A prostate biopsy involves using thin needles to take small samples of tissue from the prostate. The tissue is then looked at under a microscope to check for cancer. If you have cancer, your biopsy results will show how aggressive the cancer is – in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.

There are two main types of prostate biopsy – a TRUS (trans-rectal ultrasound) guided or transrectal biopsy, and a template (transperineal) biopsy.

In some hospitals you might have an MRI (magnetic resonance imaging) scan before a biopsy. This can help your doctor see if there is any cancer in your prostate and where it might be.

What are the advantages and disadvantages of having a biopsy?

Your doctor should talk to you about the advantages and disadvantages of having a biopsy. If you have any concerns, discuss them with your doctor before you decide whether to have a biopsy.

Advantages

  • It’s the most accurate way of finding out whether you have prostate cancer.
  • It can help find out how aggressive any cancer might be – in other words, how likely it is to spread.
  • It 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.
  • If you have prostate cancer, it can help your doctor or nurse decide which treatment options may be suitable for you.

Disadvantages

  • The biopsy can only show whether there was cancer in the samples taken, so it’s possible that cancer might be missed.
  • It can pick up a slow growing or non-aggressive cancer that might not cause any symptoms or problems in your lifetime. You’d then have to decide whether to have treatment or whether to have your cancer monitored. Treatment can cause side effects that can be hard to live with. But having your cancer monitored rather than having treatment might make you worry about your cancer. 
  • A biopsy has side effects and risks, including the risk of getting a serious infection.

What does a prostate biopsy involve?

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

Before the biopsy you should tell your doctor or nurse if you’re taking any medicines, particularly antibiotics or medicines 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 after your biopsy. It’s important to take them all so that they work properly. 

A doctor, nurse or radiologist will do the biopsy.

There are two main types of biopsy:

  • a trans-rectal ultrasound (TRUS) guided biopsy, where the needle goes through the wall of the back passage
  • a template (transperineal) biopsy, where the needle goes through the skin between the testicles and the back passage.

What does a TRUS biopsy involve?

This is the most common type of biopsy in the UK. The doctor or nurse uses a thin needle to take small samples of tissue from the prostate.

You’ll lie on your side on an examination table, with your knees brought up towards your chest. The doctor or nurse will 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. The doctor or nurse uses this image to guide where they take the cells from.

You will have an injection of local anaesthetic to numb the area around your prostate and reduce any discomfort. The doctor or nurse then puts a needle next to the probe in your back passage and inserts it through the wall of the back passage into the prostate. They take 10 to 12 small pieces of tissue from different areas of the prostate.

The doctor or nurse then puts a needle next to the probe in your back passage and inserts it through the wall of the back passage into the prostate.

The biopsy takes 10 to 15 minutes. After your biopsy, your doctor may ask you to wait until you've urinated before you go home.

It can take up to two weeks to get the results of the biopsy. Ask your doctor or nurse when you’re likely to get 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 possible side effects.

Pain or discomfort

Some men will feel pain or discomfort in their back passage (rectum) for a few days or weeks afterwards. Each man is different and while some find the biopsy painful, others have only slight discomfort. Your nurse or doctor may suggest taking mild pain-relieving drugs, such as paracetamol, to help with any pain.

If you have any pain or discomfort after the biopsy that doesn’t go away, talk to your nurse or doctor.

If you are a man who has sex with men, wait until any pain or discomfort from your biopsy has settled before receiving anal sex. Ask your doctor or nurse at the hospital for further advice.

Short-term bleeding

It’s normal to see a small amount of blood in your urine or bowel movements for about two weeks.

You may also notice blood in your semen for a couple of months – it might look red or dark brown. This is normal and should get better by itself.

If it takes longer to clear up, or gets worse, you should see a doctor straight away.

A small number of men (less than 1 in 100) may have more serious bleeding in their urine or from their back passage (rectum). If you have severe bleeding or are passing lots of blood clots, this is not normal. Contact your doctor or nurse at the hospital straight away, or go to the accident and emergency (A&E) department at the hospital.

Infection

Some men get an infection after their biopsy. It's very important to take all of the antibiotics you’re given, as prescribed, to help prevent this. But you might still get an infection even if you take antibiotics.

