Test Overview
A
prostate gland biopsy is a test to remove small
samples of prostate tissue to be looked at under a microscope. The tissue samples taken are looked at for
cancer cells.
For a prostate biopsy, a
thin needle is inserted through the
rectum (transrectal biopsy), through the
urethra, or through the area between the anus and
scrotum (perineum). A transrectal biopsy is the most common
method used.
A biopsy may be done when a
blood test shows a high level of
prostate-specific antigen (PSA). It may also be done after a
digital rectal examination finds an abnormal prostate
or a lump.
Why It Is Done
A prostate
biopsy is done to find out:
- If a lump in the prostate gland is
cancer.
- The cause of a high level of PSA in the blood.
How To Prepare
Tell your doctor if you:
- Take a blood thinner, or if you have had bleeding problems.
- Are allergic to latex or any
medicines, including anesthetics.
Be sure to tell your doctor about all the medicines you take, even over-the-counter ones.
You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Talk to your doctor about any concerns you have regarding the need for the
biopsy. Ask about its risks, how it will be done, and what the results will mean. To help
you understand the importance of the biopsy, fill out the
medical test information form(What is a PDF document?).
A prostate gland biopsy
does not cause problems with erections. It will not make you infertile.
If this test is done under
local anesthesia through the area between the anus and
scrotum (perineum), you don't have to do anything to prepare.
If
the biopsy is done through the rectum, you may need to have an
enema before the test.
If the biopsy is
done under
general anesthesia, your doctor will tell you how soon
before surgery to stop eating and drinking. Follow the instructions exactly, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of the surgery, please do so using only a sip of water.
Before the biopsy, an
intravenous line (IV) is inserted in your arm. You will get a
sedative medicine about an hour before the
biopsy.
How It Is Done
A prostate biopsy is done by a doctor who
specializes in men's genital and urinary problems (urologist). It can be done in
the doctor's office, a day surgery clinic, or a hospital operating room.
Before your biopsy, you may be given
antibiotics to prevent infection. You may be asked to
take off all of your clothes and put on a hospital gown.
Through the rectum (transrectal biopsy)
Several
positions are possible for this method. You may be asked to kneel, lie on your
side, or lie on your back with your feet resting in stirrups. Your doctor may
inject a local anesthetic around the prostate gland before the sample is
taken.
Transrectal ultrasound is often used to
guide the needle to the correct spot. A prostate biopsy is usually
done with a spring-loaded needle. The needle quickly enters the prostate gland
and removes a tissue sample. Between 6 and 12 samples are taken from different
areas of the prostate.
The biopsy can also be done with a needle
guide attached to your doctor's finger. He or she inserts the finger into your
rectum. Then the needle slides along the guide, through the wall of the
rectum, and into the prostate gland. The needle is turned to collect a tissue
sample and then pulled out.
A transrectal biopsy takes about 30
minutes.
Through the urethra (transurethral biopsy)
For
this method, you will lie on your back. Your feet will rest in stirrups.
General,
spinal, or
local anesthesia may be used.
A lighted
scope (cystoscope) is inserted into your urethra. It allows
your doctor to look directly at the prostate gland. A cutting loop is passed
through the cystoscope to remove small pieces of prostate tissue.
This type of biopsy usually takes about 30 to 45 minutes.
Through the perineum (transperineal biopsy)
Transperineal biopsy is not done as often as the other two types. You will lie on an exam table either on your side or
on your back with your knees bent. General or local anesthesia may be
used.
Your
skin at the biopsy site is cleaned with a sterile solution. The area
around it is covered with sterile cloth. Your doctor will wear gloves.
It is very important that you do not touch this area.
Transrectal ultrasound is generally used to
guide the needle to the correct spot.
A small cut is made in your perineum. Your doctor
inserts a finger into the rectum to hold the prostate gland. He or she will then insert
the needle through the cut and into the prostate gland. To collect a
sample of tissue, the needle is gently turned and then pulled out. Biopsy
samples may be taken from several areas of the prostate. Pressure is applied to
stop the bleeding. A small bandage is placed over the cut. The biopsy
usually takes about 15 to 30 minutes.
How It Feels
You may feel a slight sting when you
get a shot of medicine to numb your skin. You may feel a dull
pressure as the needle is inserted. For a transrectal biopsy, you may
feel pressure in the rectum while the ultrasound probe or guiding finger is in
place. You also may feel a brief, sharp pain as the needle is inserted
into the prostate gland. Usually several samples are collected.
After the biopsy, you will be asked to avoid activity
for about 4 hours. You may have mild pain in your pelvic area and blood in your
urine for up to 5 days. Also, you may have a change in color of your
semen for up to 1 month after the biopsy. If you had
a transrectal biopsy, you may have a small amount of bleeding from your
rectum for 2 to 3 days after the biopsy.
If you have a
transurethral biopsy, you may have a urinary catheter in place for a few hours
after the biopsy. You also may need to take an antibiotic medicine for
several days after the biopsy.
If you have a general anesthetic,
you will be in a recovery room for a few hours after the biopsy. You will need
someone to drive you home when you are released. When you get home, your
muscles may ache. You may feel tired for the rest of the day.
Risks
A prostate biopsy has a slight risk of causing
problems such as:
- Infection. This is more common in men who have
prostatitis. Usually, taking antibiotic medicine
before the test prevents an infection.
- Bleeding
into the urethra or
bladder. This can cause a blood blister (hematoma). Or you may be unable to urinate or need to urinate often.
- Bleeding from the
rectum. If you have a transrectal biopsy, you may have a small amount of
bleeding from your rectum for 2 to 3 days.
- An
allergic reaction to the anesthetic medicines used
during the biopsy.
After the biopsy
Call your doctor right away if
you:
- Have heavy bleeding or bleeding that lasts
longer than 2 to 3 days.
- Have increased pain.
- Have a
fever.
- Are unable to urinate within 8 hours or have blood in the
urine for longer than 2 to 3 days.
Results
A
prostate gland biopsy is a test to remove small
samples of prostate tissue to be looked at under a microscope. Results are
usually ready within 10 days.
Normal prostate biopsy results do not rule out
cancer. There's a chance that a cancer may be missed since the
biopsy takes a small amount of tissue.
If the test finds prostate cancer cells, a grade (Gleason score) will be given. Your doctor will discuss this with you. The
Gleason score is a tool for predicting how fast-growing the cancer
is.
What Affects the Test
The results of the test may not be helpful if not enough biopsy tissue was taken to make a diagnosis.
What To Think About
- If the test results show cancer, other tests may
be needed to see the spread of the cancer. These tests may include a
blood test (prostate-specific antigen), bone scan,
lymph node biopsy, or
CT scan.
- Not all
types of prostate cancer are treated. There are many things to consider when
deciding on a treatment plan. To learn more, see the topic
Prostate Cancer.
References
Other Works Consulted
- Loeb S, Carter HB (2012). Early detection, diagnosis, and staging of prostate cancer. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2763-2770. Philadelphia: Saunders.
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
- Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
- Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
- Scher HI, et al. (2015). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 932-980. Philadelphia: Walters Kluwer.
Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerChristopher G. Wood, MD, FACS - Urology, Oncology