What to Expect from a Prostate Biopsy: A Complete Overview

If your doctor has recommended a prostate biopsy, it’s natural to have questions about what to expect. This quick guide covers the basics, from why it’s done, how to prepare, what the procedure involves, to what recovery looks like, so you can feel more informed and confident moving forward.

What is a Prostate Biopsy?  

A prostate biopsy is a procedure done to remove small samples of tissue from the prostate gland. The prostate is a walnut-shaped gland that is part of the male reproductive and urinary system. It produces fluid for semen that nourishes and transports sperm. The prostate sits below the urinary bladder and wraps around the urethra (the tube that carries sperm and urine out of the body). 

A prostate biopsy is done to diagnose and grade prostate cancer. Grading a cancer means assigning a score based on how abnormal the cancer cells appear under the microscope compared to normal cells. A prostate biopsy may also be done to help diagnose other prostate conditions, such as benign prostatic hyperplasia (BPH).

Your doctor may recommend a prostate biopsy if:

• You have signs and symptoms of prostate cancer. For example, blood in your semen, blood in your urine, frequent urination, trouble getting a urine stream started, and getting up frequently at night to urinate.

• You have a high PSA level for your age. Prostate-specific antigen (PSA) is a blood test to measure a protein that is present at higher levels in men with prostate cancer and certain other prostate conditions.

• You have suspicious lumps or bumps felt during a digital rectal exam (DRE). This exam is done by inserting a gloved, lubricated finger into your rectum to assess pelvic structures, including the prostate. Your urologist or primary care doctor may perform this exam.

• Tissue samples from a previous prostate biopsy revealed cells that were not cancerous but abnormal nonetheless. Your doctor may order a repeat prostate biopsy to rule out prostate cancer.

Types of Prostate Biopsies 

Doctors typically use transrectal ultrasound imaging to guide the biopsy needle to the prostate gland. There are two types of prostate biopsies:

• A transrectal prostate biopsy is done through the rectum and is the more common type.

• A transperineal biopsy is done through the skin between the scrotum and anus.

Preparing for a Prostate Biopsy

During an office consultation before your prostate biopsy, your healthcare provider will explain the procedure to you and give you a chance to ask questions.

You may be asked to sign a consent form, giving your doctors permission to perform the procedure. 

Your doctor may check a urine sample for signs of urinary tract infection. If one is present, they will prescribe antibiotics to clear the infection before a prostate biopsy is done.

There is no special diet before a prostate biopsy. You don’t need to be fasting. However, your doctor may ask you to eat only a light meal and drink only clear fluids before the procedure. If you are having a transrectal biopsy, your healthcare provider may recommend an enema the night before or the morning of your biopsy.

Medication Precautions

• Drug Allergies: Tell your doctor if you are allergic to any medicines, anesthesia, latex, or adhesive materials like medical tape.

• Medication List: Give your healthcare provider a complete list of your medications, including prescription drugs, over-the-counter medicines, herbal products, and dietary supplements.

• Blood Thinners: Tell your doctor if you have a history of bleeding disorders or are on any blood-thinning medicines (anticoagulants). Your doctor may ask you to stop taking blood thinners a few days before your prostate biopsy as they can increase the risk of bleeding. Examples of blood thinning medications include aspirin, ibuprofen, warfarin (Coumadin), and clopidogrel (Plavix).

• Antibiotics: Take the prescribed antibiotic as directed. Your doctor will likely start you on antibiotics the day before your prostate biopsy and continue you on them for a few days afterwards to prevent infection.

The Prostate Biopsy Procedure  

A prostate biopsy is usually performed by a specialist called a urologist. The entire procedure takes 10 to 30 minutes to perform, and you can go home the same day. 

Here are the steps of the procedure:

1. After you arrive in the procedure room, you change into a hospital gown. Shaving may be necessary, especially if you are having a transperineal biopsy.

2. Your doctor gives you antibiotics to prevent infection and local anesthesia, a sedative, or light IV sedation to help you relax and numb the area.

3. For a transrectal biopsy, you lie on your left side with your knees drawn up to your chest. For a transperineal prostate biopsy, you lie on your left side or on your back with your thighs apart and knees bent.

4. Your doctor numbs the area with a local anesthetic to reduce discomfort.

5. The doctor inserts a lubricated ultrasound probe into your rectum to generate images using sound waves. The ultrasound probe is inserted to guide the biopsy needle.

6. A thin needle is inserted to take 10-12 small samples from various parts of the prostate gland. You may feel slight discomfort or pressure when the biopsy samples are obtained. 

7. The tissue samples will be sent to the laboratory for analysis.

8. You can go home after a short period of observation. You should arrange for someone to drive you home afterwards, especially if you received a sedative. 

