Prostate Biopsy Procedure

Procedure Overview

What is a prostate biopsy?

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A prostate biopsy is a procedure in which prostate gland tissue samples are removed with a special biopsy needle or during surgery to determine if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.
A prostate biopsy may be performed in several different ways:

• transrectal method - through the rectum (this is the most common)
  
• perineal method - through the skin between the scrotum and the rectum
  
• transurethral method - through the urethra using a cystoscope (a flexible tube and viewing device)
  

Another procedure that may be used to evaluate the prostate gland is a prostate/rectal sonogram. Please see this procedure for additional information.

What is the prostate gland?

The prostate gland is about the size of a walnut and surrounds the neck of a man’s bladder and urethra - the tube that carries urine from the bladder. It is partly muscular and partly glandular, with ducts opening into the prostatic portion of the urethra. It is made up of three lobes: a center lobe with one lobe on each side.
As part of the male reproductive system, the prostate gland’s primary function is to secrete a slightly alkaline fluid that forms part of the seminal fluid (semen), a fluid that carries sperm. During male climax (orgasm), the muscular glands of the prostate help to propel the prostate fluid, in addition to sperm that was produced in the testicles, into the urethra. The semen then travels through the tip of the penis during ejaculation.

Reasons for the Procedure

A prostate biopsy is performed after other diagnostic tests indicate a problem with the prostate gland. The most common tests are:

• digital rectal examination (DRE) - the physician places a gloved, lubricated finger into the rectum to feel the prostate and check for any abnormalities
  
• prostate-specific antigen (PSA) - a blood test that may suggest the presence of prostate cancer
  
• transrectal ultrasound (TRUS) - a test using sound wave echoes to create an image of the prostate gland to visually inspect for abnormal conditions like gland enlargement, nodules, or tumors
  

A prostate biopsy may be performed to diagnose prostate cancer and to determine the cause of an enlarged prostate gland.
There may be other reasons for your physician to recommend a prostate biopsy.

Risks of the Procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• bruising and discomfort at the biopsy site
  
• prolonged bleeding from the biopsy site
  
• infection near the biopsy site
  
• difficulty urinating
  

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  
• Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
  
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  
• Generally, no prior preparation, such as fasting or sedation, is required for the transrectal or perineal method. If the transurethral method is to be used, general anesthesia may be used. If you are to have general anesthesia, you may be instructed to fast before the procedure, generally after midnight. Your physician will give you specific instructions.
  
• If your physician uses the transrectal method, you may have an enema the night before or the morning of the biopsy.
  
• You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home. This is most likely if your physician is using the transurethral method.
  
• Based upon your medical condition, your physician may request other specific preparation.
  
  

  During the Procedure

  A prostate biopsy is usually performed on an outpatient basis. Procedures may vary depending on your condition and your physician’s practices.
  Generally, a prostate biopsy follows one of these processes:
  

  transrectal method:

• You will be asked to remove clothing and will be given a gown to wear.
  
• You will be positioned on your left side, with your knees bent. You should lie still during the procedure.
  
• This method may be performed with a local anesthetic.
  
• Usually, a transrectal ultrasound (TRUS) will be used to guide the placement of the biopsy needle.
  
• The physician will insert a needle through the wall of the rectum into the prostate gland. You may feel discomfort or pressure when the needle enters the prostate gland. Sometimes a spring-loaded biopsy needle will be used, which is said to be nearly painless.
  
• The physician will obtain several tissue samples from different parts of the gland.
  
• The prostate tissue sample will be sent to the lab for examination.
  

perineal method:

1. You will be asked to remove clothing and will be given a gown to wear.
   
2. You will be positioned on your left side, with your knees bent, or lying on your back with knees bent and thighs apart. You should lie still during the procedure.
   
3. The skin between the scrotum and the rectum will be cleansed with an antiseptic solution.
   
4. You will feel a needle stick when the local anesthetic is injected. This may cause a brief stinging sensation.
   
5. When the area is numb, the physician will make a small incision in the skin.
   
6. The physician will place a gloved, lubricated finger into the rectum to locate and stabilize the prostate gland.
   
7. The biopsy needle will be inserted several times into the prostate to obtain samples from different parts of the gland.
   
8. The biopsy needle will be withdrawn and firm pressure will be applied to the biopsy site until the bleeding has stopped.
   
9. The prostate tissue sample will be sent to the lab for examination.
   

transurethral method:

1. You will be asked to remove clothing and will be given a gown to wear.
   
2. You will be positioned on your back with knees bent and thighs apart.
   
3. The procedure may be performed under a local or general anesthetic.
   
4. The physician will insert a cystoscope (a flexible tube and viewing device) through the opening at the end of the penis into the urethra.
   
5. The physician will insert instruments through the cystoscope to obtain the prostate gland samples.
   
6. The prostate tissue sample will be sent to the lab for examination.
   

After the Procedure

Your recovery process will vary depending upon the type of anesthesia that is used. If you were given general anesthesia, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.
If local anesthetic was used, you may resume your normal activities and diet unless otherwise instructed. You may feel the urge to urinate or have a bowel movement after the biopsy. This feeling should pass after a few hours.
There may be blood in your urine or stool for a few days after the biopsy. This is common. Blood, either red or reddish brown, may also be in your ejaculate for a few weeks after the biopsy.
The biopsy site may be tender or sore for several days after the biopsy. Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Notify your physician to report any of the following:

• increase in the amount of blood in your urine or stool
  
• difficulty urinating
  
• fever and/or chills
  

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

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