About prostate biopsy
Biopsy is an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease. just because your doctor orders a biopsy, it doesn’t mean that you have cancer. Doctors use biopsies to test whether abnormalities in your body are caused by cancer or by other conditions. A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate using a thin needle to take small samples of tissue from the prostate.
There are two main types of prostate biopsy:
Talk to your doctor or nurse about whether you will have a TRUS biopsy or a transperineal biopsy.
In many hospitals you may have a special type of magnetic resonance imaging (MRI) scan, called a multi-parametric MRI (mpMRI) scan, before having a biopsy. In other hospitals you may have a biopsy first.
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 or specialist nurse before you decide whether to have a biopsy.
Advantages
- It’s the only way to find out for certain if you have cancer inside your prostate.
- 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.
- If you have prostate cancer, you’ll usually need to have had a biopsy if you want to join a clinical trial in the future. This is because the researchers may need to know what your cancer was like when it was first diagnosed.
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 would then have to decide whether to have treatment or to have your cancer monitored. Having your cancer monitored rather than having treatment may make you worry about your cancer. But having treatment can cause side effects that can be hard to live with. The knowledge of having a slow growing or non-aggressive cancer affects everyone differently and there is no right or wrong way to feel.
- A biopsy has side effects and risks, including the risk of getting a serious infection.
- If you take medicines to thin your blood, you may need to stop taking them for a while, as the biopsy can cause some bleeding for a couple of weeks.
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 such as warfarin or aspirin.
You may be given some antibiotics to take before your biopsy, either as tablets or an injection, to help prevent infection. You might 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 or nurse 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 transperineal biopsy, where the needle goes through the skin between the testicles and the back passage (the perineum).
The type of biopsy you will have depends on your hospital.
What is a TRUS biopsy?
The doctor or nurse uses a thin needle to take small samples of tissue from the prostate through the wall of the back passage (rectum).
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. If you’ve had an MRI scan, the doctor or nurse may use the images to decide which areas of the prostate to take biopsy samples 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 usually take 10 to 12 small pieces of tissue from different areas of the prostate. But, if the doctor is using the images from your MRI scan to guide the needle, they may take fewer samples.
The biopsy takes 5 to 10 minutes. After your biopsy, your doctor may ask you to wait until you’ve urinated before you go home. This is because the biopsy can cause the prostate to swell, so they’ll want to make sure you can urinate properly before you leave. You should ask your doctor or nurse if you need to get someone to take you home or if you can drive yourself home.
What is a transperineal biopsy?
This is where the doctor inserts the biopsy needle into the prostate through the skin between the testicles and the back passage (perineum).
A transperineal biopsy can be done under either general anaesthetic or local anaesthetic. If you have a biopsy under general anaesthetic, you will be asleep and won’t feel anything. A general anaesthetic can cause side effects – your doctor or nurse should explain these before you have your biopsy.
If you have a biopsy using a local anaesthetic, you are awake during the procedure and the anaesthetic numbs the prostate and the area around it.
The doctor 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.
There are two main types of transperineal biopsy you may have:
A targeted transperineal biopsy
This is where the doctor may just take a few samples from the area of the prostate that looked usual on the scan images from your MRI.
A template transperineal biopsy
This is where the doctor places a grid (template) over the area of skin between the testicles and back package. They then insert the needle though holes in the grid, into the prostate. They might take up to 25 or more samples from different areas of the prostate. A template biopsy is sometimes used if a TRUS biopsy hasn’t found any cancer, but the doctor still thinks there might be cancer.
You will need to wait a few hours to recover from the anaesthetic before going home. You should ask your doctor or nurse if you need to get someone to take you home or if you can drive yourself home.
A transperineal biopsy usually takes about 20 to 40 minutes. You will need to wait a few hours to recover from the anaesthetic before going home. You should ask your doctor or nurse if you need to get someone to take you home or if you can drive yourself home. Your doctor may ask you to wait until you’ve urinated. This is because the biopsy can cause the prostate to swell, so they’ll want to make sure you can urinate properly before you leave.
What are the side effects of a 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 feel pain or discomfort in their back passage (rectum) for a few days after a TRUS biopsy. Others feel a dull ache along the underside of their penis or lower abdomen (stomach area). If you have a transperineal biopsy, you may get some bruising and discomfort in the area where the needle went in for a few days afterwards.
If you receive anal sex, wait about two weeks, or until any pain or discomfort from your biopsy has settled, before having sex again. Ask your doctor or nurse at the hospital for further advice.
Some men find the biopsy painful, but 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 that doesn’t go away, talk to your nurse or doctor.
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 who have a TRUS biopsy may have more serious bleeding in their urine or from their back passage (rectum). This can also happen if you have a transperineal biopsy but it isn’t very common. 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. This is more likely after a TRUS biopsy than after a transperineal biopsy. It’s very important to take any 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 urgently than usual
- needing to urinate more often than usual during the day or night
- a high or very low temperature
- pain in your lower abdomen (stomach area) or back.
