This leaflet explains the process of having prostate biopsy through
the perineum. It should answer your questions however if you have
further question speak to the doctor or the nurse who you saw in
clinic.
The prostate is only found in men and is a gland at the base of the bladder inside your pelvis. It is the size of a walnut. The urethra
carries urine from the bladder through the centre of the prostate and penis to the outside. The prostate surrounds the urethra part which
is underneath the bladder.
The prostate produces a substance called prostate specific antigen (PSA). A blood test can measure the level of PSA.
A prostate biopsy is where small samples of tissue are taken from your prostate gland. The samples are then sent to be examined
under a microscope by a specialist.
Due to the special way in which the specimens are prepared for the histopathologist (specialist in examining the cells of the body) the
results take upto two weeks to come back.
There are a number of reasons why you might have been advised to have a prostate biopsy:
• You may have had a blood test showing a high level of prostate-specific antigen (PSA). PSA is a protein that is released into
your blood from your prostate gland. High levels of PSA may indicate prostate cancer.
• Your doctor/nurse specialist may have found a lump or abnormality during a digital rectal examination (DRE). A DRE is where a doctor feels your prostate gland through your rectum (back passage) with his/her index finger.
• You may have had an MRI scan of the prostate that may have showed abnormal areas in your prostate. A prostate biopsy clarifies whether the abnormal areas harbour prostate cancer or not.
• You may have a known diagnosis of prostate cancer that has not required treatment and your doctor/nurse specialist might
have recommended you enrol in active surveillance of the prostate cancer. This is a process that includes regular PSA testing ever six months, MRI scans and prostate biopsy every 2 to 5 years.
The biopsy can find out whether any of your prostate cells have become cancerous or, if you have pre-existing cancer, whether the cancer has changed. It can also diagnose other conditions such as benign prostatic hyperplasia (enlargement of the prostate), prostatitis (inflammation of the prostate, usually caused by a bacterial infection).
Occasionally the doctor may recommend observation and regular PSA blood test instead of the prostate biopsy if the suspicion of
prostate cancer is low. Generally if there is suspicion of cancer and if your body is fit to undergo the procedure the doctor will recommend
a prostate biopsy.
Most of the prostate biopsy procedures are done with a needle puncture through the perineum (the area between the testicles
and the back passage) – you may find this uncomfortable. This procedure is being increasingly adopted by urologists as it minimises
the risk of urine tract infection after the biopsy.
The procedure is usually done in the outpatient (urology unit) under local anaesthetic. You are expected to go home after you recover
from the procedure.
You will need an escort home after the procedure.
Prostate biopsy takes 20-30 minutes to perform. You may be given antibiotics before the procedure.
The doctor /nurse will give you local anaesthetic to numb the skin and the area around the prostate before taking needle samples from
the prostate. An ultrasound probe in the back passage is used to guide where the needle is taking the samples in the prostate.
The doctor / nurse will put the samples in special pots and send them for analysis by the Histopathologist.
Following prostate biopsy procedure you will be asked to wait around the outpatient centre for around an hour. You are generally well
enough to go home after that and once you have passed urine.
Ultrasound is a way of seeing different body parts using high frequency sound waves to create images of your internal structures.
The sound waves bounce off tissues and organs and are picked up and then displayed on a screen.
Because your prostate gland is in front of your rectum, a small ultrasound probe can be inserted into the rectum to create an image
of your prostate gland. You may feel some discomfort in the back passage. This is called a trans-rectal ultrasound or TRUS. This
will help to guide your doctor or specialist nurse when he/she is performing the biopsy.
We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form
on the day of the procedure. This states that you agree to have the biopsy procedure and you understand what it involves. If you would
like more information about our consent process, please speak to a member of staff caring for you.
Although serious complications are rare, every procedure has risks.
Your doctor will discuss these with you in more detail:
• Blood when you pass urine: This is not uncommon and
can range from peachy coloured urine to rose or even claret
coloured. It is rarely a sign of a serious problem. Blood in
the urine can be expected to last upto 10 days and to clear
gradually. Increasing your fluid intake will usually help ‘flush the
system’ and clear any bleeding. However, if there is persistent
or heavy bleeding every time you pass urine you should go to
your nearest A&E department. • Blood in the semen: This a common occurrence after prostate
biopsy. Most people will get fresh looking blood initially in their
semen after prostate biopsy. This can last for up to 12 weeks.
Usually it fades gradually and the semen colour in the interim
can turn brown before the colour become normal again. Blood
in the semen will have no adverse effect on you or your partner.
Some people prefer to use condoms but this is not necessary.
• Difficulty passing urine: It is possible that the biopsy may
cause an internal bruise and swelling of the prostate that
causes you difficulty passing urine. This can happen in two in
every 100 cases and is more likely to happen in men who had
difficulty passing urine before having the biopsy. Many people
experience change in their urinary symptoms after prostate
biopsy. This can be increased frequency of urinating, and a rush
to find the toilet. It is usually a temporary change and it settles
within a week or two.
