Prostate cancer is a common form of cancer in males. It affects the prostate gland, which plays a role in producing semen.

Prostate cancer affects 1 in 8 males, according to the American Cancer Society, and the risk increases after a person reaches the age of 65 years.

This type of cancer is highly treatable, especially if a person receives a diagnosis when the disease is in the early stages. Statistics show that nearly everyone with a diagnosis of localized or regional prostate cancer will survive at least another 5 years.

However, prostate cancer often produces no symptoms in the early stages. For this reason, most experts recommend screening after 50 years of age, or earlier if a person has a family history of the condition.

The main tests for screening are a prostate specific antigen (PSA) test and a digital rectal examination (DRE). If the results of these tests suggest that cancer could be present, a doctor may recommend a biopsy. A prostate biopsy is the only effective way to diagnose prostate cancer.

This article explains the prostate biopsy procedure, including what to expect before and afterward.

Before performing a prostate biopsy, a doctor will use local anesthesia to numb the area. They will then use an ultrasound probe to guide a needle to take several small samples of prostate tissue.

The doctor will insert the probe into the rectum to obtain an image of the prostate gland. The prostate is on one side of the rectal wall. Using the image for guidance, the doctor will use the needle to remove 6–14 core samples, depending on the type of biopsy. They will usually take some samples from each side of the prostate.

A spring-loaded tool punches the needle through the rectal wall into the prostate gland. Each sample comprises a minute cylindrical core of cells. The action is very quick, and the anesthesia means that it is not usually painful. Typically, the entire procedure takes less than 10 minutes.

A transperineal biopsy is another type of biopsy procedure. During this operation, a doctor will make a small puncture site between the anus and the scrotum. To extract the samples, they will insert the needle through the cut and into the prostate.

The doctor may use an ultrasound or MRI scan to guide the procedure. Ultrasound guided biopsies usually take up to 45 minutes to complete. An MRI guided biopsy can provide more detailed images. These biopsies may take 30–90 minutes and involve the use of a contrast dye. Healthcare staff will monitor the individual for up to an hour afterward.

Will it hurt?

Although it may be uncomfortable, the procedure is not usually painful. A doctor will most likely administer an anesthetic injection into the rectum area before the procedure to numb any pain. The injection may cause some discomfort, as might the probe. During the biopsy, the individual should not feel any pain due to the anesthesia, but they might feel a pinch as the needle enters the tissue.

It can take several days to recover from a prostate biopsy. During this time, a person may experience:

  • pain in the area
  • blood in the urine or semen
  • bleeding from the rectum
  • an infection

To reduce the risk of infection, doctors usually provide the individual with antibiotics to take before the biopsy and for up to 2 days afterward.

A person can minimize the recovery time following a prostate biopsy by:

  • maintaining hydration
  • avoiding alcohol until they have completed the course of antibiotics
  • avoiding strenuous exercise for 5 days
  • taking pain relievers according to a doctor’s advice
  • avoiding sexual activity for 3 days

A biopsy can sometimes cause side effects. These may include:

  • frequently needing to urinate
  • a burning sensation when urinating
  • blood in the urine
  • blood in the semen
  • blood in the stool
  • urinary tract or prostate infection
  • urinary retention

Before a biopsy procedure, the doctor will ask the person about their overall health. They will need to know about any medications and supplements the individual is taking and any allergies or other medical conditions.

The doctor may ask the person to prepare by:

  • stopping the use of blood thinners, such as aspirin or warfarin, 7–10 days before the biopsy
  • starting to take antibiotic pills 1–2 days before the biopsy to reduce the risk of infection
  • eating only a light meal on the day of the examination
  • using an enema at home before attending the biopsy
  • arranging a lift home from the procedure if they will require sedation

It is also useful to ask questions and find out as much as possible beforehand about the biopsy and what the results might mean. Having this information can help people feel more confident and in control of the process.

