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Prostate Biopsy Procedure What You Should Know

Medically reviewed by Matt Coward, MD, FACS — By James Roland on September 29, 2022If your doctor suspects that you have prostate cancer, they may advise you to undergo a prostate biopsy procedure. A biopsy is a standard cancer screening test that involves the careful removal of small tissue samples, which are then examined in a laboratory to determine whether they contain cancer cells or any other abnormal cells. Here is what you should know about a prostate biopsy, including when you might need this procedure and how often it may lead to a cancer diagnosis.

What is a prostate biopsy

A prostate biopsy is an invasive procedure in which a healthcare professional uses a needle to remove several small pieces of prostate tissue. A pathologist — a doctor who specializes in diagnosing cancer and other diseases — analyzes all the samples. If the pathologist finds cancer cells, they may also be able to tell how aggressive the cancer is, which will help determine what you need to do next. A prostate biopsy procedure should be performed only if there are other indications that cancer may be present. For example, a prostate biopsy may be appropriate if a prostate-specific antigen (PSA) test has found that your levels of this prostate-produced protein are higher than expected for your age. A doctor would likely order a second PSA test to confirm the elevated levels before considering a biopsy. If you’ve had a previous prostate biopsy that detected no cancerous cells, but your PSA levels are elevated, your doctor may advise you to have another biopsy. A second biopsy may also be appropriate if a previous biopsy detected abnormal cells that weren’t cancerous. Additionally, your doctor may recommend a biopsy if a digital rectal exam has revealed lumps or other changes to your prostate.

How does a prostate biopsy procedure work

There are several steps to a prostate biopsy procedure.

Prepping before the procedure

At least a week before your prostate biopsy procedure, you should discuss your medications with your doctor. You may need to temporarily stop using blood thinners or nonsteroidal anti-inflammatory drugs, as these types of medication can raise the risk of bleeding complications during the procedure. You may need to do an enema the night before your biopsy and possibly a second enema an hour or two before the procedure.

During the prostate biopsy

Depending on the type of procedure you’re having, a doctor may ask you to lie on one side with your knees pulled up toward your chest or lie on your stomach. They will then apply a special gel to the area they will be examining. In order for the doctor to obtain tissue from only suspicious parts of your prostate, imaging is necessary to help guide the biopsy needle to the right spots. A commonly used imaging technique is the transrectal ultrasound (TRUS), which involves placing a thin ultrasound probe into the rectum. TRUS uses sound waves to create images of the prostate. Your doctor may also use magnetic resonance imaging (MRI), which involves magnetic fields and special radio waves that create detailed pictures of the prostate. Once your doctor locates the areas to be biopsied, they will insert a core needle into your prostate to remove a small cylinder of tissue. In a typical prostate biopsy, they will remove 10 to 12 samples. A prostate biopsy procedure usually takes around 10 minutes. You’ll likely experience some soreness and discomfort for a few days afterward. During that time, you should refrain from heavy lifting and other strenuous activities.

After the procedure

It will take up to a week to get your biopsy result, which is called a pathology report. This report will indicate whether the biopsy found any cancerous cells or any noncancerous but abnormal cells. Alternatively, the report may reveal that no cancerous or abnormal cells were found.

How painful is a biopsy of the prostate

Prior to removing any tissue samples, your doctor will numb the area that is to be biopsied, which should reduce the pain. Once that medication wears off, you may feel some soreness for the next few days You may also experience very minor bleeding from your rectum, and you may see some blood or a red tinge in your urine, semen, and stools for a couple of days or weeks.

Do they put you to sleep for a prostate biopsy

Though a prostate biopsy procedure is uncomfortable, you will be awake throughout the process. You may be able to drive home, but your doctor’s office may suggest that you have someone drive you.

How often do prostate biopsies find cancer

The likelihood that a prostate biopsy will detect cancer depends greatly on the pre-biopsy profile of the person undergoing the procedure. If you have a high PSA score and/or suspicious changes to your prostate, a biopsy is more likely to detect cancer than if you have no significant risk factors or indications that you may have cancer. This is why it’s important to have a thorough conversation with your doctor about why they are recommending a biopsy. A small 2015 study found a positivity rate of 52%, which the researchers noted was higher than most published averages.

Are there other ways to detect cancer instead of biopsies

In recent years, the combination of an MRI-guided and TRUS-guided biopsy is becoming more popular. The combination of these the two imaging technologies, known as a fusion biopsy, allows the doctor to see combined images of the prostate that are more detailed than MRI or ultrasound alone. According to a 2019 review, prostate biopsy is the “gold standard” screening for prostate cancer, and the combination of MRI and TRUS has advantages over traditional biopsy procedures. A separate 2020 review suggests that TRUS-guided biopsies without MRI tend to result in an excessive amount of findings associated with non-significant disease and that they under-detect clinically significant cancer findings. Apart from biopsies, your doctor may turn to other tests to detect prostate cancer or the possibility of cancer. These other screenings include:a digital rectal exam, which cannot confirm the presence of cancer but can help determine which part of the prostate is affected and whether the cancer may have spread to nearby tissuea PSA blood test, which is not a perfect screening method because low PSA levels can be detected in people with cancer, while elevated levels can exist when no cancer is presenturine tests, which are a relatively new additions to the set of diagnostic tools doctors can use — a 2019 report in the journal Prostate Cancer and Prostatic Diseases suggests that some urine tests may be 90% accurate for clinically significant tumors

Takeaway

A prostate biopsy procedure is the most definitive way of diagnosing prostate cancer, though new tests and technologies are emerging that may make this invasive screening unnecessary for many people. If your doctor suggests that you have a biopsy, be sure to ask them why they are recommending the procedure and what the risks and benefits of the biopsy may be. Last medically reviewed on September 29, 2022

How we vetted this article

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Eskra J., et al. (2019). Approaches to urinary detection of prostate cancer.
ncbi.nlm.nih.gov/pmc/articles/PMC6640078/Fusion biopsy. (n.d.).
cancer.gov/publications/dictionaries/cancer-terms/def/fusion-biopsyLipsitz D, et al. (2015). A comparison of prostate biopsy rates among urologists in a large group practice and implications of PSA screening.
ascopubs.org/doi/abs/10.1200/jco.2015.33.15_suppl.e16024Noureldin M, et al. (2020). Current techniques of prostate biopsy: An update from past to present.
ncbi.nlm.nih.gov/pmc/articles/PMC7354294/Streicher J, et al. (2019). A review of optimal prostate biopsy: Indications and techniques.
ncbi.nlm.nih.gov/pmc/articles/PMC6713958/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Sep 29, 2022 By James Roland Edited By Mike Hoskins Medically Reviewed By Matt Coward, MD, FACS Copy Edited By Jill Campbell Share this articleMedically reviewed by Matt Coward, MD, FACS — By James Roland on September 29, 2022

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