Prostate cancer is a common form of cancer for males. It affects the prostate gland, which plays a role in producing semen.
This type of cancer is highly treatable, especially if a person receives a diagnosis 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, some experts recommend screening after 50 years of age, or earlier if people have a higher risk.
The main tests for screening are the prostate specific antigen (PSA) test and the digital rectal examination (DRE). If results from these tests suggest that cancer is present, a doctor may recommend a biopsy. A prostate biopsy is the only effective way to diagnose prostate cancer.
This article explains the procedure of a prostate biopsy, and what to expect before and afterward.
During a prostate biopsy, a doctor will use a needle to take several small samples of prostate tissue. They will use an ultrasound probe to guide the needle. They may also use anesthesia to numb the area beforehand.
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 then use a needle to remove between two and 14 core samples, depending on the type of biopsy. They will usually take some from each side of the prostate.
A spring loaded tool punches the needle through the rectal wall into the prostate gland. Each sample is a minute cylindrical core of cells.
The action is very quick, and it is not usually painful, due to the anesthesia.
A transperineal biopsy is another type of biopsy procedure.
During this operation, a doctor will make a small cut 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 may take 30–90 minutes and can involve the use of a contrast dye. The individual will be monitored for up to an hour afterward.
Will it hurt?
A doctor will usually administer an anesthetic injection into the rectum area before the procedure.
During the biopsy, the individual should not feel any pain, but they might feel a pinch as the needle enters the tissue.
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.
Before the test, the doctor may ask the person to:
- Stop taking blood thinners, such as aspirin or warfarin, 7–10 days before the biopsy.
- Start taking antibiotic pills 1–2 days before the biopsy, to reduce the risk of infection.
- Eat only a light meal on the day of the examination.
- Use an enema at home before attending the biopsy.
- Arrange a lift home if they are having 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 them 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 a biopsy, 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 symptoms are significant, or if they worsen rather than improve, the person should contact their doctor.
Are there any other options for testing for prostate cancer? Find out here.
Some discomfort is likely during the recovery time, but sometimes, more severe complications can arise.
If the following occurs, the person should call their doctor at once:
- prolonged or heavy bleeding
- a fever
- difficulty urinating
- worsening pain
In rare cases, sepsis can occur. Sepsis is a potentially life threatening infection that needs urgent medical attention.
Signs and symptoms of sepsis
- a rapid heart rate
- fever and chills
- shortness of breath
- pain and discomfort
- clammy or sweaty skin
Learn more here about sepsis.
Other tests for prostate cancer include a digital rectal examination (DRE) and the prostate specific antigen (PSA) test.
A doctor will normally carry out these tests before recommending a biopsy. However, only a biopsy can confirm the presence of cancer.
What tests are there for prostate cancer? Find out here.
A biopsy will show if 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 to what extent the cells have changed and how quickly cancer is likely to progress.
The pathologist, who examines the sample, will give the cells a grade.
These range from grade 1, which looks normal, to grade 5, where significant changes have occurred.
If cells are grade 1–2, doctors do not normally consider this as cancer.
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 3 out of 12 samples are cancerous, cancer is less widespread.
Another way to grade cancers is to use the Gleason score. This score reflects how likely cancer is to spread quickly or how aggressive it is likely to be.
Find out more about the Gleason score for prostate cancer in our dedicated article here.
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 men 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.
Carcinoma in situ refers to cells that are not yet cancerous but could become so. They can occur almost anywhere in the body.
Find out more in our dedicated article about what carcinoma in situ means in the prostate and elsewhere.
The outlook depends on the results of the biopsy and other tests.
If results show that cancer is present in or around the prostate gland only, there is an almost 100% chance of surviving at least another 5 years. This is because effective treatment is available, and because 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 present
- how far cancer has spread
Prostate cancer is a common cancer among males.
Those with a high risk of prostate cancer should start speaking to their doctor from the age of 40 years about screening. Those with an average risk may wish to consider screening from the age of 50 years.
Clearly, prostate cancer is common, and many men will get it. But I often see that experts do not recommend regular screening. What is the best thing to do?
The best thing to do is to discuss your options with your doctor. Then both of you can discuss your individual risk factors, such as family history, diet, chemical exposure, and so on, to determine if you should have prostate cancer screening.
You can also discuss the risks and benefits of prostate cancer screening with the PSA (prostate specific antigen) blood test, digital rectal exam (DRE), or other screening alternative tests.Yamini Ranchod, PhD, MS Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.