The doctor may prescribe an antibiotic to reduce the risk of an infection occurring after the biopsy. After the procedure, a person may experience:

  • some light bleeding from the rectum
  • some drowsiness, if the procedure involves sedation or anesthesia
  • some discomfort for 1–2 days
  • blood in the feces, urine, or sperm

If any side effects are significant or worsen rather than improving, the person should contact their doctor.

Learn more about other testing options for prostate cancer.

Some discomfort is likely during the recovery time, but sometimes, more severe complications can arise. If the following symptoms occur, the person should immediately contact their doctor:

  • prolonged or heavy bleeding
  • fever
  • difficulty urinating
  • worsening pain

In rare cases, sepsis can occur. Sepsis is a potentially life threatening infection that needs urgent medical attention. The signs and symptoms of sepsis include:

  • a rapid heart rate
  • fever and chills
  • confusion
  • shortness of breath
  • pain and discomfort
  • clammy or sweaty skin

Learn more about sepsis.

The authors of a 2019 review conclude that an MRI may be more likely to find a mass within the prostate than a biopsy but note that errors still occur with this method. While a prostate biopsy can determine for certain whether prostate cancer is present, the possibility of complications means that it is preferable to avoid unnecessary biopsies.

As such, evidence suggests that combining the techniques may be the most effective strategy to identify clinically significant cancers without unnecessary testing.

Other tests for prostate cancer include a DRE and the PSA test. A doctor will usually carry out these tests before recommending a biopsy. However, only a biopsy can confirm the presence of cancer.

Learn more about tests for prostate cancer.

A biopsy will show whether the prostate cells are normal or cancerous. If the cells are normal, the doctor may recommend no further action. If cancer is present, the biopsy can also reveal the extent to which the cells have changed and how quickly the disease is likely to progress.

Gleason score

The pathologist who examines the sample will give the cells a grade, known as the Gleason score. This score reflects how aggressive cancer is likely to be, or the chances of it spreading quickly. The score ranges from grade 1, which looks normal, to grade 5, where significant changes have occurred. If cells are grade 1–2, doctors do not generally consider this to be cancer.

Learn more about the Gleason score.

A biopsy can also show how far cancer has spread. For example, if all the biopsy samples contain cancerous cells, cancer is likely to be present throughout the prostate gland. If only three out of 12 samples are cancerous, cancer is less widespread.

Precancerous cells and PIN

Sometimes, the results will show that precancerous cells, or prostatic intraepithelial neoplasia (PIN), are present.

If these PIN are low grade, the doctor will not consider this a matter of concern. Many males have low grade PIN. However, if the PIN are high grade, there is a chance that cancer may develop. In these cases, a doctor may suggest further tests.

If a person already has prostate cancer, the grade of the PIN does not matter, as it does not affect the severity or the Gleason score of the cancer.

Carcinoma in situ refers to cells that have the potential to become cancerous. They can occur almost anywhere in the body.

Learn more about carcinoma in situ.

Although prostate biopsies are a useful tool, evidence suggests that they can miss about 20% of cancers. Many people who do not require a biopsy may also mistakenly have one. A 2020 study notes that combining a biopsy with MRI targeting allowed doctors to identify cancer in 62.4% of samples.

The outlook for a person undergoing a prostate biopsy depends on the results of the biopsy and other tests. If the results show that cancer is only present in or around the prostate gland, there is an almost 100% chance of the individual surviving at least another 5 years. The reason for this is that effective treatment is available, and many types of prostate cancer are slow growing.

However, if cancer has spread to other organs, such as the liver or lungs, the chance of someone surviving another 5 years or more falls to 30%.

Factors that affect the outlook for a person with prostate cancer include:

  • their age and overall health
  • the type of cancer
  • how far cancer has spread

Prostate cancer is a common cancer among males. Individuals who know that they have an increased risk of prostate cancer should start speaking with a doctor about screening from the age of 40 years. Those with an average risk may wish to consider screening from the age of 50 years.