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Prostate Biopsy

(Transrectal Biopsy; Transurethral Biopsy; Transperineal Biopsy)

by Michelle Badash, MS

Definition

A prostate biopsy is the removal of a small amount of tissue from the prostate gland. The tissue is examined to determine whether there is cancer.

Prostate Cancer

Nucleus image
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

A prostate biopsy is usually done after an abnormal finding by:

  • Digital rectal exam
  • Prostate specific antigen blood test

A prostate biopsy is the only way to find out if cancer cells are present.

Possible Complications    TOP

Complications are rare. But, no procedure is free of risk. If you are planning to have a prostate biopsy, your doctor will review a list of possible complications. These complications may include:

  • Infection
  • Bruising or lengthy bleeding from the rectum or in urine or semen
  • Difficulty urinating
  • Reactions to anesthesia

Factors that may increase the risk of complications include:

  • Smoking
  • History of bleeding disorders or easy bruising
  • Use of any medications, over-the-counter medicines, or herbal supplements
  • Sensitivity or allergy to latex, medicines, or anesthesia

Be sure to discuss these risks with your doctor before the procedure.

What to Expect    TOP

Prior to Procedure

You may be asked to do the following:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin)
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • Begin taking an antibiotic if advised by your doctor.
  • Use an enema several hours before the procedure.
  • If you will be getting general anesthesia, do not eat or drink anything after midnight.

Anesthesia

The type of anesthesia depends on the method that your doctor uses:

  • Transurethral biopsy and perineal biopsy:
    • General anesthesia —blocks pain and keeps you asleep through the surgery, given through an IV in your hand or arm
    • Local anesthesia—just the area that is being operated on is numbed, given as an injection and may also be given with a sedative
  • Transrectal prostate biopsy—local anesthesia

Description of the Procedure

Your doctor will use one of the following methods to do the biopsy:

  • Transrectal biopsy (most common method)—Your doctor will insert a small ultrasound device into the rectum. This device will produce sound waves to create an image of the prostate. These images will help guide placement of the needle. Your doctor will then insert the needle through the wall of your rectum and into the prostate gland.
  • Transurethral biopsy—Your doctor will insert a lighted flexible tube through the penis into the urethra. The urethra carries urine from the bladder. Your doctor will get the biopsy with a cutting loop that is passed through the flexible tube.
  • Perineal biopsy—Your doctor will make a small incision in the perineum. The perineum is the area between the scrotum and the rectum. The doctor will insert a small needle into the prostate gland to get the biopsy.

How Long Will It Take?

About 30 minutes

Will It Hurt?

You may have discomfort and soreness at the biopsy site.

Postoperative Care

When you return home after the procedure, do the following to help ensure a smooth recovery:

  • Stay hydrated. Drink plenty of fluids for the next few days.
  • Avoid difficult physical activity the day and evening of the procedure.
  • Keep in mind that you may see blood in your urine, stool, or semen for several days.
  • Ask your doctor when you can resume taking any blood-thinning medicine.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor's instructions.

After the sample is taken, it will be sent to a pathologist. This doctor will analyze the sample for cancer. If cancer is present, your doctor will work with you to develop a treatment plan.

Call Your Doctor    TOP

After arriving home, contact your doctor if any of the following occurs:

  • Inability to urinate
  • Blood in the urine more than 2-3 days post-biopsy
  • Signs of infection, including fever and chills
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency, or frequency of urination
  • Cough, shortness of breath, or chest pain
  • Rectal bleeding that lasts more than 2-3 days after the biopsy

In case of an emergency, call for medical help right away.

RESOURCES:

Urology Care Foundation
http://www.urologyhealth.org/
National Cancer Institute
http://www.cancer.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca
Prostate Cancer Canada
http://www.prostatecancer.ca/

References:

Causes, Natural History & Diagnosis of Prostate Cancer. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=103 . Updated January 2011. Accessed December 13, 2012.
How is prostate cancer diagnosed? American Cancer Society website. Available at: http://www.cancer.... . Updated September 4, 2012. Accessed December 13, 2012.
Rodriguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol . 1998;160(6-I):2115-2120.
Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis . 2007;10(2):127-36. Epub 2007 Jan 9.
Understanding prostate changes: a health guide for men. National Cancer Institute, National Institutes of Health website. Available at: http://www.cancer.... . Accessed December 13, 2012.
6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed November 2012 by Adrienne Carmack, MD
Last Updated: 11/26/2012