A prostate biopsy is a diagnostic procedure performed to detect abnormal or cancerous cells in the prostate gland. This small gland, located just below the bladder in individuals assigned male at birth, plays an essential role in producing seminal fluid. A biopsy is often conducted when there are indications of potential prostate abnormalities, such as elevated PSA levels or irregularities found in a rectal exam or imaging scans.

Purpose of the Procedure

The main goal of a prostate biopsy is to identify the presence of cancer in the prostate. Healthcare providers may recommend this test if:

  • PSA levels are abnormally high.

  • A suspicious area is found during a digital rectal exam.

  • MRI imaging reveals an unusual lesion.

  • There is a strong clinical suspicion of prostate cancer.

Following the biopsy, a pathologist examines the collected tissue samples to determine whether cancer cells are present.

Types of Prostate Biopsies

The core needle biopsy is the most commonly used method. It involves removing small tissue samples (cores) from the prostate. Two main approaches are used:

Transrectal Biopsy: This method involves inserting a needle through the rectal wall into the prostate. Ultrasound guidance (TRUS) is often used to improve accuracy. When combined with MRI imaging to enhance targeting, this is referred to as an MRI fusion biopsy.

Transperineal Biopsy: Here, the needle is inserted through the perineum—the skin between the anus and the scrotum. This technique reduces the risk of rectal complications and infections.

Other biopsy techniques include:

  • Fine Needle Aspiration (FNA): Utilized for lymph nodes near the prostate.

  • Laparoscopic Biopsy: Involves small incisions to access and sample nearby tissues.

Procedure Overview

To maximize detection accuracy, multiple samples are taken from various areas of the prostate using a pattern known as the 12-core sextant biopsy. This helps ensure a comprehensive evaluation, whether the biopsy is transrectal or transperineal.

Preparation

Before the procedure, patients may be advised to:

  • Stop medications that increase bleeding risk (e.g., NSAIDs, blood thinners).

  • Take antibiotics to prevent infection.

  • Use an enema to clear the rectum.

  • Discuss any allergies, medications, or prior imaging results.

Patients should also plan for assistance after the procedure, especially if sedation or anesthesia is used.

During the Procedure

The procedure is typically performed in a medical office or outpatient facility. Patients lie on their side or stomach while a local anesthetic is administered. A lubricated ultrasound probe is inserted into the rectum to visualize the prostate. Guided by imaging, a needle is inserted to collect samples.

Depending on whether MRI fusion or contrast imaging is used, the procedure can last between 10 and 25 minutes. Recovery time varies based on the anesthesia used.

Aftercare and Recovery

Post-procedure, mild discomfort, spotting in urine or semen, and rectal soreness are common. Most symptoms resolve within a few days. Antibiotics may be continued, and physical exertion should be minimized temporarily. Patients are monitored briefly before being discharged.

Potential Risks

While generally safe, prostate biopsies carry potential risks, including:

  • Mild bleeding or spotting

  • Infection

  • Temporary urinary retention

  • Pain or discomfort in the rectum or perineum

These risks can be mitigated with proper technique, sterile conditions, and pre/post-procedure antibiotics.

Understanding the Results

Biopsy results are typically available within a few days. The report can show:

  • Negative: No cancer detected. If suspicion remains high, additional testing may be advised.

  • Positive: Cancerous cells identified. The report may also include details about the tumor’s location and aggressiveness (grade).

  • Atypical: Unusual cell patterns that are not clearly cancerous but may require further investigation.

Conclusion

A prostate biopsy is a crucial tool in diagnosing prostate cancer. Although the thought of undergoing a biopsy may be stressful, the procedure is relatively quick and provides essential information for early detection and treatment planning. By working closely with healthcare providers and following pre- and post-procedure instructions, patients can navigate this process confidently and take important steps toward managing their prostate health effectively.