Prostate Biopsy: What It Is, How to Prepare, Side Effects, Recovery & Results

The American Cancer Society estimates that 288,300 new cases of prostate cancer will be diagnosed in 2023. While the overall 5-year survival rate is 97%, that number goes down significantly if the cancer has spread to distant parts of the body.

Prostate cancer biopsies can help detect both cancer and cells that look suspicious. They are part of a diagnosis and treatment plan aimed at helping catch the disease before it spreads.

This short guide will detail what a prostate biopsy is, who should have one, how it’s done, the best ways to prepare for the procedure, and what the results mean for your prostate health.

What is a prostate biopsy?

A prostate biopsy procedure is when a doctor, often a urologist, inserts a long needle into the prostate gland to take tissue samples. These samples are then examined under a microscope to check for signs of the disease, according to the American Cancer Society.

When should men get a prostate biopsy?

Your doctor will review your initial screening tests, including the prostate-specific antigen (PSA) test and the digital rectal exam (DRE), to help determine if a biopsy is needed.

Dr. Ramdev Konijeti, director of genitourinary oncology at Scripps MD Anderson Cancer Center in San Diego, said an abnormal PSA result often spurs further investigation.

“When I find an abnormal PSA, very commonly these days, we get an MRI of the prostate to get a high-resolution picture, so we can see exactly how the prostate looks and if there's any degree of suspicion for prostate cancer,” he said.

In addition to the MRI picture, Konijeti said that family health history, ethnic background and a comparison of current and historical PSA results are also taken into consideration when deciding if a biopsy is necessary.

How to prepare for a prostate biopsy

If your doctor does recommend a prostate biopsy, Mount Sinai Health notes there are a number of suggestions they might offer to help you prepare for the procedure, such as:

• Getting on a lighter meal schedule the day before the procedure
• Taking antibiotics before, during and after the biopsy
• Using an at-home enema to cleanse your rectum
• Avoiding certain medications and substances for several days before, such as herbal supplements, vitamins, aspirin, ibuprofen and nonsteroidal anti-inflammatory drugs (NSAIDs)

How is a prostate biopsy done?

The Mayo Clinic notes there are two main types of prostate cancer biopsy:

• Transrectal biopsy, in which a biopsy needle is passed through the rectum
• Transperineal biopsy, in which the biopsy needle is inserted into a small cut made in the skin between the anus and scrotum

“The transrectal approach is the most commonly used approach in the United States,” Konijeti, who is also a urologic surgeon at Scripps Clinic, explained.

“We have people lay down on their side and we insert an ultrasound probe into the rectum in order to visualize the prostate and to measure it,” he continued. “Then we give them numbing medication, similar to a dental procedure, where they can't feel anything else. And then we pass needles through the ultrasound probe that can directly target various areas of the prostate.”

Prostate biopsy side effects

While Mount Sinai advises that biopsies are typically safe, there are a few potential side effects to be on the lookout for, including:

• Difficulty urinating
• Allergic reaction to medications
• Biopsy site infection
• Blood infection (sepsis)

Prostate biopsy recovery

Your doctor will likely ask you to restrict your activity for 24 to 48 hours after the biopsy, according to the Mayo Clinic. They may also keep you on antibiotics for a few days.

You might also feel sore and notice small amounts of blood in your urine, semen and stool for several weeks. However, if you develop a fever, increasing pain, heavy bleeding or issues urinating that last more than a couple of days, you should reach out to your doctor right away.

What do the results mean?

A pathologist will use both the PSA test results and a cancer grading scale known as Gleason scoring to help determine your prostate cancer diagnosis, Konijeti said.

“Low-risk prostate cancer is deemed to be a [Gleason] grade of six and a PSA of less than 10. Intermediate risk is a grade of seven, and/or a PSA of 10 to 20, and high risk is grades eight to 10… and/or a PSA of greater than 20,” he said.

If your biopsy results come back positive for prostate cancer, Konijeti recommended a good first step to take.

“In general, if a person is diagnosed with prostate cancer, they should be sure to meet with a team of doctors,” he advised. “That usually comprises a urologist, a radiation oncologist and possibly a medical oncologist. [This is] because people do seem to have better outcomes when they're working with a team of doctors for their prostate cancer.”

SOURCE: Ramdev Konijeti, MD, director, genitourinary oncology, Scripps MD Anderson Cancer Center, San Diego