If your GP thinks you might need further tests to work out if you have a prostate problem, they will refer you to see a hospital specialist, usually a urologist. The specialist might repeat some of the tests you were given by your GP.

Depending on the results, they might offer you another PSA test in the near future to check that your PSA is not rising. Or they might recommend a prostate biopsy. This will usually be a TRUS (trans-rectal ultrasound) guided biopsy, although sometimes you’ll have a more detailed biopsy called a template biopsy.

In some hospitals you might be offered an MRI scan before a biopsy to help the doctor decide if you need a biopsy. Other tests you might have include a urine flow test and an ultrasound scan of your bladder. These are usually done to check for an enlarged prostate.

Prostate biopsy

A prostate biopsy involves taking small pieces of prostate tissue to be looked at under the microscope, to see if there is any prostate cancer.

A high PSA level alone does not automatically mean that you must have a biopsy. Your specialist should talk to you about the pros and cons of having a biopsy, and discuss any concerns you may have before you decide whether to have it.

Men who have cancer that has spread outside the prostate gland might not need a biopsy if they have a very high PSA level, or if another test, such as a bone scan, shows that the cancer has spread. Talk to your doctor or nurse about this.

What is a TRUS biopsy?

A TRUS (trans-rectal ultrasound) guided biopsy involves using thin needles to take around 10 to 12 small samples of tissue from the prostate. Your doctor can tell you how many samples they’ll take. The biopsy is done through the back passage. An ultrasound scan will be done at the same time to help guide the biopsy needles and measure the size of the prostate gland.

If you decide to have a biopsy, you might be given an appointment to come back to the hospital at a later date or you may be offered the biopsy straight away.

Before the biopsy you should tell your doctor or nurse if you’re taking any medicines, particularly drugs that thin the blood.

You’ll be given some antibiotics to take before your biopsy, either as tablets or an injection, to help prevent infection. You will also be given some antibiotic tablets to take at home – it’s important to take all of them for them to work properly.

The biopsy will be done either by a urologist, a radiologist, or a specialist nurse. You’ll lie on your side on an examination table, with your knees brought up towards your chest. They’ll put an ultrasound probe into your back passage (rectum), using a gel to make it more comfortable. The ultrasound probe scans the prostate and an image appears on a screen. A needle is then inserted through the wall of the back passage into the prostate gland – using the ultrasound image as a guide.

You will have a local anaesthetic injection into your back passage to numb the area and reduce any discomfort. Each man is different and while some describe the biopsy as painful, others have only slight discomfort.

The biopsy will take 10-15 minutes. You might have to wait for a little while, or until you have gone for a pee before going home. This is to make sure you‘re able to urinate.

Prostate biopsy diagram

If you experience any discomfort after the biopsy, talk to your nurse or doctor. They may suggest taking mild pain-relieving drugs, such as paracetamol, to help with this.

If you’re gay or bisexual you might need to be careful when you have sex. If you have anal sex, you should ideally wait around six weeks after a biopsy before you receive anal sex. Ask your doctor or nurse at the hospital for further advice.

It can take up to two weeks to get the results of the biopsy. Ask your doctor or nurse when they expect to have your results.

What are the side effects of a TRUS biopsy?

Having a biopsy can cause side effects. These will affect each man differently, and you may not get all of the side effects.

Some men worry that having a biopsy will cause problems with having erections but there isn’t any evidence for this.

Short-term bleeding

You might see a small amount of blood in your urine or stools for up to two weeks. You may also notice blood in your semen for a couple of months – and your semen may look rust coloured (dark brown) for a few weeks. This is normal, but if it takes longer to clear up, or gets worse, you should see a doctor straight away. If you have severe bleeding after the biopsy and are passing lots of thick-looking clotted blood, this is not normal. If this happens contact your doctor or nurse at the hospital straight away, or go to the accident and emergency (A&E) department at the hospital.


There’s a small risk of getting a urine infection after the biopsy. A course of antibiotics will help clear this up. Up to 3 in 50 men (6 per cent) may have a more serious infection. It's very important to take all of the antibiotics you’ve been given, as prescribed, to help prevent this.

