Prostate Biopsy

There are two main types of prostate biopsy. 

• Transperineal biopsy. A needle goes through the skin between the scrotum and the back passage (perineum).

• Transrectal ultrasound (TRUS) guided biopsy. A very fine needle goes through the wall of the back passage (rectum) into the prostate.

   

Most hospitals are moving towards using transperineal biopsies. This is because there is more chance of infection after a transrectal biopsy. Talk to your doctor about which type of biopsy you are having. 

You may be given some antibiotics to take before the biopsy. This will help prevent infection (more common in the transrectal biopsy). 

Please let your healthcare team know if you are taking medicines to thin your blood, e.g:

• Warfarin
• Clopidogrel
• Apixaban
• Edoxaban
• Rivaroxabon
• Dipridamole
• Dabigatran. 

You will need to stop taking these treatments a few days before your biopsies. Please do not stop taking these medications before talking with your healthcare team.

What happens before the biopsy?

• The biopsy can be done by a clinical nurse specialist or a doctor. 
• Biopsies are often carried out under a local anaesthetic. This means that the doctor will numb:
  • The prostate
  • The area around the prostate
  • The area between the back passage and testicles (perineum).
  • Sometimes a general anaesthetic is used.
• Some people find the biopsy very uncomfortable. You may feel anxious about having it done. You can talk to your doctor about your concerns before the biopsy is done. 
• You may be asked to give a sample of pee when you arrive. This is to check if you have an infection in your pee. 
• You will need to remove the bottom half of your clothes (underwear) and put on a gown. 
• If you are having a local anaesthetic, you can eat and drink normally before your appointment.
• If you are having a general anaesthetic, you will be asked to fast for at least 6 hours before the biopsy. 

What happens during the biopsy?

• You will usually be asked to lie on your back with your knees bent and thighs apart or your legs in stirrups. This may be on a bed or special chair. 
• An ultrasound probe is put into your back passage. This lets the doctor or nurse see your prostate on the screen. A needle is inserted either:
  • Through your back passage (transrectal biopsy), or 
  • Through the area between your testicles and back passage (transperineal biopsy). 
• A special grid may be used as a template. This helps to make sure that all areas of the prostate are included. 
• The biopsies are taken with a device that has a spring-loaded needle within it. You may hear a click like a staple gun as the sample is taken. It may feel like a flicking sensation. If you feel pain during the first sample, do tell the nurse or doctor. They may be able to give you more local anaesthetic. 

• The whole test takes about 20–40 minutes. 

   

When can I go home?

• If you had a local anaesthetic, you should be able to go home as soon as you feel able. You may feel lightheaded when you first get up. So, many hospitals recommend that you get someone else to drive you home. You can eat and drink normally. 
• If you have had a general anaesthetic, you will need to stay at the hospital until you have fully recovered. You are not allowed to drive for at least 24 hours after having a general anaesthetic. 
• Most hospitals will ask you to take a pee before you leave. This is to check that you are not having problems peeing. You may see some blood in your pee.
• If you are not able to pee at all, you may need a catheter. This is a small, flexible tube that goes from into your bladder and drains into a bag. 

• You may get a bit of blood leaking from puncture wounds in your perineum. The hospital may give you a pad to put in your underwear. It may be a good idea to bring along a pad just in case. 

When will I get my results?

• You won’t get any results at the time of the scan. All the samples are sent to the lab and will be looked at under a microscope. 
• You should get results within one-to-three weeks. Ask your doctor or nurse how long it will take and how you will get the results.

What do my results mean?

• Your prostate biopsy is used to get a grade group. This is used to measure how aggressive your prostate cancer is.
• To get this grade, your biopsy cells are first given a Gleason score. 
• When healthy prostate cells turn into cancerous cells, they start to look different. This can be seen by looking at your biopsy samples under a microscope. 

• The sample of cells are scored from three-to-five. This is based on how much the cancerous cells look like normal cells. 
• Low-grade cancerous cells look more like normal cells. The higher the score, the more abnormal the cells look.

• For example, if your score is 4 + 3 = 7, it means that most of your cancer cells are scored four and the next most common are scored three.  The two grades are then added together to give the final grade group. This grade group goes from one-to-five. 

Your doctor or nurse should talk to you about any possible risks and side effects before you have the biopsy. If they don’t do this, you can ask them. 

Transperineal biopsy

Almost all patients:

    Blood in your pee for up to 10 days.

    Blood in your semen. This can last for up to six weeks. 

People may also get:

• Bruising in the area between the scrotum and back passage (perineum)
• Discomfort in the prostate
• Temporary problems with erections.

You may be unable to pee. If this happens, please tell your doctor straight away or call 111.

In some cases there is a failure to detect a significant cancer in your prostate.

Transrectal biopsy

Almost all patients:

    Blood in your pee for up to 10 days.

    Blood in your semen. This can last for up to six weeks. 

    Blood in your poo.

People may also get:

• Discomfort in the prostate from brusing
• Infection in the pee that needs antibiotics.

If your pee is:

• Cloudy
• Smells unpleasant

or if you have pain when you pass pee, you may have an infection. You will need to speak to your GP.

If you experience any of the following symptoms, you will need to contact your GP or 111 straight away. 

• A high temperature (over 38 degrees C)
• Shivering
• Sweating
• Problems passing pee.

Our services search tool (link will open in a new tab) will allow you to search for hospitals near you that offer:

• Perineal biospy with local anaesthetic
• Perineal biospy with general anaesthetic

and/or

• Transrectal ultrasound guided biospy (TRUS)