A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. The prostate is a small, walnut-shaped gland in men that produces fluid that nourishes and transports sperm. It is performed by a doctor who specializes in the urinary system and men’s sex organs (urologist).
Why the Procedure is Performed
A prostate biopsy is used to detect prostate cancer. Your doctor may recommend a prostate biopsy if:
- Results of a prostate-specific antigen (PSA) test are higher than normal for your age
- Your doctor found lumps or other abnormalities during a digital rectal exam
- You’ve had a previous biopsy that was normal, but you still have elevated PSA levels
- A previous biopsy revealed prostate tissue cells that were abnormal but not cancerousHow the Procedure is Performed
Prostate biopsy samples can be collected in different ways. Your prostate biopsy may involve:
- Passing the needle through the wall of the rectum. This is called a trans-rectal biopsy, and it is the most common way of performing a prostate biopsy. Details are described below.
- Collecting a tissue sample through the tip of the penis. This way of performing a prostate biopsy is called a trans-urethral biopsy. A long, thin tube equipped with a camera is passed through the opening (urethra) at the tip of the penis in order to access the prostate.
- Inserting the needle through the area of skin between the anus and scrotum. This type of prostate biopsy involves making a small cut in the area of skin (perineum) between the anus and the scrotum through which a sample of tissue is drawn out.
- For the trans-rectal prostate biopsy, your doctor will start by having you lie on your side, with your knees pulled up to your chest. In some cases, you may be asked to lie on your stomach. After cleaning the area and applying gel, your doctor will gently insert a thin ultrasound probe into your rectum.
- Trans-rectal ultrasonography is used to create images of your prostate using sound waves. Your doctor will use the images to identify the area that needs to be numbed with an anaesthetic injection, if one is used. The ultrasound images are also used to guide the prostate biopsy needle into place.
- An injection of a numbing medication is then used to reduce the discomfort associated with the prostate biopsy. A needle is used to inject the anaesthetic at various points near
the base of the prostate. Once the biopsy device is situated, your doctor will retrieve thin, cylindrical sections of tissue with a hollow, spring-propelled needle. The procedure typically causes a very brief, uncomfortable sensation each time the spring-loaded needle takes a sample. Your doctor may target a suspicious area to biopsy or may take samples from several places in your prostate. In most cases, doctors will take 10 to 12 tissue samples. The entire procedure usually takes about 5 to 10 minutes.
How to Prepare For the Procedure
To prepare you for your prostate biopsy, your urologist may have you:
- Stop taking medication that can increase the risk of bleeding, such as warfarin, aspirin, ibuprofen and any herbal supplements for several days before the procedure
- Do a cleansing enema at home before your biopsy appointment
- Take antibiotics 30 to 60 minutes before your prostate biopsy to help prevent infectionDuring the Procedure
You will feel discomfort during the procedure. Try to relax as much as possible and ask for numbing medicine if you still feel unbearable pain after the initial one.
After the Procedure
After a prostate biopsy, you’ll probably need to take an antibiotic for a few days. You may feel slight soreness and have some light bleeding from your rectum.
You may have blood in your urine or stools for a few days. You may also notice that your semen has a red or rust-coloured tint caused by a small amount of blood in your semen. This can last for several weeks. Call your doctor if you feel any of these has lasted for too long or is getting worse.
Common risks associated with a prostate biopsy include:
- Bleeding at the biopsy site (Rectal bleeding)
- Blood in your semen
- Difficulty urinating