A fever (high temperature), chills, pain or burning when you pee, or difficulty peeing are signs of an infection. This can happen even if you’ve been taking antibiotics. If you have these symptoms you should go to your nearest hospital A&E department straight away.

Urine retention

A small number of men find they can’t pee after a biopsy – this is called urine retention. If this happens contact your doctor or nurse at the hospital straight away, or go to the A&E department at the hospital.


Some men feel discomfort or pain in the biopsy area for a few days or weeks afterwards. Speak to your doctor or nurse about drugs to relieve pain if you need them.

What are the pros and cons of a biopsy?


A biopsy is the most accurate way of finding out:

  • whether you have prostate cancer
  • how aggressive it might be – how likely it is to spread.

This can help you and your doctor or nurse decide which treatment options may be suitable for you.

A biopsy can pick up a faster growing cancer at an early stage – when treatment may prevent the cancer from spreading to other parts of the body.


The biopsy can only show whether there was cancer found in the samples taken. If your biopsy result is normal it can’t rule out cancer completely. This is because the biopsy collects tissue from small areas of the prostate, so it's possible that cancer can be missed.

A biopsy can pick up a slow growing or non-aggressive cancer that might not cause any symptoms or problems in your lifetime. You may then have to make decisions about whether to have treatment or have your cancer monitored.

A biopsy can also have side effects.

Other types of prostate biopsy

What is a template biopsy?

A template biopsy involves taking more tissue samples than a TRUS biopsy. The number of samples taken will vary but can be around 30-50 from different areas of the prostate. The biopsy needles are inserted through the skin between the testicles and the back passage (perineum).

With this type of biopsy, more of the prostate is looked at, so there is more chance of finding prostate cancer cells. But this also means that there’s more chance of finding a slow-growing cancer that might not cause any symptoms or problems during your lifetime. Ask your doctor to explain the pros and cons of a template biopsy, and the possible side effects.

You might have a template biopsy if no cancer was found with a TRUS biopsy but your doctor still thinks there might be cancer. And some hospitals use template biopsy rather than TRUS biopsy in the first place.

What does a template biopsy involve?

This biopsy is normally done under general anaesthetic, so you will be asleep and won’t feel anything.

The doctor will place a grid (template) over the area of skin between the testicles and the back passage (perineum). They will insert the needles through the holes in the grid, into the prostate. The doctor will put an ultrasound probe into your back passage, using a gel to make it more comfortable. An image of the prostate will appear on a screen which will help the doctor to guide the biopsy needles.

The template biopsy will take about 20-40 minutes. You might need to wait a few hours or until you have peed before going home.

What are the side effects of a template biopsy?

The side effects of a template biopsy are similar to those of a TRUS biopsy. But there’s less risk of serious infection as the needles go through the skin, rather than the back passage.

There is more chance of urine retention after a template biopsy, but your doctor will make sure you’re able to pee before you go home. If you can’t pee, you might need to have a catheter for a few days at home. A catheter is a thin tube that’s passed into your bladder to drain urine out of the body.

You may have some bruising and discomfort in the area where the needles were inserted for a few days afterwards.

What is a transperineal biopsy?

Some men are unable to have an ultrasound probe or biopsy needles inserted into their back passage because of other medical conditions. These men will have the biopsy needles inserted through the area of skin between the testicles and the back passage (perineum).

What do my biopsy results mean?

The biopsy samples will be looked at under a microscope to check for any cancer cells. Your doctor will be sent a report, called a pathology report, with the results. The results will show:

  • whether any cancer was found
  • how many biopsy samples contained cancer
  • how much cancer is present in each sample.

You might be sent a copy of the pathology report. If you have trouble understanding any of it, ask your doctor to explain it. Or you could call our Specialist Nurses.

If cancer is found

Gleason grade and Gleason score

You may hear your doctor talk about your Gleason grade and your Gleason score when they talk about your biopsy results.

