What to Expect During a Prostate Biopsy

What Is a Prostate Biopsy?

A biopsy is a type of diagnostic test used to identify the presence of disease, including cancer, in the tissues of the body. During the procedure, a doctor removes a small amount of tissue, fluid, or from the prostate. This sample is then studied under a microscope to look for abnormal cells and other indicators of cancer.

Most prostate biopsies are core needle biopsies, meaning that an instrument called a core needle is used to obtain the tissue sample. This type of needle has a hollow center that facilitates tissue collection. It can be inserted into the prostate through one of two different approaches:

• Transrectal biopsy: The needle is inserted through the wall of the rectum.
• Transperineal biopsy: The needle is inserted through the skin between the scrotum and anus.

In most cases, multiple samples will be taken to ensure accurate results. These samples will be sent to a medical laboratory for examination and testing.

Preparing for a Prostate Biopsy

The steps a patient will take to prepare for having a prostate biopsy will vary somewhat based on factors such as any medications he may be taking, his overall health, and the biopsy approach to be used/ The doctor will provide specific instructions on how to prepare. These instructions may include:

• Pausing medications: If the patient is taking any blood-thinning medications, he may need to pause the medication temporarily prior to the biopsy to reduce bleeding during or after the procedure.
• Have a pre-procedure enema: The patient may be asked to inject a fluid into his rectum before the procedure, which will clean the rectum and clear away any stool.
• Taking antibiotics: Prostate biopsies carry a small risk of infection. To prevent complications, patients may be instructed to take antibiotics before and after the procedure.
• Providing a urine sample: This sample will be tested for a urinary tract infection (UTI). If the patient has an infection, the biopsy will be postponed until the UTI clears up.

Patients should be sure to follow all instructions before their biopsy. This will ensure the most accurate results possible while minimizing possible side effects.

How Is a Prostate Biopsy Performed?

Prostate biopsies are typically performed by a urologist. The biopsy is an outpatient procedure, meaning the patient doesn’t have to plan for an overnight hospital stay. It typically does not involve sedation.

The patient is asked to put on a hospital gown before lying down on a procedure table. The urologist typically will then insert a transrectal ultrasound (TRUS) device into the patient’s rectum. This will allow the doctor to observe the prostate during testing. The doctor may also inject a local anesthetic near the prostate to numb it, reducing discomfort during the procedure.

Using the TRUS imagery for guidance, the urologist quickly inserts a thin needle into the prostate. When the needle is pulled out, it will contain a small cylinder or core of tissue. This process is repeated about 12 times in different parts of the prostate. The biopsy instrument is spring-loaded for fast insertion and removal. As a result, each sample causes only brief discomfort.

The entire biopsy procedure takes about ten minutes to complete. Afterward, the patient returns home while waiting for the laboratory to provide test results.

After the Prostate Biopsy

The patient may feel some soreness in the biopsy area following the procedure. There may also be some light bleeding from the rectum or a small amount of blood in the patient’s urine. This is normal and should stop within a few days. Seeing blood in the semen after ejaculation is also normal and may last longer, up to a few weeks. Patients should avoid heavy physical activity for 24 to 48 hours after the procedure to prevent heavy bleeding and to allow the site to heal properly.

Prostate biopsies carry little risk of complications. Nevertheless, patients should contact their doctor if:

• Bleeding does not stop or slow down after a few days
• Any soreness gets worse
• They develop a fever or chills
• They experience belly or pelvic pain
• Urinating becomes difficult or painful
• Urine changes in appearance

Patients should also be careful to follow the doctor’s post-procedure instructions for keeping the biopsy site clean.

Understanding Prostate Biopsy Results

Biopsy samples are sent to a medical laboratory to be evaluated by a pathologist. The pathologist will examine the samples under a microscope to identify signs of cancer. If cancer is present, the pathologist may perform additional tests to learn more about the cancer’s characteristics, which can help a urologist or medical oncologist identify which treatment options may be most effective for the patient. The pathology report typically takes a few days to deliver but can take longer. The information provided may include:

Positive or Negative for Cancer

Of course, the most important information provided in a prostate biopsy pathology report is whether cancer cells were found on any samples. If no cancer cells were found, the test is called negative. If cancer cells were found on one or more samples, the test is positive.

Gleason Score or Grade Group

If cancer is found, a Gleason score or grade will be assigned to it. This is a numerical scale used to convey how abnormal the cancer cells look under a microscope. Higher-grade cancers look more abnormal and are also more likely to be aggressive. Gleason scores can be categorized as follows:

• Gleason score of 6 or less: The cancer is well-differentiated or low-grade. The cancer cells are unlikely to spread quickly.
• Gleason score of 7: The cancer is moderately differentiated or intermediate grade. The cells look somewhat different from normal cells and may spread.
• Gleason score of 8 to 10: The cancer is poorly differentiated or high-grade. The cells are extremely abnormal and are likely to spread aggressively.

Some cancer care centers use grade groups instead of Gleason scores. These are reported on a scale of 1 to 5. As with Gleason scores, a higher-grade group indicates more abnormal cells and a greater risk of spread.

Guidance on Treatment Options

Cancer cells from prostate biopsies may also be tested to help determine the potential impact of different treatment options. The results of these tests will tell doctors whether certain targeted therapies, hormone therapy, or immunotherapy are likely to be effective against the patient’s cancer.

Other Information

The pathology report may also contain other information about the cancer, including:

• The number of core samples that contain cancer
• The percentage of cancer cells in each core
• Whether the cancer is found on one or both sides of the prostate

Learn More About Prostate Cancer Care at an RCCA Location Near You

Regional Cancer Care Associates offers comprehensive cancer care at more than 20 locations across New Jersey, Connecticut, Massachusetts, Maryland, and the Washington, D.C., area, allowing patients to receive treatment close to home. Contact us today to learn more.