Symptoms of a urine infection may include:

  • pain or a burning feeling when you urinate
  • dark or cloudy urine with a strong smell
  • needing to urinate more often than usual
  • pain in your lower abdomen (stomach area).

If you have any of these symptoms, contact your doctor or nurse at the hospital straight away. If you can’t get in touch with them, contact you GP.

Around 3 in 100 men (three per cent) get a more serious infection that requires going to hospital. If the infection spreads into the blood stream, it can be very serious. This is called sepsis. Symptoms of sepsis may include:

  • a high temperature (fever)
  • chills and shivering
  • a fast heartbeat
  • fast breathing
  • confusion or changes in behaviour.

If you have symptoms of sepsis, go to your nearest hospital A&E department straight away.

Acute urine retention

A small number of men (less than 1 in 50) find they suddenly and painfully can’t urinate after a biopsy – this is called acute urine retention. This happens because the biopsy can sometimes cause the prostate to swell, which can make it difficult to urinate. 

If this happens when you’re at home, contact your doctor or nurse at the hospital straight away, or go to your nearest A&E department. You might need a catheter for a few days – this is a thin tube that’s passed into your bladder to drain urine out of the body.

Sexual problems

You can masturbate and have sex after a biopsy. If you have blood in your semen (see above), you might want to use a condom until the bleeding stops.

A small number of men have problems getting or keeping an erection (erectile dysfunction) after having a biopsy. This isn’t very common and it should get better over time, usually within two months. Speak to your doctor or nurse if you’re worried about this.

What is a template (transperineal) biopsy?

This is where the doctor or nurse inserts the biopsy needle into the prostate through the skin between the testicles and the back passage (perineum). The needle is inserted through a grid (template).

It takes more tissue samples from more areas of the prostate than a TRUS biopsy. The number of samples taken will vary but can be around 30 to 50 from different areas of the prostate. This could mean that there is more chance of finding prostate cancer cells, if you have any.

You might have a transperineal biopsy if other health problems mean you can’t have a TRUS biopsy. You may also have a transperineal biopsy if no cancer was found with a TRUS biopsy but your doctor still thinks there might be cancer. In some hospitals, you’ll be offered a template biopsy rather than TRUS biopsy.

This biopsy is normally done under general anaesthetic, so you will be asleep and won’t feel anything. If you aren’t able to have a general anaesthetic for health reasons, you may be able to have a spinal (epidural) anaesthetic so that you can’t feel anything in your lower body.

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

The transperineal biopsy will take about 20 to 40 minutes. You will need to wait a few hours to recover from the anaesthetic before going home. And you will need to get someone to take you home.

What are the side effects of a template biopsy?

The side effects of a transperineal biopsy are similar to those of a TRUS biopsy (see above). But you’re less likely to get a serious infection after a transperineal biopsy – this is because the needles go through the skin, rather than the back passage.

You’re more likely to have difficulty urinating (urine retention) after a transperineal biopsy than after a TRUS biopsy. This is because more samples of tissue are taken, so there may be more swelling. Your doctor will make sure you’re able to urinate before you go home. If you can’t urinate, you might need to have a catheter for a few days at home.

You may also have some bruising and discomfort in the area where the needle was inserted for a few days afterwards.

You might have some side effects from the anaesthetic. Your doctor or nurse will explain the possible side effects before you have your biopsy.

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. They may also show how many biopsy samples contained cancer and how much cancer was present in each sample.

You might be sent a copy of the pathology report. And you can ask to see copies of letters between the hospital and your GP. If you have trouble understanding any of the information, ask your doctor to explain it or speak to our Specialist Nurses.

I asked to see the letters from the hospital to my GP. It helped me remember the different tests and discussions that I’d had.

- A personal experience

 

If cancer is found

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 can help to take a family member, partner or friend with you for support when you get the results. You could also ask them to make some notes during the appointment.

How likely is my prostate cancer to spread?

Your biopsy results will show how aggressive the cancer is – in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.