Gleason grade

If there is prostate cancer in your biopsy samples, they are given a Gleason grade. This grade tells you how aggressive the cancer is – in other words, how likely the cancer is to grow and spread outside the prostate

When cancer cells are looked at under the microscope, they have different patterns, depending on how quickly they are likely to grow. The pattern is given a grade from 1 to 5. This is called the Gleason grade. If a grade is given, it will usually be 3 or higher, as grade 1 and 2 are not cancer.

Gleason score

There may be more than one grade of cancer in the biopsy samples. An overall Gleason score is worked out by adding together two Gleason grades.

The first is the most common grade in all the samples. The second is the highest grade of what’s left. When the most common and the highest grade are added together, the total is called the Gleason score. 

Gleason score = the most common grade + the highest other grade in the samples

For example, if the biopsy samples show that:

  • most of the cancer seen is grade 3 and
  • the highest grade of any other cancer seen is grade 4, then
  • the Gleason score will be 7 (3+4).

Because grade 1 and 2 are not cancer, the combined Gleason score is normally 6 or higher. So your Gleason score can normally only be between 6 (3+3) and 10 (5+5).

Some men will only be told their total Gleason score and not given their Gleason grades. 

What does the Gleason score mean?

The higher the Gleason score, the more aggressive the cancer and the more likely it is to spread.

But your Gleason score is one of a few things that helps give your doctor an overall idea of your cancer. They will also need to look at your PSA level and how far your cancer has spread (the stage).

Getting the results

If cancer is found, this is likely to be a big shock, and you might not remember everything your doctor or nurse tells you. It might help to take a family member, partner or friend with you for support when you get the results. You can also ask them to make some notes during the appointment.

You might be sent a copy of the letter your specialist writes to your GP – or you can ask for this.

If no cancer is found

If no cancer is found this is obviously reassuring. However, this means ‘no cancer has been found’ rather than ‘no cancer is present’. There could be some cancer that was missed by the biopsy needles – this is less likely with a template biopsy.

Your doctor will talk to you about what to do next. They might suggest keeping an eye on your prostate with PSA tests, DREs or MRI scans. If they still suspect that cancer is present, they will talk to you about having another biopsy. You may be offered either another trans-rectal ultrasound biopsy, or a template biopsy.

What else might the biopsy results show?

Sometimes the biopsy finds other changes to your prostate cells, called PIN or ASAP. Read more about PIN or ASAP.

  • What does my Gleason score mean?  

    Here are the different Gleason scores that can be given after a prostate biopsy. This is just a guide. Your doctor or nurse will talk you through what your results mean.

    • 3+3 - All of the cancer cells found in the biopsy look likely to grow slowly.
    • 3+4 - Most of the cancer cells found in the biopsy look likely to grow slowly. There were some cancer cells that look more likely to grow at a more moderate rate.
    • 4+3 - Most of the cancer cells found in the biopsy look likely to grow at a moderate rate. There were some cancer cells that look likely to grow slowly.
    • 4+4 - All of the cancer cells found in the biopsy look likely to grow at a moderately quick rate.
    • 4+5 - Most of the cancer cells found in the biopsy look likely to grow at a moderately quick rate. There were some cancer cells that are likely to grow more quickly.
    • 5+4 - Most of the cancer cells found in the biopsy look likely to grow quickly.
    • 5+5 - All of the cancer cells found in the biopsy look likely to grow quickly.

Other tests

Researchers have been looking at other tests that might help to diagnose prostate cancer. These tests are not widely available and more research is needed before we can be sure how useful they are.

Free and total PSA test

This test measures the amount of two different types of PSA in the blood. It can help tell whether you have a high PSA level because of prostate cancer, or because of a non-cancerous prostate problem. But doctors don’t yet agree on what levels of the different types of PSA show that a man has prostate cancer, so it’s not used that often. The test is only suitable for men who have a PSA level between 4 and 10 ng/ml.

A urine test called a PCA3 test

Your doctor or nurse will massage your prostate then ask you to give a urine sample. Cells from the prostate pass into the urine where they can be looked at with a special test that looks at your genes. This test might help specialists decide which men should have a biopsy, or it might be useful for monitoring men who’ve already had a biopsy. At the moment the PCA3 test is only available in a few private hospitals and clinics, as we still need more research about how good it is.

Will I need to have a scan?

