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Having a prostate biopsy

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A prostate biopsy takes small samples of your prostate gland tissue. This is looked at under a microscope to diagnose conditions of the prostate, or prostate cancer.

We use a type of biopsy called a transperineal prostate biopsy

There is information on this page about:

The prostate gland

Prostate glands are only found in men. It is about the size of a walnut.

Your prostate gland is just below your bladder and in front of your bottom (rectum).

It makes a white fluid that becomes part of your semen.

Prostate biopsy

A prostate biopsy takes small samples of tissue from your prostate gland. The samples are looked at under a microscope by a specialist doctor called a histopathologist.

A prostate biopsy can tell us if:

  • any of your prostate cells have become cancerous
  • if you have prostate cancer, it can tell us if the cancer has changed
  • it can also diagnose other conditions, such as non-cancerous (benign) areas of the prostate, inflammation of the prostate (prostatitis), or prostatic intraepithelial neoplasia (PIN), which is a change in the cell type, but is not cancer

Why you might need a prostate biopsy

There are a number of reasons why you might have a prostate biopsy.

  • You had a blood test showing a high level of prostate-specific antigen (PSA). PSA is a protein that is released into your blood from the prostate gland. If you have high levels of PSA, and an MRI scan that shows a change in the prostate, you will need a biopsy.
  • You might have had previous biopsy that showed no evidence of cancer, but your PSA blood test or MRI scan are still abnormal. If this happens you might need a prostate biopsy.
  • If you have prostate cancer that has not needed treatment and has been on continued observation (active surveillance), you might need a prostate biopsy if your PSA level has gotten higher, or if a follow-up MRI scan has shown changes.
  • Your doctor or nurse might have found a lump during a digital rectal examination (DRE) and recommend a prostate biopsy. A DRE is where a doctor or nurse feels your prostate through your bottom (rectum) with their finger.

Having a prostate biopsy

We do prostate biopsies through the perineal skin. This is the skin between your bottom and your scrotum. This is called a transperineal prostate biopsy.

You will have an ultrasound probe placed in your bottom so we can see the prostate. We then take samples of the prostate through the perineal skin.

An ultrasound probe

An ultrasound is a scan that creates images of the inside of your body. It displays the images on a screen. This helps to guide your doctor or nurse when they are doing the biopsy.

Your prostate gland is in front of your bottom (rectum), so a small ultrasound probe can be put in your rectum to get an image of the prostate gland. This is called a trans-rectal ultrasound (TRUS).

Local or general anaesthetic

The biopsy can be taken using either a local or general anaesthetic.

  • Local anaesthetic is medicine used to numb an area of your body. The prostate biopsy can be done safetly and comfortably under local anaesthetic. Over 8 in 10 (80%) of people have a prostate biopsy under local anaesthetic. 
  • If you have found the finger examination of the prostate very uncomfortable, you might have sedation medicine or a general anaesthetic through a drip into a vein (intravenously). This means you will be asleep during the biopsy and should not feel anything. 

Your doctor or nurse will talk to you about these options, and which might be best for you before you have your biopsy. You can ask them for more information about having an anaesthetic. 

Preparing for a prostate biopsy

 

Before you have a biopsy, you should tell the doctor or nurse if:

 

  • you are taking any medicines, particularly antibiotics or medicines that help to stop your blood clotting (anticoagulants), such as aspirin, warfarin, clopidrogrel, rivaraxoban or dipyridamole
  • you have allergies to any medicines, including anaesthetic
  • you have ever had bleeding problems
  • you have an artificial heart valve

 

You should take all of your medicines as normal before your biopsy, unless you have been told otherwise by your doctor who organised the biopsy.

On the day of your prostate biopsy

The biopsy is usually done in clinic or as day case. This means you will come into hospital, have the biopsy and leave on the same day.

You will be sent a letter telling you when and where to come on the day.

You will see your urology doctor or nurse specialist, who will go through the biopsy procedure with you, and ask you to sign a consent form. You can ask them any questions you have.

If you are having a biopsy with local anaesthetic

It is important to make sure that you are not hungry or thirsty. You can eat and drink before the biopsy.

  1. You will be asked to lie on the table and your legs will be placed in supportive stirrups.
  2. Your doctor or nurse will examine your prostate with a finger in your bottom. They will use a special gel to relax your bottom (anus) muscle.
  3. They will then tape your scrotum out of the way, and lift your legs so that your hips are bent as far as possible. If you find this position difficult, let your doctor or nurse know.
  4. They will use antiseptic to clean the perineal skin, which is the area of skin the biopsy will be taken through.
  5. You will be given an injection of local anaesthetic. This will numb the area so that you should not feel any pain. The injection will sting for a few seconds at first. 
  6. The ultrasound probe is covered in gel to make putting it in your bottom easier. The probe will be in your bottom for the whole procedure so that your doctor or nurse can see your prostate.
  7. Very fine needles are then put through the numb skin to take biopsies of your prostate. The needle is spring-loaded, so it is put into the prostate and removes a tissue sample very quickly. You might feel a short, sharp pain as it is put in.
  8. You will hear the click of the ‘gun’ as the needle takes the biopsy. Normally, 24 to 28 biopsy samples are taken.
  9. You can leave hospital as soon you can have a pee normally.
  10. You will be asked to rest at home for about 4 hours.

