Prostate biopsy

If prostate cancer is suspected, doctors may recommend a medical procedure called a prostate biopsy. If you or a loved one are undergoing a prostate biopsy soon, this guide may help you learn more about the procedure.

Why are prostate biopsies done?

To learn about the health of your prostate, your doctor may ask questions about your medical and family history and conduct a physical examination known as a digital rectal exam (DRE). You also may require a PSA blood test. PSA stands for prostate-specific antigen, a type of protein the prostate produces. Certain PSA levels may indicate that something is abnormal within the prostate.

If PSA results are abnormal, a prostate biopsy may be ordered. In general terms, a biopsy is a medical test that involves extracting cells or tissue from a part of the body to look for the presence of disease. In the case of a prostate biopsy, prostate tissue from the prostate gland is removed and examined under a microscope by a pathologist. It’s an important procedure because only a biopsy can definitively diagnose prostate cancer. The PSA blood test and DRE are only indicators that cancer may be present.

Prostate biopsy types

There are several types of biopsies that may be performed, but they all have the same goal—to remove a number of core tissue samples from the prostate. A pathologist then examines these tissue samples under a microscope to see whether cancer cells are present. If they are, the prostate cancer is assigned a grade, based on how likely it is to grow and spread.

A prostate biopsy is likely to be either transrectal or transperineal. For both procedures, a long, hollow needle is used to remove tissue from the prostate. The difference is where the needle is inserted.

• Transrectal biopsy (the most common type of prostate biopsy), through the wall of the rectum
• Transperineal biopsy, through the skin located between the scrotum and anus

How to prepare for the procedure

It’s normal to feel worried or concerned leading up to your biopsy, but try to stay calm. The doctor may provide you with guidelines about what to expect, what to do in advance, and any special information relevant to your health.

• You may be asked to stop taking blood-thinning medications for a few days beforehand.
• A course of antibiotics may be prescribed in advance to reduce the chance of infection.
• It may also be helpful to arrange for a friend or family member to come with you and drive you home, especially if you’re having sedation during the procedure.

What to expect

During the procedure

Usually, a prostate biopsy is performed by a urologist, a doctor specializing in the urinary system (which includes the kidneys, bladder and urethra) and the male reproductive system.

Here is how a prostate biopsy is typically performed:

• Your doctor first injects the biopsy area with a local anesthetic, so you don’t feel pain or discomfort.
• Then, the doctor may set up imaging tests, such as a transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI), to get a clear picture of the prostate, resulting in more accurate positioning when taking the core samples for the biopsy.
• Using a long, hollow, spring-loaded needle, your doctor takes a core sample from the prostate. It’s incredibly fast, with each sample taking less than a second. This may be repeated multiple times, giving your medical team several samples from various parts of the prostate.

The procedure typically takes a few minutes.

Risks and side effects

The risks associated with a biopsy are small, but it’s important to know that all medical procedures have some risk involved. The most common prostate cancer biopsy side effects and complications include:

• Blood in the urine
• Pain or discomfort around the anus and scrotum area
• Light rectal bleeding
• Blood in semen when ejaculating
• Infection

If something doesn’t feel right after your biopsy, call your medical team as soon as possible to get advice.

When will I get my results?

Shortly after the biopsy, your doctor receives the pathology report from the laboratory. You may be asked to schedule a follow-up appointment to go over the results.

Negative result: If the results are negative, this means no cancer cells were found in the core tissue samples taken during the biopsy.

Positive result: If the results are positive, this means cancer cells were identified.

Inconclusive result: In some cases, the results may be inconclusive, which means that additional tests are needed.

If the biopsy is positive, it’s assigned a grade. While the grade assigned to prostate cancer was previously known as a Gleason score, urologists are now moving toward a system known as Grade Groups. Your Grade provides an estimate on how quickly the cancer is likely to grow and spread. The pathology report also identifies how many tissue samples contained cancer, and where they were located.