What Is a Prostate Biopsy?
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Medically reviewed by Jamin Brahmbhatt, MD
A prostate biopsy is a procedure that involves extracting tissue samples from the prostate and examining them under a microscope to check for the presence of cancerous cells. The prostate is a small, walnut-shaped reproductive organ present in people assigned male at birth. It produces fluid that helps form semen. The muscles from the prostate also help expel semen during ejaculation.
A prostate biopsy is usually performed by a urologist, a medical doctor who specializes in the urinary system. This procedure is generally performed when other tests, such as a prostatic-specific antigen (PSA) blood test or prostate MRI, suggest prostate cancer. Other healthcare providers involved in prostate cancer evaluation may include radiologists, pathologists, and medical oncologists.
Purpose
The primary purpose of a prostate biopsy is to determine if you have prostate cancer. Urologists typically recommend this test when:
There is a clinical suspicion of prostate cancer
An abnormality, such as a lump, is detected during a digital rectal exam, a test carried out to examine the lower rectum and pelvis
You have a higher than normal prostatic-specific antigen (PSA), a protein produced by the prostate that can indicate cancer when present in high amounts
There is an abnormal lesion found on your prostate during magnetic resonance imaging (MRI), a noninvasive medical imaging test
After analyzing the biopsy test result, a pathologist will be able to determine whether the tissue samples extracted have cancer cells.
Types of Prostate Biopsy
A core needle biopsy, which involves using a hollow needle to remove a small piece of prostate tissue called “a core,” is the primary method of diagnosing prostate cancer. This prostate biopsy can be carried out in two ways: a transrectal biopsy and a transperineal biopsy.
Transrectal Biopsy
The urologist carrying out this procedure passes a hollow biopsy needle through the wall of the rectum into your prostate to collect a tissue sample. This procedure is now commonly done alongside imaging like transrectal ultrasound (TRUS), a type of imaging that helps guide the needle from the rectum into the prostate. The procedure can be done in the office under local anesthesia or with intravenous (IV) sedation at a surgical center.
When the images from pre-procedure MRI are combined with the ultrasound during the biopsy, the procedure is called an MRI fusion biopsy.
After retrieving the tissue sample, the sample is viewed under a microscope to look for malignant (cancerous) cells.
Transperineal Biopsy
A transperineal biopsy involves passing the biopsy needle through the area of skin between the scrotum and the anus, called the perineum. Ultrasound is still used during this procedure.
This type of biopsy bypasses the rectum and the prostate through the skin. Transperineal biopsies are associated with a lesser risk of infection and rectal bleeding compared to transrectal biopsies.
The procedure can be done in an office setting with local anesthesia or general anesthesia.
Other Biopsies
To check if cancer from the prostate has spread to nearby lymph nodes or areas of the body, other forms of biopsies may be performed, such as:
Fine needle aspiration (FNA): This is a type of biopsy procedure in which a thin needle is used to collect tissue samples from lymph nodes (part of your body’s immune system that helps you fight infection) around the prostate.
Laparoscopic biopsy: During laparoscopic biopsies, a small surgical cut is made in the pelvis, and a laparoscope—a thin rod with light and a small camera at its end—is used to collect tissue samples to check for cancer.
How Does It Work?
The urologist will try to ensure that all areas of the prostate are sampled to reduce the chances of missing a cancerous tumor (if present). One common pattern they use to help achieve this is the 12-core sextant biopsy. This is when they use ultrasound (with or without MRI fusion) to take tissue samples from three areas of the prostate gland (the base, mid-gland, and apex) on both sides. This pattern can be used both during transrectal and transperineal biopsies. More than 12 samples may be taken during a prostate biopsy.
Here is an overview of what to expect before, during, and after a prostate biopsy.
Before the Test/The Pre-Test
Before a prostate biopsy, your healthcare provider may:
Advise you not to take other medications, such as herbal medications, blood thinners, or non-steroidal anti-inflammatory drugs (NSAIDs), about 7–10 days before the procedure
Prescribe antibiotics like Ciproxin (ciprofloxacin) and Vantin (cefpodoxime) a day or two before the procedure to reduce your risk of infections
Suggest a pre-biopsy rectal culture (a type of lab test used to identify bacteria in the rectum) to help them determine the best antibiotic to prescribe
Recommend that you use a Fleet Enema, a liquid medicine that helps with bowel movement, to cleanse the rectum shortly before the procedure.
Walk you through what to expect during and after the procedure
Make sure to bring your health insurance card and a list of any current medications you’re taking with you to your procedure.
