with them at the time of the biopsy.

Occasionally, some men will experience mild discomfort at the biopsy site, but this can be managed by Tylenol or Advil. Some men may notice blood in their urine, which should only last a couple of days. Blood in a man’s ejaculate can occur in decreasing amounts for up to a few weeks, or for several months in rare cases.

Serious rectal bleeding or infection are rare. Men who have had a prostate biopsy should call our offices if they experience elevated temperature, severe pain or bleeding, passage of blood clots or other unexpected symptoms. They should call us immediately if they experience:

  • Fever.
  • Chills.
  • Flu-like symptoms.
  • Difficulty voiding.
  • Excessive rectal bleeding.

FAQs about prostate biopsy

Can the patient have a bowel movement after the biopsy? Yes, a bowel movement is not dangerous and should not be painful.

Will the biopsy affect the man sexually? There are reports of erectile dysfunction (ED) after biopsy with most data indicating temporary issues lasting less than 12 weeks. This may be multi-factorial from stress/anxiety, anatomical, nerve block and hematoma as possible factors. Sometimes blood may appear in semen but this presents no danger to the man or his partner.

Why does a man with no prostate cancer symptoms need a prostate biopsy? Prostate cancers usually don’t present any symptoms during their early stages. So if cancer is present, it is during this “silent” stage that treatment is far more successful. Therefore, it’s important to conduct a prostate biopsy as early as possible, as it is the only means of positively identifying prostate cancer.