If you’re diagnosed with prostate cancer, you might need more tests to try to find out whether the cancer has spread outside the prostate. The results should help you and your doctor decide which treatments might be suitable for you.

You might not need to have these tests if your PSA is low and your Gleason score suggests that the cancer is unlikely to have spread.

MRI scan

MRI (magnetic resonance imaging) uses magnets to create a detailed picture of your prostate and the surrounding tissues. You might have an MRI scan to find out if the cancer has spread and you’re thinking about treatment options such as radiotherapy or surgery. An MRI scan is often the first type of scan used as it’s the most accurate way of looking at the prostate.  

Before the scan you’ll be asked questions about your health and, as the scan uses magnets, you will be asked whether you have any implants that could be attracted to the magnet, such as a pacemaker for your heart. You’ll also need to take off any jewellery or metal items when you have the scan.

You will be asked to lie very still on a table, which will move slowly into the scanner. Some MRI scanners are doughnut-shaped. Others are shaped like a long tunnel – so more of your body will be inside it. If you have a fear of enclosed spaces (claustrophobia), you should tell your radiographer (the person who takes the images).

The radiographer might give you an injection of a special dye during the scan. Let them know if you know you’re allergic to the dye that’s used. It’s not radioactive.

The scan takes between 30 and 40 minutes. The machine is very noisy but you won’t feel anything. The radiographer will leave the room but you’ll be able to speak to them through an intercom, and you might be able to listen to music through headphones. You can take a friend or family member into the room with you while you have the scan.

CT scan

A CT (computerised tomography) scan can show whether the cancer has spread beyond the prostate, for instance to the lymph nodes or nearby bones. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your groin are near the prostate and are a common place for prostate cancer to spread to. You may have this scan to find out if the cancer has spread and if you are thinking about treatment options such as radiotherapy or surgery.

Your hospital might ask you not to eat or drink for a few hours before the scan. You will be given an injection of a special dye – this can give you a warm feeling and you might feel like you need to go to the toilet. The dye helps the doctor see the prostate and surrounding organs more clearly on the scan. It’s not radioactive. You’ll need to take off any metal jewellery, as this can affect the images.

Before your scan appointment let your doctor know if:
• you already know you are allergic to the dye
• you have any other allergies
• you are taking the drug metformin for diabetes.

The CT scanner is shaped like a large doughnut. You will be asked to lie on a table which moves slowly through the hole in the middle of the scanner. The radiographer will leave the room but you’ll be able to speak to them through an intercom, and they can see you at all times. You will need to keep still, and you might be asked to hold your breath for short periods. The scan will take 10-20 minutes.

Bone scan

You might have a bone scan if there’s a chance your cancer has spread outside the prostate. A bone scan can show whether any cancer cells have spread to the bone. This is a common place for prostate cancer to spread to.

Tell your doctor or nurse if you have arthritis or have ever had any broken bones or fractures, or surgery to the bones, as these will also show up on the scan.

You might be asked to drink plenty of fluids before and after the scan. A small amount of a safe radioactive dye is injected into a vein in your arm. If there is any cancer in the bones, the dye will collect in these areas and show up on the scan. It takes two to three hours for the dye to travel around your body and collect in your bones so you’ll need to wait a while before you have the scan.
You will be asked to lie on a table while the scanner moves very slowly down your body taking pictures. This takes around half an hour. The camera will pick up any ‘hot spots’ where the radioactive dye has collected. These ‘hot spots’ can show if the cancer has spread to the bone.

The doctor will look at the results of the scan carefully to see whether any cancer is present. You may need to have X-rays of any ‘hot spots’ to check if they are definitely cancer. If it’s still not clear, you may need to have an MRI scan. Occasionally, some men have a bone biopsy, but this is only needed in rare cases.

You may be asked to avoid contact with children and pregnant women for up to 24 hours after the scan.

What happens next?

Your doctor or nurse will tell you how long it will take for the results of all the tests to come back. It’s usually around two weeks. Your doctor, nurse and other specialists will use the results of the tests to work out the stage of the cancer.

Read more about staging and what this means.


Updated: February 2014 | Due for review: February 2016

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