During the Test
A prostate biopsy is usually done in your healthcare provider’s office or at a surgical center. During the procedure:
You will need to remove all jewelry and any metallic objects and wear a gown or loose, comfortable clothing. It is best to leave your valuables at home.
Your healthcare provider will ask that you lie on your stomach or one side and pull your knees towards your chest.
They may apply a local anesthetic to the area to numb it, and then apply a gel in readiness for an ultrasound.
They will insert a small ultrasound probe into the rectum to create images of the prostate. They may also combine the real-time ultrasound with a prior MRI result with superior image quality to find the suspicious area where they need to collect the sample.
They will use the imaging tools to guide the biopsy needle, punch it into the target area in the prostate gland, and quickly collect minute-sized cylindrical cores of cells, which will be sent to the lab for analysis.
You may feel mild discomfort when the probe is inserted into the rectum. The biopsy needle may also cause slight pain.
The entire procedure for an ultrasound-guided biopsy may take 10-15 minutes. On the other hand, an MRI-guided biopsy procedure may take between 15-25 minutes, and post-procedure monitoring may take about 45 to 60 minutes (if done under general anesthesia). It may also require injecting contrast material (a dye that helps with improving the contrast of the images on the MRI) into your veins before the sample collection.
After the Test/The Post-Test
Some people may experience soreness in the rectum after the procedure, but that, too, resolves with time. Side effects like nausea, pain, and allergic symptoms may also occur in rare cases. This is also why you will likely stay for brief monitoring after the procedure. The type of anesthesia used will also determine how fast you will recover.
After your healthcare provider confirms that you are okay, they may prescribe more antibiotics and tell you when to expect the biopsy result. They may also advise you to rest and avoid intensive activities for a day or two.
Risks and Precautions
A prostate biopsy is generally safe, but it’s not without risks. Some associated risks include:
Fever
Infection
Blood in urine or semen
Bleeding from the rectum
Pain and soreness
Urinary retention
Using the transperineal biopsy approach and taking antibiotics can help reduce the risk of infection. Mild pain relief medications and anesthetic agents (which reduce sensation) can help ease associated pain and discomfort. Using imaging techniques during a biopsy helps reduce the chances of missing the cancer.
How To Prepare for Prostate Biopsy
Before your prostate biopsy procedure, you can speak to your healthcare team about getting pre-procedure counseling. This will help you prepare for the procedure and also help relieve anxiety. During your counseling, feel free to discuss related topics like:
Where the procedure will take place
What to bring along with you for the procedure
The medications you are currently taking and if you should continue taking them until the day of the biopsy
A list of allergies that could interfere with the procedure (e.g., allergy to the contrast material)
What to eat or drink before the procedure and whether you need to fast (not eat for a while) beforehand
Whether or not your insurance covers the procedure and if you will have a co-payment or out-of-pocket cost.
You may also need to bring someone along for emotional support and to help drive you back home after the procedure. If your biopsy requires general anesthesia, you will not be able to drive afterward.
Results
Biopsy results are usually ready within about 2-5 days after the procedure and are often accessible at your healthcare provider’s office. The result, called a pathology report, will reveal whether the biopsy found cancerous or if there are abnormal cells in your prostate.
Interpreting Your Results
A prostate biopsy result may report:
Negative: This means the pathologist (the healthcare provider who examined your sample) did not find cancer cells in the biopsy sample. You might not need to do more tests if your other tests don’t raise suspicion of prostate cancer. If they do raise suspicion, your provider may suggest you run more tests or repeat the prostate biopsy, as there is a possibility you had a “false-negative” result.
Positive: A positive result means cancer cells are present in the prostate samples, and cancer treatment should be initiated. The result may also include information about which part of the prostate the cancer is located in and the cancer grade (i.e., how abnormal the cells look under the microscope). Cancers with higher grades are more likely to grow and spread faster.
Atypical: A pathologist may report an atypical or suspicious result when they don’t see prostate cancer but notice the cells don’t look normal. Further tests are often needed in this case to find out exactly why the cells appear atypical.
A Quick Review
A positive biopsy test is the only test that can conclusively and dependably confirm a prostate cancer diagnosis. It can be carried out in two major ways: transrectal and transperineal, with or without imaging guidance. The test is considered safe but has some potential risks, such as infection, rectal bleeding, and pain. However, healthcare providers often take precautions to minimize these risks.
You may feel anxious if your healthcare provider suggests a prostate biopsy. Remember that the goal is to find out if there are any cancer cells in your prostate so treatment can begin early. Early detection may increase the chances of treatment success. Depending on the result of your test, your healthcare provider will discuss the next action to take.
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