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What to Expect from a Prostate Biopsy

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If you're facing a prostate biopsy, it's natural to be apprehensive. Here's a realistic guide to this commonly-performed procedure.

An abnormal prostate-specific antigen (PSA) test provides an important clue to your prostate health. But it cannot determine with certainty whether you have prostate cancer. Until more sophisticated tests are developed, a biopsy of the prostate -- though not perfect -- is the best way to find out whether a high PSA level indicates cancer.

About 800,000 prostate biopsies are performed in the U.S. each year. Known formally as transrectal ultrasound-guided biopsy, prostate biopsy is an in-office procedure that takes about 15 minutes to perform. Despite its reputation as a very painful procedure, a prostate biopsy can be performed with minimal to moderate pain through the use of lidocaine, a local anesthetic. Lidocaine gel can be applied inside the rectum, or the anesthetic can be injected through the rectal wall to numb the nerves around the prostate. Some urologists also may give a mild sedative before the procedure. Good pain control not only keeps you comfortable during the prostate biopsy, but it also helps ensure that the proper number of samples can be taken.

You will be advised to discontinue blood-thinning medications like aspirin, Coumadin (warfarin), or Plavix (clopidogrel) seven-10 days before the prostate biopsy to help prevent excess bleeding after the procedure. If you take vitamin E, fish oil, ginkgo biloba or other dietary supplements with blood-thinning effects, be sure to let your doctor know. He or she may recommend that you stop taking those as well.

Because the prostate biopsy usually is taken through the wall of the rectum, an enema is required the day of the procedure to clean out the intestines and reduce the risk of fecal contamination and infection. As an extra precaution against infection, most doctors also prescribe an antibiotic to be taken before and after the prostate biopsy.

During the prostate biopsy, you will be asked to lie on your side, with your knees pulled toward your chest. A thin ultrasound probe is inserted into the rectum. The probe emits sound waves that are converted into video images of the prostate. These images are used to guide the lidocaine injection (if one is used) and to position the biopsy device. The spring-loaded biopsy “gun,” with its hollow, ultra-thin needle, is mounted on the ultrasound probe. The biopsy device is directed at varied areas of the prostate, removing a thin (1/16 of an inch) column of prostate tissue (called a core) with each split-second firing through the rectal wall. At least 10-12 cores should be taken and sent to the pathologist for evaluation.

You may experience minor rectal bleeding, or see blood in your stool or urine for a few days. Small amounts of blood in your semen may give it a pinkish tinge for several weeks.

Bear in mind that infection is rare but serious. Call your doctor if you experience any symptoms of infection: fever, painful urination or discharge from the penis. You also should call your doctor if you experience heavy or prolonged bleeding; significant pain, swelling or redness near the biopsied area; or difficulty in urinating.

Posted in Prostate Disorders on November 14, 2006
Reviewed June 2011

Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Health After 50 Disclaimer

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Health After 50 Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the editors cannot be answered in this space.

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Since the prostate biopsy is an invasive procedure, and is not without risk, it is important to understand that the indicator for a biopsy is reliable. The PSA fluctuates as a function of many factors, e.g. diurnal, dietary, bladder and prostate infection, sexual activity. How does one assure that there is a good reason to have a biopsy on the basis of a PSA reading which is so variable?

Example: My urologist wanted me to undergo a biopsy when my PSA reading exceeded 4.0 in spite of the fact that he knew that I had a case of prostatitis one month prior. It has taken 9 months for the rise of my PSA due to the infection (peak of 8.6) to return to below 4.0.

Posted by: LymphActivist | November 16, 2006 1:44 AM

My biopsy came back a gleason 6+6 showing low grade limited cancer, the post surgery pathology came back a gleason 5+5 with extensive high grade cancer. My advise is to all is to find the most experienced urologist around you who will do the best biopsy possible.

Posted by: lbi103 | November 18, 2006 6:57 AM

My urologist recommended a biopsy because my PSA went from a 4.5 to a 5.1 in a two week period, however; I had a case of prostatitis which was treated with an antibiotic for three weeks. From my point of view, I should have been treated for 6-8 weeks with an antibiotic before a biopsy was preformed. However, I did not have the 6-8 weeks of an antibiotic and went ahead with the biospy as recommended by the urologist. Now the results of the biopsy indicates that I have a T2 cancer. I believe that the infection influenced the results of the biospy. What do others think of this idea, please give a few comments or ideas? I plan on getting a second opinion.

Posted by: psy1 | November 18, 2006 8:32 AM

The post i made earlier this morning stated 6+6 gleason...must have still been asleep, obviously i meant 3+3. always get a second opinion, and try to go to the best around you. did they give you a gleason score when they told you T2?

Posted by: lbi103 | November 18, 2006 10:23 AM

I had a prostate biopsy 15 days ago and I am passing a few cc of brown looking urine with a few pieces of brown solid matter. This happens about 2 or 3 times a day. Is this old blood from the biopsy? Your article indicates that bleeding usually stops in a few days. Is this dried blood? I this normal for a biopsy? What is going on? During a recent visit to my doctor, he took a urine sample and at that time it was clear, which seemed to satisfy him. (A few hours later I again passed the mystery brown material.) Thank you for your comments. . Maxx

Posted by: Maxx | May 19, 2007 1:24 PM

I changed to a new urologist, and he is not 'comfortable' with the prior biopsy, since he didn't do it himself. So he suggested a lack of confidence, of where samples were taken. At my suggestion, he noticed that the biopsy samples were labeled. Shouldn't one just construct a visual from the labels, and then see where the samples were taken? He wants to do a new biopsy in 4 months. It will be my third.

Posted by: geogeo | July 4, 2007 12:05 AM

Following my prostate biopsy 21 days ago, I'm having the same problem as Maxx above comment:

I am passing a few cc of brown looking urine with a few pieces of brown solid matter...

Any answer for Maxx and me?

Posted by: Gabvoice2 | November 29, 2008 5:56 PM

I also had a prostate biopsy three weeks ago. I still have some light blood in my urine. However, I notice dark blood spotting when I arise in the morning. I assume that this is old blood. There are also some very small clots once in awhile. I would think that the passing of blood and the spotting would taper off after a few days. The nurse at the urologist's office said that passing blood may continue for a month, but I do not see a tapering off. The condition is the same as it was the day after the biopsy. I doubt that it will cease in the next week. Anyone else experience this same thing?

Posted by: 126starr | February 22, 2010 11:39 PM

I had biopsies a few years ago.I have been aggravated with an "irritated" prostate and some sexual dysfunction ever since. My PSA went up one point so they want to do the biopsy again. I started testosterone replacement which is known to raise it plus it is slightly enlarged and according to the Doctor "it could be a mistake at the lab". But, let's not consider any of that. Let's get the $$$$$. That's what these tests and retests are all about.

Posted by: prbbs | November 2, 2010 11:39 AM

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