Prostate biopsy: What to expect

Prostate biopsy: What happens, how to prepare, and risks

By Jenna Fletcher   

Reviewed by Christina Chun,
Prostate cancer is a very
common form of cancer for men. It is most common in men over the age of 50, but
it can develop at any time during a man’s life.

Prostate cancer is often slow
to grow and spread. Symptoms may not appear until the cancer is in its more
advanced stages.
Early detection can help
prevent prostate cancer from entering the more advanced stages. A prostate
biopsy is the only effective means to diagnose prostate cancer.
This article addresses some of
the questions a man may want to ask before having a prostate biopsy.
happens in a prostate biopsy?
During the procedure, the
doctor inserts an ultrasound probe into the rectum to create an image of the
prostate gland. The prostate is located just on the other side of the rectal
Using the ultrasound image as
a guide, the doctor removes several samples from the prostate with a
spring-loaded tool.
The device quickly punches a
needle through the rectal wall into the prostate and removes minute cylindrical
cores of cells. Typically, a biopsy removes around 10 to 12 core samples,
usually five or six from each side of the prostate.
In some cases, a doctor may
decide that a larger sample is needed. In these cases, the doctor performs a
“saturation” biopsy, which collects 20 to 30 samples, sometimes more.
The entire procedure takes
about 20 minutes. After the biopsy, doctors may suggest that men take an
antibiotic to prevent infection.
Another procedure called a
transperineal biopsy involves making a small cut between the anus and the scrotum.
The biopsy needle is inserted through the cut and into the prostate and
extracts a sample of tissue. The doctor will likely use an ultrasound scan to
guide the procedure.
How to prepare

Preparation will vary based on
the doctor’s recommendations.
Here are some general ways to
prepare for the prostate biopsy:

  • Stop taking any medication
    that increases the risk of bleeding. Medications, such as warfarin, ibuprofen,
    aspirin, and certain herbal supplements should be stopped several days before
    the procedure.
  • Urine samples may be requested
    to test for a urinary tract infection. If an infection is present, the biopsy
    will be postponed until the infection clears up.
  • A doctor may order an enema at
    home before the biopsy.
  • Doctors may prescribe
    antibiotics that people should take before the biopsy to help prevent
    infections from the procedure.
Men should also prepare
themselves to receive the results of the biopsy. People should find out as much
as they can by reading about prostate cancer and asking questions about the
next steps in case cancer is diagnosed.
Before the procedure, doctors
usually provide a detailed list of instructions for men to follow. If an
individual has any questions, it is also best to ask them before the biopsy
takes place.
How does a prostate biopsy

In most cases, a doctor will
administer an anesthetic injection into the prostate gland before the
procedure. Despite the numbness from the anesthetic, a man may still feel a
pinch as the needle punctures the gland.
Most men report that they only
feel mild to moderate discomfort during the procedure, but some men experience
much greater pain.
Afterward, as with any invasive
procedure, there may be lingering tenderness and discomfort as the puncture
wounds heal.
Risks and complications

As with any invasive
procedure, there are some risks involved. The most common risk factors include
infection and bleeding. Other risks include blood in the semen or urine,
discomfort in the area of surgery for a few days, and difficulty urinating.
To help prevent further
complications after the biopsy, men should look out for these signs:

  • prolonged or heavy bleeding
  • fever
  • difficulty urinating
  • worsening pain
A man should contact his
doctor if he experiences any of these symptoms, as an infection may be present.
Other tests for prostate

A doctor is likely to perform
screening tests before a biopsy to help determine whether a biopsy is even
Although the medical community
does not fully agree on the benefits of screening all men, the general advice
is that those over 50 get routine examinations to check for the presence of
prostate cancer.
Screening tests include the following:
Digital rectal exam (DRE)
During a DRE, the doctor
inserts a lubricated, gloved finger into the rectum to examine the prostate.
The doctor feels for
abnormalities in texture, size, or shape. Any abnormalities may require
additional tests to determine the presence of cancer.

Prostate-specific antigen
(PSA) test
For the PSA, a doctor draws a
blood sample from a vein in the man’s arm.
PSA is a substance produced by
the prostate. Low numbers of PSA are normal, but higher numbers may indicate an
infection, inflammation, or possible cancer.
After the biopsy, further tests
and examinations carried out in the lab will help the doctor determine how fast
any cancer is growing, how likely it is to spread, and the best course of
treatment to pursue.
One of the most common ways to
grade the type of cancer that may be present is by applying the Gleason score,
which classifies cancer into one of five distinct categories.
To classify the biopsy, a
doctor examines the tissue under a microscope and determines which two areas in
the sample have the highest concentration of cancer cells. They then assign
each of these samples a value of 1 – 5.
Adding the two values together
gives the Gleason score. The lower the score, the less advanced the cancer is
likely to be.

The outlook for a man depends
on the results of the biopsy and other tests. Some major factors that affect
the overall outlook for a man include:

  • stage of the cancer
  • whether the cancer has spread
  • the Gleason score
  • age of the man
  • other health conditions
For stage 1 prostate cancer
where the cancer has not spread outside the prostate, doctors usually recommend
treatment that consists of active surveillance for both young and older men.
Younger men, however, may
eventually choose to undergo more aggressive treatments. Older men may decide
not to treat stage 1 prostate cancer as treatment may cause complications with
other health conditions.
For prostate cancer in more
advanced stages or that has spread beyond the prostate, men will likely undergo
more aggressive treatment options upon diagnosis.
As with stage 1 cancers, a
doctor can help make the decision of how to treat the cancer based on the age
and overall health of the man.
If prostate cancer is
diagnosed in the early stages, the chance of surviving at least another 5 years
is almost 100 percent.
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.