Prostate Biopsy

A prostate biopsy is used to diagnose prostate cancer after a high PSA, a lump or irregularity, or abnormal prostate imaging (like MRI).

A prostate biopsy is done with the patient on their side or in lithotomy. After local anesthesia using an ultrasound placed into the rectum the urologist will inject local anesthesia and then survey the prostate using the ultrasound. Thin-core samples are taken via a trans-rectal or trans-perineal needle—typically 10–12 cores, though the number varies. If a patient has an abnormal MRI then additional biopsies are taken to target the suspicious area seen on the MRI. The procedure lasts 10-15 minutes.

A prostate biopsy checks for prostate cancer. The tissue also shows how aggressive the cancer is (Gleason score or WHO Grade Group) and how much cancer is present by looking at how much cancer is in each sample and how many samples are positive.

Possible Risks Include:

  • Bleeding (urine, rectum, semen) is common and may last a couple of days. Serious bleeding is rare but does occur.

  • Infection (may need antibiotics or hospitalization)

  • Urinary Retention needing temporary catheterization

  • Expected Pain/manageable with local anesthesia and oral pain meds

  • Possible false‑negative/false‑positive results leading to delayed diagnosis or unnecessary treatment.

Men choosing not to do a prostate biopsy have some alternative to determine cancer risk but there are no other tests that can officially diagnose the cancer other than a tissue sample. Often men have already had an MRI. A negative MRI decreases the chance of finding cancer on a biopsy but can’t totally rule out cancer. Blood or urine tests exist (4K score, iso-PSA, PHI, urine testing can help men classify their risk further prior to a biopsy, but can tell a man if there is cancer or not.

Men advised to have a biopsy should have at the next available time. Delaying the biospy can delay the diagnosis of cancer.

Preparation involved stopping blood thinning medication. On the day of the biopsy men will give themselves an enema prior to coming in for the biopsy. Men will also be given an antibiotic injection as well as taking an antibiotic prior to the biopsy to prevent infection

Men will be required to rest for a day or two after the biopsy. Most all men can then returns to normal activity following the procedure.