Prostate Biopsy

Your surgeon has recommended a biopsy of your prostate based on an abnormality of your prostate-specific antigen (PSA) level and/or digital rectal examination (DRE). Please take the time to read through this information carefully to gain an understanding of how this procedure works, what to expect, and what the risks are.  

What is a prostate biopsy and how does it work?  

A prostate biopsy is an outpatient procedure that is done by a radiologist or urologist.  An ultrasound probe is inserted into the rectum, and the prostate is scanned for abnormalities and measured.  Under ultrasound guidance, a needle that is attached to the probe is then used to take samples of the prostate tissue.  The  samples are then sent to the lab and inspected under a microscope to look for cancer or other changes, and a report is sent to your urologist within 2 weeks.    

Preparing for the Procedure  

BE SURE TO: 

  1. Take your ANTIBIOTICS as prescribed by your urologist 
  1. Perform a FLEET ENEMA the morning prior the procedure 
  1. Hold any BLOOD THINNERS prior to the procedure as instructed by your doctor

– You do not need to fast for this procedure.  Eat a light breakfast or lunch prior to the biopsy to reduce the chance of feeling faint afterwards.  Arrive early for your appointment, and have someone with you to drive you home if possible.    

What to Expect  

After checking in, you will be asked to change into a gown and then will be taken in to the procedure room and met by the radiologist.  An ultrasound of the kidneys and bladder may be carried out in some cases.  You will then lie on your side and a prostate exam (DRE) will be performed.  An ultrasound probe will then be inserted into the rectum and the prostate will be scanned and measured.    

The nerves around the prostate will be frozen to numb the area, and then the biopsy  samples will be taken.  Each time the needle fires to take a sample, you will hear a snap-like sound.  In most centers, 10 samples (cores) are taken, but this may vary.  

Once the procedure is completed, you will be observed for a short time then discharged home.  Some men may feel a bit light-headed afterwards, so it is recommended that you have a ride home arranged.  You may also want to plan to take the rest of the day off.  Go home and rest, and drink plenty of fluids.   

You may notice:  

  • slight burning or a slowed stream when you urinate the first day or two after the biopsy.  It is normal to see blood in the urine.  This should clear up after the first few times you urinate if you stay well hydrated.   
  • It is also normal to see blood in the stools for the first day, and to see blood in the ejaculate (semen fluid) when you climax.  This blood in the ejaculate may look bright red or rust covered, and may take many days to clear up completely. 

What are the risks?  

  • The main risk of a prostate biopsy is infection of the prostate, bladder, or epididymis (part of the sperm duct).  Even if you take your antibiotics as prescribed, there is about a 1 to 4 in 100 chance (1-4%) that you could develop such an infection, depending on where you live.  Rarely these infections can be severe and spread to the bloodstream, called sepsis.  It is very important, therefore, that you contact your doctor or go to the emergency room if you develop any signs of infection after a biopsy. There are rare reports of death caused by sepsis after a prostate biopsy.  
  • The other risk of a biopsy is bleeding.  It is normal to have some bleeding in the urine, ejaculate or rectum as noted above.  Rarely a man may experience excessive bleeding.  About 2 in 100 men (2%) may have rectal bleeding for more than 2 days, and rarely this may require urgent intervention to stop it.  About 15% of men will have blood in the urine for more than 1 day, and one-third (1 in 3) men will have blood in the ejaculate for more than a day.   
  • A final complication that rarely occurs after a biopsy is the inability to urinate, called urinary retention.  This may require placement of a tube (catheter) into the bladder until it is resolved. 

Call your doctor, go to the emergency room, or call 911 if you develop any of the following:  

Signs of infection: 

  •      Fever (temperature higher than 37.8° C or 100° F)  
  •      Chills or uncontrollable shakes  
  •      Severe burning on urination  
  •      Foul smelling cloudy urine  
  •      Swelling and redness of the scrotum  

Bleeding problems:

  •      Heavy bleeding in the urine with clots that does not clear by drinking extra fluids  
  •      Heavy and persistent rectal bleeding  
  •      Bleeding that causes you to feel faint 

What are the restrictions after a biopsy and when can I go back to work?  

It is important to keep activities to a minimum for the rest of the day and to drink plenty of water (2-3 litres) to flush the bladder out.  You may return to work the next day if you are feeling well with none of the signs listed above.  

What are the chances that I have prostate cancer?  

The chances of prostate cancer being detected depend mostly on your PSA level and the feel of your prostate on exam (DRE).  Your doctor can discuss your case with you; however, the following table provides some general guidelines: 

PSA Level (ng/ml) DRE Finding Chance of positive biopsy (%)
< 4 Normal 15
Abnormal 15-20
4 – 10 Normal 25-40
Abnormal 20-50
> 10 Normal 45-65
Abnormal 70-90

 

When will I get my results?  

Your doctor can give you an indication of when your results might be ready, and this will vary considerably from place to place.  Some doctors will call to discuss results initially on the phone, and others will schedule an appointment to review them.  

  • In Fraser Health, the typical wait time for your biopsy is 2-5 weeks and the results are usually available to you doctor two weeks after the biopsy takes place.

References: 

  1. Carter BH, Allaf ME, Patrin AW. Diagnosis and staging of prostate cancer. In: Campbell’s Urology, 9th edition. Philadelphia, Pa, Saunders; 2007:2912-2931.
  2. Kawachi MH, Bahnson RR, Barry M, et al Prostate cancer early detection, Clinical practice quidelines in oncology. J Nati Compr Canc Netw 2007 Aug;5(7):714-36.
  3. Tamey JR, Halpem EJ, Gomella LG. Ultrasonography and biopsy of the prostate. In: Campbell’s Urology, 9th edition. Philadelphia, Pa, Saunders; 2007:2883-95.