Should you stop passing urine, you will need to go to your nearest
A&E and you will require a catheter fit in to drain your bladder. A
catheter is a hollow, flexible tube that is inserted through the penis
opening to the bladder to drain.
• Erection problems: This is a rare occurrence and is usually
temporary due to discomfort and sight of blood. Most of the
time the erections return to normal levels within a week or two
after prostate biopsy. A permanent problem with erection is
extremely rare.
• Infection: This has become rare following the introduction
of biopsy through the skin rather than through the back
passage. We check your urine before the biopsy and we give
you antibiotics at the time of your biopsy to minimise the risk
of infection. However, if you develop a fever, or have pain or
a burning sensation when you pass urine, you may have an
infection and should seek medical attention from your nearest
A&E department.
• Allergic reaction: It is possible that you may have an allergic
reaction to the medication we give you. Although the risk of
this is low (less than one in 1,000 cases), you can reduce this
risk by letting us know if you have had any previous allergic
reactions to any medications or food.
Before you have a biopsy, you should let the doctor or specialist nurse know if you:
• are taking any medications, particularly antibiotics or anticoagulants (medication that helps to prevent blood clots from forming), including aspirin, warfarin, clopidogrel, rivaroxaban or dipyridamole
• have allergies to any medications, including anaesthetic
• have or have ever had bleeding problems
• have an artificial heart valve.
You should continue to take all of your medications as normal, unless you have been told otherwise by the doctor who organised your biopsy.
The biopsy procedure is usually done under local anaesthetic. Local anaesthetic is a medication used to numb the skin and the
area around the prostate. It is given with a needle. Occasionally the prostate biopsy procedure is performed under general anaesthetic.
This causes you to become temporarily unconscious (asleep). Your doctor or specialist nurse will discuss the options with you before you have your biopsy.
The biopsy is usually carried out in the urology unit as a day case, which means you will be able to come in to hospital, have the biopsy
and leave on the same day. You will be sent a letter telling you when and where to come on the day of your procedure.
Having a biopsy in the outpatients:
You need to report to the front desk, then you will be directed to meet your nurse for the day who will usually ask you to produce a
sample of urine. Afterwards, the doctor or the nurse will confirm your details and ask you to sign the consent form and will give you
antibiotics ahead of the procedure. Then you will be directed to the biopsy room where you will be asked to remove your trousers
and underwear and lie on your back in semi sitting position on the special chair which has stirrups. You will be asked to put your legs
through the stirrups. This will allow the doctor to examine your prostate with a finger in the back passage. The doctor will tape your
scrotum out of the way and then will insert a lubricant gel in your back passage. An antiseptic solution will be used to clean the skin of
your perineum (area between your scrotum and back passage). The ultrasound probe is then gently inserted to help the doctor see where
the prostate is. Local anaesthetic is then given with a needle to the skin. This is the most uncomfortable part of the procedure. The
injection will sting for few seconds.
The prostate biopsies are taken with a device that contains a spring - loaded needle. The needle is inserted into the prostate gland and
removes a tissue sample very quickly. You will hear the click of the ‘gun’ as it is used to take the biopsy. Normally, between 18-24
samples are taken. You may feel a brief, sharp pain as the biopsy needle is inserted into the prostate gland.
Having a biopsy in day surgery:
Once you have been admitted to the ward, you will see your urology doctor/nurse specialist, who will go through the procedure again
with you and ask you to sign the consent form. If you are having the procedure under general anaesthetic, then you will see the
anaesthetist as well.
If you have had a local anaesthetic you will asked to wait in the outpatient for around an hour where you will have the opportunity to
pass urine. Once you have done that then you can leave after you check with the nurse. You will be asked to rest for the remainder of
the day after your procedure.
If you have had a procedure under general anaesthetic, you will need someone to help you home, as your muscles may ache and
you may feel woozy because of the anaesthetic. General anaesthetic takes 24 to 48 hours to wear off, so please rest for this period of
time.
You may have mild discomfort in the biopsy area for one or two days after the biopsy. You will also notice some blood in your urine for a
few days. Your semen may be discoloured (pink or brown) for up to 8 weeks, and occasionally longer, after the biopsy. This is nothing
to worry about. You should drink plenty of non-alcoholic fluids while you have blood in your urine. You should avoid heavy lifting and
straining at toilet (you need to well hydrate yourself and increase your salad intake to avoid constipation after prostate biopsy).
• your pain increases
• you have a fever higher than 100.4°F (38°C)
• you do not pass urine for 8 hours and/or feeling unable to pass urine with full bladder
• you start to pass large clots of blood
• you have persistent bleeding.
After your biopsy and before your leave the department, the nurse will make you an appointment to come back to learn about your
results. This can be up to 3 weeks after your procedure.
If you have any questions about this procedure or your results,
please contact one of our prostate cancer nurse specialists, (Monday to Friday, 8am to 4pm).
Denise Lonican, Specialist Cancer Nurse 01253 953225
Melanie Fluss, Specialist Cancer Nurse 01253 953225
Donna Wraith, Specialist Cancer Nurse 01253 953225
Hannah Hutson, Specialist Cancer Nurse 01253 953225
Out of these hours, contact ward 15A.