Gleason grade

When cells are seen under the microscope, they have different patterns, depending on how quickly they’re likely to grow. The pattern is given a grade from 1 to 5 – this is called the Gleason grade. Grades 1 and 2 are not cancer, and grades 3, 4 and 5 are cancer. If you have cancer, the higher the grade, the more likely the cancer is to spread outside the prostate.

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. Whenthese two grades 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).

If you have prostate cancer, your Gleason score will be between 6 (3+3) and 10 (5+5).

Grade group

Your doctor might also talk about your "grade group". This is a new system for showing how aggressive your prostate cancer is likely to be. Your grade group will be a number between 1 and 5 (see table).

What does the Gleason score or grade group mean?

The higher your Gleason score or grade group, the more aggressive the cancer and the more likely it is to grow and spread outside the prostate. The table below describes the different Gleason scores and grade groups 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.

Gleason score

  • 6 (3 + 3) All of the cancer cells found in the biopsy look likely to grow slowly (grade group 1).
  • 7 (3 + 4) Most of the cancer cells found in the biopsy look likely to grow slowly. There are some cancer cells that look likely to grow at a moderate rate (grade group 2).
  • 7 (4 + 3) Most of the cancer cells found in the biopsy look likely to grow at a moderate rate. There are some cancer cells that look likely to grow slowly (grade group 3).
  • 8 (3 + 5) Most of the cancer cells found in the biopsy look likely to grow slowly. There are some cancer cells that look likely to grow quickly (grade group 4).
  • 8 (4 + 4) All of the cancer cells found in the biopsy look likely to grow at a moderate rate (grade group 4).
  • 8 (5 + 3) Most of the cancer cells found in the biopsy look likely to grow quickly. There are some cancer cells that look likely to grow slowly (grade group 4).
  • 9 (4 + 5) Most of the cancer cells found in the biopsy look likely to grow at a moderate rate. There are some cancer cells that are likely to grow quickly (grade group 5).
  • 9 (5 + 4) Most of the cancer cells found in the biopsy look likely to grow quickly. There are some cancer cells that looklikely to grow at a moderate rate (grade group 5).
  • 10 (5 + 5) All of the cancer cells found in the biopsy look likely to grow quickly (grade group 5).

What type of prostate cancer do I have?

Your doctor will look at your biopsy results to see what type of prostate cancer you have.

For most men who are diagnosed, the type of prostate cancer is called adenocarcinoma or acinar adenocarcinoma you might see this written on your biopsy report. There are other types of prostate cancer that are very rare. Read more about rare prostate cancers.

If no cancer is found

If no cancer is found this is likely to be reassuring. However, this means ‘no cancer has been found’ rather than ‘there is no cancer’. Sometimes, there could be some cancer that was missed by the biopsy needle.

What else might the biopsy results show?

Sometimes a biopsy may find other changes to your prostate cells, called prostate intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP). Read more about PIN and ASAP.

What happens next?

If cancer is found

Your doctor or nurse will talk you through what your results mean. You might need scans to find out whether the cancer has spread outside the prostate and where it has spread to.

Your doctor will look at all of your test results with a team of health professionals. You might hear this called your multi-disciplinary team (MDT). Based on your results, you and your doctor will talk about the next best step for you. Read our information for men who've just been diagnosed.

If no cancer is found

Your doctor will look at your other test results and your risk of prostate cancer so that you can discuss what to do next.

If your doctor thinks you may have prostate cancer that hasn’t been found, they might suggest having another biopsy or an MRI scan.

If your doctor thinks you probably don’t have prostate cancer, they may offer to monitor your prostate with regular PSA tests to see if there are any changes in the future.

