The prostate is a small gland in men that produces a fluid that nourishes and transports sperm. A prostate biopsy is a procedure performed by a urologist to remove tissue samples from the prostate using a needle to obtain several tissue samples.
The urologist may recommend a prostate biopsy if the results of initial tests, such as a blood test to measure the prostate-specific antigen (PSA) level or a digital rectal exam, suggest that the patient may have prostate cancer.
Tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities, which are a sign of prostate cancer. If cancer is present it is evaluated to determine how quickly it can progress and what the best treatment options are.
Why is it performed?
Prostate biopsy is performed to detect prostate cancer. Your Urology specialist may recommend a prostate biopsy if:
- A prostate-specific antigen test shows higher levels than normal for your age.
- The doctor finds abnormalities during a digital rectal exam.
- You have had a previous biopsy whose results were normal, but you still have elevated PSA levels.
- A previous biopsy revealed prostate tissue cells that were abnormal, but not cancerous.
What are the risks?
The most common risks of prostate biopsy are:
- Bleeding at the biopsy site: rectal bleeding is common after a prostate biopsy.
- Blood in the semen: A red or reddish-brown coloration is often seen in the semen after a prostate biopsy, but do not be alarmed. Blood in the semen may persist for a few weeks after the biopsy.
- Blood in the urine: bleeding is usually minor.
- Difficulty urinating: In some men, prostate biopsy may cause difficulty urinating after the procedure. Rarely, a temporary urinary catheter will need to be inserted.
- Infection: Rarely, men who have a prostate biopsy get a urinary tract or prostate infection that requires treatment with antibiotics.
What is the preparation like?
Medications that increase the risk of bleeding are stopped for several days before the procedure and a rectal enema is given before the biopsy. In addition, 30 to 60 minutes before the prostate biopsy, antibiotics will be given to help prevent infection from the procedure.
How can a prostate biopsy be done?
- The most common technique is to pass a needle through the wall of the rectum (transrectal biopsy).
- Another technique involves inserting a needle through the area of skin between the anus and the scrotum (transperineal biopsy). A small puncture is made in the skin area (perineum) between the anus and the scrotum and the biopsy needle is inserted into the prostate to take a tissue sample.
Transrectal ultrasonography creates images of the prostate that identify the area to be numbed with an injection to reduce the discomfort associated with the biopsy. The ultrasound images are also used to guide the prostate biopsy needle to the appropriate site.
Once the area is numbed and the biopsy device is in place, the physician will obtain thin, cylindrical sections of tissue with a spring-loaded needle. The procedure usually causes a brief sensation of discomfort each time the spring-loaded needle takes a sample.
How are the results analyzed?
A doctor who specializes in diagnosing cancer and other tissue abnormalities (pathologist) will evaluate the prostate biopsy samples. The pathologist can tell if the tissue removed is cancerous and, if cancer is present, evaluate how aggressive it is.