How to Get Ready for Your Prostate Biopsy

Prostate cancer is one of the most common types of cancers in males. A prostate biopsy is the best way to diagnose prostate cancer. During a prostate biopsy, a urologist — a physician who specializes in the urinary tract — removes small tissue samples from the prostate. A pathologist then looks at these samples under a microscope to see if there are any cancer cells. If there are cancer cells, the pathologist can also tell if the cancer is aggressive or slow growing. The medical team then uses this information to develop a treatment plan if they identify prostate cancer.

All of this means that the prostate biopsy is an important part of a prostate cancer evaluation. If you’re having a prostate biopsy, it’s normal to be nervous about both the procedure and the results. Knowing what goes on during a prostate biopsy can help you prepare mentally and physically for the procedure. Let’s take a look at what you can expect from your prostate biopsy, and what you can do before and after to make sure your procedure goes well.   

What exactly happens during a prostate biopsy?

Prostate biopsies are very common procedures and are used to diagnose other prostate conditions besides cancer. You can ask your urologist how many biopsies they’ve performed — you might be surprised by the high number. It can also be reassuring to know that your medical team has a lot of experience doing the procedure. 

There are two types of prostate biopsy: transrectal biopsy and transperineal biopsy. Some people also get magnetic resonance imaging (MRI)/ultrasound fusion biopsies. Let’s take a look at what you can expect from each one.

Transrectal biopsy

Transrectal biopsies are more common than transperineal biopsies, though this is changing. During a transrectal biopsy, the urologist passes a needle through the rectum into the prostate and removes tissue samples. Since the prostate sits inside the pelvis, right underneath the bladder, the urologist uses an ultrasound to “see” where to put the needle. 

Here’s what you should expect on the day of your transrectal biopsy:

1) You’ll be asked to change into a hospital gown and lie down on your left side.

2) You’ll be given local anesthesia to numb your pelvic area — so you won’t be asleep during the procedure, but you still won’t feel pain.

3) You’ll also get an oral pain medication like acetaminophen (Tylenol) or tramadol. 

4) If you’re very anxious, or if you continue to feel discomfort during the procedure, you can receive sedation medications through an intravenous (IV) infusion.

5) Once you’re numb, the urologist will insert a lubricated ultrasound probe into your rectum. 

6) A needle is attached to the probe and pushed through the rectal wall into the prostate. The needle is spring-loaded and produces a “click” sound when a sample is removed. 

7) Your urologist will take between 10 and 14 tissue samples.

Then your biopsy is over — the entire procedure only takes 5 to 10 minutes. 

Transperineal biopsy

Transperineal biopsies are becoming more popular because they come with a lower risk of infection. These biopsies are also better for:

• Finding cancer in the front part of the prostate 

• Getting samples that can’t be reached with a transrectal biopsy

• Testing people who have had prior rectal surgery

During a transperineal biopsy, the urologist passes a needle through the skin between the testicles and the anus into the prostate and removes tissue samples. With this approach, the urologist still needs to use an ultrasound to “see” where to put the needle. 

Here’s what you should expect on the day of your biopsy:

1) You’ll be asked to change into a hospital gown and lie down on your back with your legs in stirrups.

2) You’ll either receive local anesthesia to numb your pelvic area or general anesthesia. If you get general anesthesia, you’ll be asleep during the procedure. 

3) Once you’re numb, the urologist will place an ultrasound probe on your perineum to look at your prostate. 

4) A needle is passed through the skin of your perineum into the prostate. The needle is spring-loaded and produces a “click” sound when a sample is removed. 

5) Your urologist will take between 10 and 24 tissue samples. 

Then your biopsy is over — the entire procedure takes between 20 and 30 minutes. 

Magnetic resonance imaging/ultrasound fusion biopsies

Some people have MRI/ultrasound fusion biopsies. The MRI lets the urologist “see” the prostate more clearly so they can better plan where to put the needle to get the best samples. An MRI can be done as a part of a transrectal or transperineal biopsy. You might be asked to have your MRI done before your biopsy — or it may be done during your biopsy. If you’re also having an MRI, here’s what to expect:

1) You’ll be asked to change into a hospital gown and take off anything with metal in it, like jewelry, watches, and hearing aids

2) You’ll go over the MRI safety checklist — be sure to let the team know if you have any implants that contain metal like pacemakers or joint replacements.

3) You’ll likely need an endorectal coil. This is a thin wire covered by latex. It’s lubricated and then inserted into your rectum. 

