Your Prostate Biopsy: What to Expect

For the past century, prostate biopsies have been regularly used to detect and confirm cases of prostate cancer. In the US alone, approximately a million biopsies are performed each year.

The prostate biopsy serves as the last step in confirming prostate cancer and helps reveal the type, stage and progression of the disease. It is usually considered if the:

• Digital rectal exam found abnormal growths,
• Prostate-specific antigen (PSA) test is over 4 ng/mL or
• Imaging scan found suspicious growths

Usually, these tests alone are not enough to highlight an issue, and a combination may be done before biopsy is suggested to you. Therefore, you can rest assured that your doctors will try their best to ensure that you do not undergo this procedure unnecessarily.

The following are some common preparations usually undertaken before your prostate biopsy:

• If you are taking any blood-thinners or aspirin, you may need to stop before your procedure. This would ensure a faster recovery and prevent any complications. However, if you are carrying coronary stents, your doctor may recommend continuing low doses of aspirin as necessary.
• You may be asked to take preventative antibiotics before your procedure to limit the risk of infections.
• If you are undergoing a transrectal biopsy, you may need an enema with antiseptic solution (e.g. povidone-iodine) which will help reduce the rates of infections by clearing the bacteria in your rectum.
• If you are undergoing general anesthesia, you will be asked to fast the night before the procedure. This will help to prevent food going back up your throat while your body’s reflexes are asleep during the procedure, protecting you from vomiting or choking.
• Right before your procedure, you may be provided with a sedative to help you relax.

Depending on the selected biopsy approach and your doctor’s recommendation, either local or general anesthesia can be used for the procedure.

There are two approaches to the prostate biopsy commonly used and recommended: the transrectal approach, and the transperineal approach. Usually, an ultrasound probe is used to guide needle insertion and allow your doctor to visualize the position of your prostate more clearly. A guiding grid may also be placed to help stabilize and guide the needle positioning more accurately.

Alternatively, if these options are not available, your doctor may insert a gloved and lubricated finger into your rectum in order to hold and stabilize your prostate before the needle is inserted.

Transrectal biopsy

You will need to lie on your side with your knees bent. A finger-wide ultrasound probe will be coated with lubricant and inserted into your rectum, which may feel cold and cause a little pressure and discomfort.

A local numbing medication will then be injected around your prostate. Following that, needles will be inserted to take samples, according to how many sites need to be tested. The needle will go through the rectum to reach the prostate. You may feel some discomfort or pressure during this step, but no outright pain once the anesthesia has kicked in. Finally, the samples will be sent to the lab for further review.

Transperineal biopsy

For a transperineal biopsy, you will likely need to lie on your back with your knees bent and thighs apart. Your scrotum may be taped to expose the perineum, and note that any excess hair may be shaved off. A finger-wide ultrasound probe will be coated with lubricant and inserted into your rectum, which may feel cold and cause a little pressure and discomfort. A local anesthetic will then be injected, which may cause some stinging. Once the area is numb, a small incision in the perineum will likely be made for the needles to reach the prostate.

If you undertook general anesthesia, you would need to rest in the hospital for a few hours to monitor your recovery. Once you are alert with stable vitals, you can then be considered for discharge.

On the other hand, if local anesthetic was used, you will likely be able to return to your normal activities soon after the procedure. You may notice an urge to urinate or have bowel movements after the biopsy, but this feeling is temporary and will likely pass after a few hours.

As you recover from the procedure, some commonly seen side effects include seeing blood in your urine or stool for a few days, as well as in your ejaculate for up to a few weeks. You may experience some pain or tenderness at the biopsy site. If so, you can take pain relievers as recommended by your doctor. Be sure to avoid medications that could increase the risk of bleeding, such as aspirin (unless your doctor recommends it). You should also take extra care to keep the incision area clean after passing stools.

Rest assured, the side effects of prostate biopsy are usually mild. The main complication your doctor would be looking out for is a post-biopsy infection, the most common reason for requiring hospitalization after the procedure.

If you notice the following, you should contact your doctor:

• Excessive blood in your urine or stool
• Pain in your stomach or pelvis area
• Issues with urination (e.g. difficulty with flow, changes in smell or a burning sensation)
• Fever or chills

If you experience difficulty with urinating, you may be prescribed alpha-blockers to help relax your bladder and prostate muscles so that you can urinate with ease.

While the prostate biopsy process may be uncomfortable and induce some anxiety, you can take comfort in the fact that this is the most reliable method of diagnosing and evaluating if you have prostate cancer. If necessary, it also enables your doctors to swiftly assess the level of spread of the cancer and provide you with the possible next steps, without further delay.