Risks and Side Effects of Prostate Biopsy  

Side Effects

Common side effects after a prostate biopsy include:

• Slight soreness at the biopsy site, which can be managed with over-the-counter pain medication (acetaminophen). Do not take ibuprofen or other NSAIDs unless your doctor says it is okay to do so.

• Minor trouble urinating.

• Light bleeding from the rectum.

• Blood in the urine or blood in the stool for a few days. Some men require a temporary urinary catheter.

• Red tint to your semen for several weeks and maybe up to 2-3 months.

• Constipation, which can be managed by eating a fiber-rich diet.

Risks and Complications

Rare but serious complications of a prostate biopsy include infection and bleeding. Seek immediate medical attention if you develop:

• Fever above 100°F.

• Chills.

• Severe bleeding.

• Worsening pain.

• Inability to urinate.

Recovery Timeline

Recovery from a prostate biopsy takes 3-5 days. Your doctor may ask you to avoid strenuous activity and heavy lifting for 24-48 hours after a prostate biopsy. 

Results and Next Steps  

It can take 3-7 days to get your prostate biopsy results after a standard biopsy. You will get the results in the form of a pathology report. The results will be reported as one of the following:

Negative Result

If your prostate biopsy results are negative and your risk of prostate cancer is low based on PSA levels, you may need no further follow-up and testing other than repeat PSAs and digital rectal examinations. A repeat biopsy may be recommended in the future if you have a rising PSA level.

Suspicious Result

If your prostate biopsy does not show evidence of prostate cancer, but your doctor suspects it because of a high PSA or the presence of abnormal cells, for example, they may recommend further testing. This is because prostate biopsies sometimes return false negatives (missed prostate cancer diagnosis) because the biopsy needle did not pass through the part of the prostate tissue that is cancerous. Additional testing may include:

• Prostate Health Index (PHI)
  PCA3 tests (for example, Progensa)

• 4Kscore test

• ConfirmMDx

• Magnetic resonance imaging (MRI) scan of the prostate

• Repeat prostate biopsy

Positive Result

A positive result means prostate cancer cells were found in the biopsy samples. Your doctors will diagnose and grade the cancer based on how abnormal the cancer cells appear. Grade 1 prostate cancer cells appear nearly like normal prostate cells, while grade 5 prostate cancer cells are very abnormal-looking. 

The grades in two of the most affected areas of the prostate gland are added to calculate your Gleason score. A high Gleason score (8 to 10) indicates a more aggressive, faster-growing prostate cancer that may have spread beyond the prostate gland. A low Gleason score (below 6) indicates a slower-growing, less aggressive cancer. 

Further imaging tests may be done to look for evidence of the spread of the cancer outside the prostate gland. These tests may include a CT scan, an MRI scan, a bone scan, a PET scan, or a PSMA PET scan.

Treatment for prostate cancer depends on the grade and stage of the cancer. A cancer’s stage is determined by its spread to adjacent structures, lymph nodes, and other organs. Treatment options include:

• Surgery 

• Radiation therapy

• Medications (hormone therapy, chemotherapy, immunotherapy, and targeted therapy) 

A prostate cancer in the low Gleason grade group may not require treatment and may be monitored with active surveillance only.

Importance of Monitoring PSA Levels

Regular PSA screening can lead to early diagnosis of prostate cancer, when it can be successfully treated. The 5-year survival rate for localized prostate cancer, which is limited to the prostate gland, is 100%, whereas for metastatic prostate cancer, which has spread to other parts of the body, it is 37%.

Frequently Asked Questions

What Percent of Prostate Biopsies Are Cancerous?

About 20 to 30 percent of prostate biopsies are cancerous. Nearly 1 million prostate biopsies are performed each year in the US, triggered by elevated PSA levels. About 240,000 new cases of prostate cancer are diagnosed every year. Therefore, about 75 percent of prostate biopsies are negative for prostate cancer. It is important to remember that prostate biopsies sometimes give false negative results (tumors are present but are missed by the prostate biopsy). 

At What PSA Level Should A Biopsy Be Done?

Prostate-specific antigen (PSA) is a protein made by the prostate gland. Elevated PSA levels can be a sign of prostate cancer. PSA levels in men vary by age and should be:

• Less than 1.0 ng/mL in young men.

• 2.5 ng/mL or lower in men 59 years of age and younger.

• 4.0 ng/mL or lower in men 60 years of age and older.

What Other Factors Can Cause A High PSA Level?

• Prostatitis (inflammation)

• Prostate infection

• Recent urologic or pelvic procedures, such as cystoscopy or colonoscopy

• Certain medications, such as testosterone replacement therapy

• Sexual activity within the last 1-2 days

• Pressure on the perineum from riding a bicycle