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, call your GP.
Less than 1 in 100 men (one per cent) who have a TRUS biopsy get a more serious infection that requires going to hospital. If the infection spreads into your blood, it can be very serious. This is called sepsis. Symptoms of sepsis may include:
- a high temperature (fever)
- chills and shivering
- blue, pale or blotchy skin, lips or tongue
- a fast heartbeat
- fast breathing or difficulty 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 find they suddenly and painfully can’t urinate after a biopsy – this is called acute urine retention. This happens because the biopsy can cause the prostate to swell, making it difficult to urinate. Acute urine retention may be more likely if you have a template biopsy. This is because more samples are taken, so there may be more swelling.
Your doctor will make sure you can urinate before you go home after your biopsy. If you can’t urinate, you might need to have a catheter for a few days at home – this is a thin tube that’s passed into your bladder to drain urine out of the body.
If you develop acute urine retention 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.
Sexual problems
You can masturbate and have sex after a biopsy. If you have blood in your semen, 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 may happen if the nerves that control erections are damaged during the biopsy. It 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 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.
It can take up to two weeks to get the results of the biopsy, but it can take longer in some hospitals. Ask your doctor or nurse when you’re likely to get the results. 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.
What can help with leaking urine?
There are treatments and products available that can help, and there are things you can do to help yourself. Your treatment options will depend on how much urine you’re leaking, and how recently you had your prostate cancer treatment.
Treatments and products available that can help include:
absorbent pads and pants
pelvic floor muscle exercises
urinary sheaths
bed protectors and handheld urinals
penile clamps.
If you have sudden urges to urinate (urinary urgency) and sometimes leak urine before you get to the toilet (urge incontinence), you may be offered bladder retraining.
If you still leak urine six to twelve months after surgery and pelvic floor muscle exercises haven’t helped, there are treatments available that might help. These may include:
an internal male sling
an artificial urinary sphincter
adjustable balloons
medicines.
Talk to your doctor or nurse about treatments and products that may be suitable for you.
Absorbent pads and pants
These can be worn inside your underwear or instead of underwear to soak up any leaks. Some people find it helpful to wear close fitting underwear with pads. You may want to try female pads as your leaking improves, as these tend to be smaller and lighter and may fit better. Pads are usually very discreet, so people won’t know you’re wearing them. But you may feel more confident wearing dark trousers so it won’t show as much if your pad does leak.
Services vary from area to area, but your GP or the continence nurses at your hospital may provide some pads for free. Or you can buy them in supermarkets, chemists or online. Age UK also has a range of products that can be ordered online.
If you haven’t had your operation yet, you might find it helps to prepare by finding out what products are available. Talk to your doctor, nurse or continence advisor for more information, or visit the Continence Product Advisor website.
Pelvic floor muscle exercises
These can strengthen the pelvic floor muscles, which help control when you urinate.
Read about pelvic floor muscle exercises.
Urinary sheaths
You might hear these called external catheters. These look like condoms with a tube attached to the end that drains urine into a bag. The sheath fits tightly over the penis and you can strap the bag to your leg – under your clothes – and empty it as needed.
Bed protectors and handheld urinals
If you have to go to the toilet often during the night, or you leak urine when you’re in bed, bed protectors or handheld urinals might be useful to you.
Bed protectors are large pads that protect your sheets and mattress by soaking up any urine that you might leak. There are pads that you can wash and reuse, and others that you only use once before throwing them away
Handheld urinals are containers with a lid that can be used if you can’t reach the toilet in time or if there isn’t a toilet nearby. They have a large opening with a lid so that you can store the urine until you reach a toilet. These might also be useful if you drive long distances and don’t have any toilet near you.
Penile clamps
A penile clamp fits onto the penis and squeezes it, closing the urethra so that no urine can leak out. You should only use a penile clamp during the day for short periods of time, and should open it at least every two hours to let your blood flow back into your penis.
A penile clamp fits onto the penis and squeezes it, closing the urethra so that no urine can leak out. You should only use a penile clamp during the day for short periods of time, and should open it at least every two hours to let your blood flow back into your penis.
Penile clamps can be uncomfortable to wear and aren’t commonly used in the UK. They aren’t usually recommended by health professionals, as they reduce the blood flow to the penis. This means it can be unsafe if a clamp is put on too tightly or for too long. However, some men like to use them for activities such as swimming or jogging.
For more information about the different types of products to manage leaking urine, visit Continence Product Advisor.
Internal male sling
This is a small piece of material (mesh) that presses gently on your urethra and supports the urinary sphincter to keep it closed. This helps to stop urine leaking. You’ll have an operation to fit the sling. It should be tight enough to stop urine leaking out, but loose enough to let you urinate when you want to.