Prostate Biopsy Test and Procedure
Overview
A prostate biopsy collects small pieces of tissue from the prostate gland. The prostate is a small organ located below the bladder in males. It is important for making fluid that mixes with sperm.
Doctors usually recommend this test if other checks, like a PSA blood test or a digital rectal exam, show unusual results. A thin needle takes several tissue samples, which specialists then check under a microscope.
Doctors perform a prostate needle biopsy to look for cancer cells. If they find any cancer, they study it to see how fast it might grow and what treatments might work best.
Reasons for the Procedure
Doctors perform a prostate biopsy to find out if prostate cancer is present. They consider this procedure when:
- PSA levels are higher than normal for someone’s age.
- Abnormal findings appear during a digital rectal exam.
- Previous biopsies showed unusual cells, even if they were not cancer.
- Continued high PSA after a normal biopsy.
Doctors use the results to help with diagnosis, screening, and decisions about treatment or active surveillance.
Possible Problems
Prostate biopsy procedures can cause several complications. Bleeding commonly occurs at the biopsy site, in the urine, or in semen. The semen may appear red or brown for a few weeks after the biopsy. Rectal bleeding often happens but tends to stop on its own.
Some people experience trouble urinating after the procedure. Rarely, a temporary catheter helps with this. There is also a small risk of infection in the urinary tract or prostate, which may require antibiotics.
Complications can influence decisions about managing high-grade cancer, adenocarcinoma, and high-grade prostatic intraepithelial neoplasia. The team sometimes uses sedation during the procedure.
| Complication | How Often |
|---|---|
| Bleeding (rectum, urine) | Common |
| Blood in semen | Very Common, lasts weeks |
| Urinary problems | Less common, rarely needs catheter |
| Infection | Uncommon |
How You Prepare
Before the procedure, a healthcare professional gives instructions about stopping certain medications, such as blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs), to lower the risk of bleeding.
Some herbal supplements might also need to be stopped. Patients usually provide a urine sample to check for a urinary tract infection and may receive antibiotics to help prevent infection.
A cleansing enema is often done at home before coming in. For pain relief, the team may discuss options during the visit. They may also discuss if imaging, like ultrasound or MRI, will be used during the biopsy.
What You Can Expect
Different Ways to Collect Prostate Tissue
Doctors use a few main methods to collect small pieces of prostate tissue.
The two most common are:
| Method | How It’s Done | Tools Used |
|---|---|---|
| Transrectal biopsy | A thin needle passes through the rectal wall into the prostate. | Transrectal ultrasound (TRUS), biopsy needle |
| Transperineal biopsy | The needle goes through a small cut between the anus and scrotum. | MRI or CT scan for guidance, core needle |
Doctors most often use the transrectal approach. The transperineal method is another option, especially if more detailed guidance is needed. Both methods remove several small samples, called tissue cores, from different areas of the prostate.
Sometimes, systematic biopsy—sampling from set regions—is used. For some procedures, anesthesia helps with discomfort. Imaging, such as an MRI or ultrasound, guides the needle.
What Happens During a Biopsy Using the Rectum
For a transrectal prostate biopsy, the person lies on their side—or sometimes on their stomach—with knees pulled up. A thin probe, coated in gel, is gently inserted into the rectum. Sound waves from the transrectal ultrasound (TRUS) create pictures of the prostate so the doctor can see where to take samples.
The doctor gives a shot of local anesthesia to numb the area. Then, a spring-loaded biopsy needle takes small pieces of tissue from the prostate. This part might feel uncomfortable or cause a short pinch each time a sample is taken. Usually, 10–12 tissue cores are removed. The procedure is quick and typically takes about 20 minutes in total.
What Happens After the Biopsy
After a prostate biopsy, light activity is usually advised for a day or two. Doctors might prescribe antibiotics to lower the chance of infection. Common side effects include:
- Slight pain or soreness in the biopsy area.
- Minor bleeding from the rectum.
- Blood in urine or bowel movements for a few days.
- Reddish or rusty-colored semen, which may last several weeks.
Most symptoms go away on their own. If anyone notices fever, trouble urinating, ongoing bleeding, or pain that gets worse, they should call their doctor right away.
Test Outcomes
After a prostate biopsy, a pathologist examines the tissue samples to look for cancer cells and any changes in cell structure. The pathologist checks the overall appearance, texture, and color of the samples. This information is often included as a “gross description” in the report.
A microscopic review then identifies if the cells are normal, show early changes, or are cancerous. Cancer cells in the prostate are most often called adenocarcinoma. Sometimes, cells look unusual but are not cancerous; terms like “prostatic intraepithelial neoplasia” or “atypical small acinar proliferation” may be used to describe these findings.
If cancer is detected, the report will include a Gleason grade and Gleason score. The Gleason score is created by adding up the two main pattern grades seen under the microscope. It usually ranges between 6 and 10. This score helps doctors understand how aggressive the cancer might be:
| Gleason Score | Grade Group | Description |
|---|---|---|
| 6 | 1 | Low-grade |
| 7 | 2 or 3 | Medium-grade |
| 8-10 | 4 or 5 | High-grade |
- A lower score (6) means the cancer is less aggressive.
- A score of 7 shows a medium level of aggressiveness.
- Higher scores (8-10) indicate faster-growing cancer.
Besides the Gleason score, the pathologist may list the Gleason grade group, which is another way to sort the results. The staging of the cancer, if available, tells how far the cancer might have spread, but this is not always part of the initial biopsy result. The final part of the report contains the pathologist’s diagnosis. This section might also suggest additional testing if the findings are uncertain or need more detail.