References

Updated July 2016|To be reviewed July 2018

  • List of references  

    • Berney DM. The case for modifying the Gleason grading system. BJU Int. 2007;100(4):725–726.
    • Bostwick DG, Meiers I. Atypical small acinar proliferation in the prostate: clinical significance in 2006. Arch Pathol Lab Med. 2006;130(7):952–957.
    • Buskirk SJ, Pinkstaff DM, Petrou SP, Wehle MJ, Broderick GA, Young PR, et al. Acute urinary retention after transperineal template-guided prostate biopsy. Int J Radiat Oncol. 2004 Aug;59(5):1360–6.
    • Clouston D, Bolton D. In situ and intraductal epithelial proliferations of prostate: Definitions and treatment implications Part 1: Prostatic intraepithelial neoplasia. BJU Int. 2012;109(s3):22–26.
    • Eichler K, Wilby J, Hempel S, Myers L, Kleijnen J, University of York, et al. Diagnostic value of systematic prostate biopsy methods in the investigation for prostate cancer: A systematic review. Centre for Reviews and Dissemination (CRD); 2005.
    • Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, et al. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016;40(2):244–252.
    • Laurila M, van der Kwast T, Bubendorf L, di Lollo S, Pihl C-G, Ciatto S, et al. Detection rates of cancer, high grade PIN and atypical lesions suspicious for cancer in the European Randomized Study of Screening for Prostate Cancer. Eur J Cancer. 2010 Nov;46(17):3068–72.
    • Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013 Dec;64(6):876–92.
    • Moch H, Cubilla A, Humphrey P, Reuter V, Ulbright T. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs—Part B: Prostate and BladderTumours [Internet]. 2016. Available from: http://www.europeanurology.com/article/S0302-2838%2816%2900205-0/abstract/the-2016-who-classification-of-tumours-of-the-urinary-system-and-male-genital-organs-part-b-prostate-and-bladder-tumours
    • Montironi R, Scattoni V, Mazzucchelli R, Lopez-Beltran A, Bostwick DG, Montorsi F. Atypical Foci Suspicious but not Diagnostic of Malignancy in Prostate Needle Biopsies. Eur Urol. 2006 Oct;50(4):666–74.
    • Mottet N, Bellmunt J, Briers E, Bolla M, Cornford P, De Santis M, et al. EAU Guidelines on Prostate Cancer 2016 [Internet]. European Association of Urology; 2016. Available from: http://uroweb.org/wp-content/uploads/EAU-Guidelines-Prostate-Cancer-2016.pdf
    • Murray KS, Bailey J, Zuk K, Lopez-Corona E, Thrasher JB. A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy. BJU Int. 2015 Aug;116(2):190–5.
    • National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.
    • National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management. NICE guideline 51. 2016.
    • National Institute for Health and Clinical Excellence. Transperineal template biopsy and mapping of the prostate. 2010.
    • NHS Cancer Screening Programmes. Undertaking a transrectal ultrasound guided biopsy of the prostate. PCRMP Guide No 1. 2006.
    • NHS Choices. Urinary tract infection in adults [Internet]. 2016. Available from: http://www.nhs.uk/conditions/Urinary-tract-infection-adults/Pages/Introduction.aspx
    • Pinkstaff DM, Igel TC, Petrou SP, Broderick GA, Wehle MJ, Young PR. Systematic transperineal ultrasound-guided template biopsy of the prostate: Three-year experience. Urology. 2005 Apr;65(4):735–9.
    • Public Health England. Prostate cancer risk management programme (PCRMP): benefits and risks of PSA testing [Internet]. GOV.UK; 2016. Available from: https://www.gov.uk/government/publications/prostate-cancer-risk-management-programme-psa-test-benefits-and-risks/prostate-cancer-risk-management-programme-pcrmp-benefits-and-risks-of-psa-testing
    • Rosario DJ, Lane JA, Metcalfe C, Donovan JL, Doble A, Goodwin L, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ. 2012;344:d7894.
    • Symons JL, Huo A, Yuen CL, Haynes A-M, Matthews J, Sutherland RL, et al. Outcomes of transperineal template-guided prostate biopsy in 409 patients. BJU Int. 2013;112(5):585–593.
    • Tuncel A, Toprak U, Balci M, Koseoglu E, Aksoy Y, Karademir A, et al. Impact of transrectal prostate needle biopsy on erectile function: Results of power Doppler ultrasonography of the prostate. Kaohsiung J Med Sci. 2014 Apr;30(4):194–9.
    • Zynger DL, Yang X. High-grade prostatic intraepithelial neoplasia of the prostate: the precursor lesion of prostate cancer. Int J Clin Exp Pathol. 2009;2(4):327.