Do you have to be awake for a prostate biopsy?

The procedure may be done under a local or general anesthetic. (Local anesthetic means medicines are used to make you numb. General anesthetic means medicines are used to put you into a deep sleep during the procedure.)

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What is a prostate biopsy?

The prostate gland is found only in males. It sits below the bladder and wraps around the urethra (the tube that carries urine out of the body). The prostate helps make semen. A biopsy is a procedure used to remove a small piece of tissue or cells from the body so it can be examined under a microscope. In a prostate biopsy, prostate gland tissue is taken out with a biopsy needle or during surgery. The tissue is checked to see if there are cancer or other abnormal cells in the prostate gland.

A prostate biopsy may be done in several different ways:

Transrectal method. This is done through the rectum and is the most common. Perineal method. This is done through the skin between the scrotum and the rectum. Transurethral method. This is done through the urethra using a cystoscope (a flexible tube and viewing device). Ultrasound is usually used to look at the prostate gland and guide the biopsy needle.

Why might I need a prostate biopsy?

A prostate biopsy is done after other tests show that there may be a problem with the prostate gland. It is the best method to diagnose prostate cancer. There may be other reasons for your healthcare provider to recommend a prostate biopsy.

What are the risks of a prostate biopsy?

Some possible complications of a prostate biopsy may include:

Bruising and discomfort at the biopsy site

Bleeding

Infection

Trouble urinating

You may have other risks, depending on your condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a prostate biopsy?

Some things you can expect before a prostate biopsy include:

Your healthcare provider will explain the procedure and you can ask questions.

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 anything is not clear. Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia. Make sure your healthcare provider has a list of all medicines (prescription and over-the-counter) and all herbs, vitamins, and supplements that you are taking. Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure. Generally, no prior preparation, such as fasting or sedation, is needed 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 told to fast (not eat or drink anything) before the procedure, generally after midnight. Your healthcare provider will give you specific instructions. If your healthcare provider uses the transrectal method, you may need to use an enema the night before or the morning of the biopsy.

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You may get a sedative before the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home. You will most likely get a sedative if your healthcare provider is using the transurethral method. You may start to take antibiotics the day before the biopsy is done and continue them for a few days after it. This is to help prevent infection.

Follow any other instructions your healthcare provider gives you to get ready.

What happens during a prostate biopsy?

A prostate biopsy is usually done on an outpatient basis. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, a prostate biopsy follows one of these processes:

Transrectal method

You will remove your clothing and put on a hospital gown. You will be positioned on your left side, with your knees bent. This type of biopsy may be done with a local anesthetic to numb the tissue the needle will pass through. Usually, a transrectal ultrasound (TRUS) will be used to guide the placement of the biopsy needle. The healthcare provider will use a spring-loaded tool that quickly inserts 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. The needle is put in several times to take tissue samples from different parts of the gland. The prostate tissue samples will be sent to the lab for exam.

Perineal method

You will remove your clothing and put on a hospital gown. You will be positioned on your left side, with your knees bent, or lying on your back with your knees bent and thighs apart. The skin between your scrotum and rectum will be cleaned with an antiseptic solution. You will feel a needle stick when the local anesthetic is injected. This may cause a brief stinging sensation. When the area is numb, the healthcare provider may make a tiny incision (cut) in the skin. The healthcare provider will place a gloved, lubricated finger into your rectum to locate and stabilize the prostate gland. The biopsy needle will be inserted through the incision and into the prostate several times to get samples from different parts of the gland. The biopsy needle will be removed and firm pressure will be applied to the biopsy site until the bleeding has stopped. Sutures are usually not needed. The prostate tissue samples will be sent to the lab for exam.

Transurethral method

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You will remove your clothing and put on a hospital gown. You will be positioned on your back with knees bent and thighs apart. The procedure may be done under a local or general anesthetic. (Local anesthetic means medicines are used to make you numb. General anesthetic means medicines are used to put you into a deep sleep during the procedure.) The healthcare provider will insert a cystoscope (a flexible tube and viewing device) into the opening at the end of your penis, through the urethra, and up to the prostate gland. The healthcare provider will insert tiny instruments through the cystoscope to take out samples of the prostate gland. The cystoscope will be removed. The prostate tissue samples will be sent to the lab for exam.

What happens after a prostate biopsy?

Your recovery process will vary depending on the type of anesthesia that is used. If you were given general anesthesia, you will be taken to a 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 go back to 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. This, too, is normal. The biopsy site may be tender or sore for several days after the biopsy. Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding, so be sure to take only recommended medicines.

Call your healthcare provider if you have any of these:

Increase in the amount of blood in your urine or stool

Belly or pelvic pain

Trouble urinating

Changes in the way your urine looks or smells or burning with urination (may be signs of infection)

Fever and/or chills

Your healthcare provider may give you other instruction, depending on your situation.

Before you agree to the test or the procedure make sure you know:

hopkinsmedicine.org - Prostate Biopsy | Johns Hopkins Medicine

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