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.
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.
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.
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.