What Happens During a Prostate Biopsy?

Your doctor has recommended you undergo a biopsy of your prostate gland. Perhaps your prostate-specific antigen (PSA) blood test results were higher than normal for your age. Your doctor may have detected some abnormalities during your digital rectal exam. In any case, if you have never had this procedure before, you are probably wondering what happens during a prostate biopsy.

How do you prepare for a prostate biopsy?

Your doctor will ask you to provide a urine sample to make sure you don’t have a urinary tract infection. If such an infection is detected, you will need to delay your biopsy until it clears. If you get the all-clear, then you will need to cease taking any medication that can increase the risk of bleeding, such as aspirin, ibuprofen, warfarin, and certain natural supplements such as vitamin E.

The night prior to the biopsy, you will need to do a cleansing enema at home. Approximately 30 to 60 minutes before you undergo the procedure, you will take an antibiotic to help prevent infection that may occur as a result of the biopsy.

What happens during a prostate biopsy?

A prostate biopsy involves collecting minute tissue samples from your prostate. This can be achieved in one of two ways, of which the first is the most common:

The surgeon passes a needle through the rectal wall (called a transrectal biopsy); or

The surgeon makes a small cut in the perineum (area between the anus and scrotum; called a transperineal biopsy) and inserts a needle to obtain the samples. Surgeons generally use a CT or MRI scan to guide them through this procedure.

In either case, you will be asked to lie on your side and bring your knees up toward your chest or to lie on your stomach. If you are having a transrectal procedure, an ultrasound probe will be inserted into your rectum to obtain images of your prostate. Once the surgeon has identified the section of the prostate from which the samples will be harvested, he or she will give you an injection to numb the area.

The ultrasound images allow the surgeon to accurately retrieve tissue samples using a spring-loaded needle. In most cases, 10 to 12 samples are taken and the procedure is over in about 10 minutes.

In cases of a transperineal biopsy, several dozen samples may be taken. Although a transperineal biopsy is more complex than a transrectal procedure, it can allow surgeons access to areas of the prostate that are more challenging to biopsy. This procedure may be used for men who have already had a transrectal prostate biopsy that did not identify the cause of an elevated PSA. One advantage of the transperineal biopsy is that the risk of infection is less than with a transrectal biopsy because the needle does not make contact with the rectum and potential infectious organisms.

What can you expect after a prostate biopsy?

Men who undergo a transrectal biopsy typically go home the same day, while those who have a transperineal biopsy may need to stay in hospital for 24 hours. Your doctor will recommend you engage in light physical activities only for 24 to 48 hours (the latter for transperineal biopsy). You can expect to take an antibiotic for several days and experience the following side effects: mild soreness, light rectal bleeding (transrectal biopsy), and blood in your urine and/or stools for several days. A bruised scrotum or perineum are common. Blood in the semen may last for up to 12 weeks. Over-the-counter pain killers may be taken to manage any discomfort.

See also: What To Do After A Prostate Biopsy