If you are having a general anaesthetic or sedation biopsy

If you are having a general anaesthetic or intravenous sedation for your biopsy, you will be told when to stop eating and drinking before the biopsy.

  • The general anaesthetic or sedation will be given through a small needle in the back of your hand. This will make you sleep for the whole procedure, so you will not feel any pain or discomfort.
  • You will wake up in the recovery room and your surgeon will see you before you are sent home from hospital (discharged).
  • You will need someone to help you get home, as your muscles might ache and you might feel sleepy because of the anaesthetic.
  • General anaesthetic takes 24 to 48 hours to wear off, so please rest at home for this time.
  • Before you leave hospital, you might be given antibiotics to take at home to stop an infection. You must finish the course as prescribed.

After a prostate biopsy

You might have some discomfort in the area you had the biopsy for 1 to 2 days.

You might notice some blood in your pee for a few days. Your semen might be pink or brown for up to 6 weeks, and sometimes longer. This is nothing to worry about. You should drink lots of non-alcoholic fluids while you have blood in your pee.

When to go to the Emergency Department (A&E)

Go to your local Emergency Department if:

  • your pain gets worse after the biopsy
  • you have a high temperature (fever), which is more than 38C
  • you do not pee for 8 hours
  • you start to have large clots of blood in your pee
  • you have lots of bleeding

If you need to visit an Emergency Department, please ask them to contact the on-call urology team at Guy’s Hospital for advice, phone: 020 7188 7188, bleep number 1228.

Prostate biopsy results

Please make sure you have an appointment for the follow-up clinic before you leave hospital. You will get your results at this appointment.

Usually this will be in our Histology Clinic on a Monday afternoon, about 1 week after your biopsy.

Risks of a prostate biopsy

Although serious risks are rare, every procedure has some risk. Your doctor or nurse will talk to you about all the risks and how they might affect you before you have your biopsy.

  • Infection. This happens to 1 in 500 people (0.2%). You might need antibiotics after your biopsy to lower the chance of infection. This is not always needed. If you get a high temperature (fever), or have pain or a burning sensation when you pee, you might have an infection. You should go to your local Emergency Department (A&E) straight away.
  • Blood when you pee. This is common. You might have anything between peach coloured pee, to rose or even deep red coloured pee. It is not usually a sign of a serious problem. Drinking more water will usually help ‘flush the system’ and clear any bleeding. If there is heavy bleeding or bleeding every time you pee, you should go to your nearest Emergency Department (A&E).
  • Finding it hard to pee. It is possible that the biopsy can cause an internal bruise that makes it difficult for you to pee. This happens in less than 1 in every 200 people (0.5%). It is more likely to happen if you had difficulty peeing before the biopsy, or if you had a general anaesthetic or sedation for the biopsy. If you find it hard to pee, you might need a flexible tube that drains pee from your bladder (a catheter). You will need to go to your nearest Emergency Department (A&E).
  • Allergic reaction. You might have an allergic reaction to the medicine we give you during the biopsy. This risk is low (less than 1 in 1,000 people). Let us know if you have had any allergic reactions to any medicines or food in the past before you have your biopsy.

 

  • Asking for your consent (permission)

    We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form to say that you agree to have the biopsy and you understand what it involves. If you would like more information about our consent process, please speak to a member of staff caring for you.

Other treatment options (alternatives)

A transperineal prostate biopsy is our standard test to diagnose prostate cancer. We do not offer transrectal biopsies. We believe a transperineal biopsy is safer and more accurate than any other type of prostate biopsy.

Useful sources of information

Prostate Cancer UKsupport and information for people with prostate cancer.

Macmillan Cancer Support, support and information for people affected by cancer. 

Dimbleby Cancer Carecancer support services for Guy’s and St Thomas’. We have a drop-in information area staffed by specialist nurses in the Welcome Village of the Cancer Centre at Guy’s. 

 

 

 

 

Ref number: 2334/VER8

Date published: May 2020 | Review date: May 2023

© 2020 Guy’s and St Thomas’ NHS Foundation Trust

A list of sources is available on request

 


Where next?

 Contact us

If you have any questions about having a prostate biopsy, or your results, please contact one of our prostate cancer nurse specialists.

Phone: 020 7188 7339, Monday to Friday, 8am to 5pm.

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