4) If you’re having an MRI with contrast such as gadolinium, a technologist will start an IV in your arm to give you a dose to make the images clearer.

5) You might also receive a medication to slow your intestines so they don’t move as much during the MRI. Movement can affect the quality of the pictures.

6) If you get claustrophobic, the team can also give you medication to help you relax.

7) You’ll get a pair of headphones or earplugs to wear, since the MRI machine is quite loud. 

8) Your MRI will then start. It usually takes about 30 to 40 minutes. 

What foods or medications should you avoid before a prostate biopsy?

Make sure you let your healthcare team know about all medications and supplements that you are taking. Bleeding can happen after a prostate biopsy, so you might be asked to stop taking any blood thinner medications for a week before your biopsy. 

You won’t have any food restrictions before getting your prostate biopsy. If you’re having certain types of anesthesia, you won’t be able to eat or drink anything for 8 hours prior to your biopsy.

What happens after the prostate biopsy?

Your provider might ask you to stay in the office until you’ve urinated. During the biopsy, your prostate might become swollen and push on your bladder, which can block your ability to pee. Your medical team will want to make sure you’re able to empty your bladder before your leave.

If you don't receive general anesthesia, you’ll be able to drive yourself home. However, you might have discomfort while sitting down — so it’s best to arrange a ride home.

Your biopsy samples will be sent to the pathology lab for analysis. Studies show that waiting for these results is stressful. Make sure you reach out to your support system and take care of your mental health. 

What side effects might you experience after a prostate biopsy?

A prostate biopsy is a safe procedure, but you may experience some side effects. These include: 

Blood in your urine: This is normal for up to 10 days after the biopsy. Most people report blood in their urine.

Blood in your semen: This is normal for up to 6 weeks after the biopsy. This is also a very common side effect.

Pain or discomfort: This can be in the groin or rectum, which can last for a few days. You can try acetaminophen (Tylenol) to help with pain relief. If you receive anal sex, you should wait about 2 weeks, or until your pain has resolved before having sex. 

Bruising in the groin area: This happens in about half of people. It’s more common if you have a transperineal biopsy. 

Temporary problems with erections: This is less common. Only about 5% of people have this side effect. 

What complications may occur during a prostate biopsy?

The rate of complications for transrectal and transperineal biopsies is about the same. Prostate biopsies are safe procedures, but sometimes complications occur, such as:

Severe rectal bleeding: This happens more often with transrectal biopsies or in cases where you’re taking blood thinners. It’s a rare complication that happens in fewer than 1% of people. If you have severe bleeding from your anus or you’re passing clots — this is not normal, and you should seek care right away. 

Acute urinary retention: This means you can’t pee because the prostate is swollen and blocking the passage of urine from the bladder. This happens to about 1% of people. It’s more common if you have more samples taken from your prostate. If you can’t urinate — seek care right away. You might need to have a catheter placed until your prostate is no longer swollen. 

Urine infection: You can get a urine infection after a prostate biopsy. This happens to 5% of people and is more common after a transrectal biopsy. To lessen the chance of infection, you will take an antibiotic before your biopsy. Signs of urine infection include pain or burning during urination and needing to urinate more often than normal. If you have symptoms of a urine infection, call your urologist right away. 

Severe infections: Some people get a more serious infection after a biopsy. Though it’s uncommon, it can be very serious because it can spread to your blood. If you have any of these symptoms, go to the emergency room right away:

• Fever

• Chills or shivering  

• Fast heart rate or fast breathing

• Confusion

Bottom line

A prostate biopsy is the only way to accurately diagnose prostate cancer. It’s a safe procedure that is done with anesthesia, so it’s painless. An early diagnosis of prostate cancer can be life saving — so it’s important not to put off a prostate biopsy if you need one. Consider reaching out to your support system and focusing on your mental health while waiting for your results to come back.

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Written by:

Ronald W. Dworkin, MD, PhD

Ronald W. Dworkin, MD, is a board-certified anesthesiologist who has been practicing anesthesiology in a community hospital for 30 years. He has taught in the honors program at George Washington University for over 10 years and works as a senior fellow at the Hudson Institute.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Brandon R. Mancini, MD, MBA, FACRO

Brandon R. Mancini, MD, MBA, FACRO, serves as medical director at BAMF Health in Grand Rapids, Michigan in the emerging field of theranostics. His primary clinical focus is on the treatment of people with metastatic prostate and neuroendocrine cancers.

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