How to Prepare for Your Prostate Biopsy

Prostate cancer is a common type of cancer. A prostate biopsy is the best way to help diagnose prostate cancer. During a prostate biopsy, a urologist — a physician who specializes in the urinary tract — removes small tissue samples from the prostate. Then, a pathologist 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.

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 review how to prepare for your prostate biopsy and what to expect afterwards.   

How is a prostate biopsy performed?

There are types of prostate biopsies: a transrectal biopsy and a transperineal biopsy. Some people also get magnetic resonance imaging (MRI)/ultrasound fusion biopsies. Let’s take a look at how they’re performed.

Transrectal biopsy

During a transrectal biopsy, the urologist passes a needle through the rectum into the prostate and removes tissue samples. The urologist uses ultrasound to help guide the needle. They may also use an MRI either before or during the biopsy to help them guide the needle.

Transperineal biopsy

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. The urologist uses ultrasound to help guide the needle. They may also use MRI to help them guide the needle. Transperineal biopsies are becoming more popular than transrectal biopsies because they come with a lower risk of infection. 

What’s the best way to prepare for a prostate biopsy?

Your healthcare team will give you specific instructions on how to prepare for your prostate biopsy. The steps you need to take depend on your medical history and the type of biopsy you need. But there are some general steps everyone should take. Here are some things that can help you get ready for your prostate biopsy.

Review medications and allergies with your healthcare team

Before your biopsy, you should review all your medications and supplements with your healthcare team. Your team may ask you to stop or change certain medications before your biopsy. For example, most people need to stop taking blood thinners several days before a prostate biopsy to avoid excessive bleeding. It’s also important to review any allergies with your healthcare team. You may need to avoid certain anesthesia or contrast medications depending on your allergies.

Talk with your team about voiding medications

Many people take a medication called tamsulosin (Flomax) before a prostate biopsy. Research suggests that people who take tamsulosin before a prostate biopsy have less pain when passing urine after their biopsy. Talk with your team about whether you should take tamsulosin before your biopsy. Most people need to start taking tamsulosin 4 days prior to a prostate biopsy.

Learn how to give yourself an enema

Your healthcare team may ask you to take a saline (Fleet) enema 2 hours before your prostate biopsy. An enema will clear stool from your bowels, which will make it easier for your urologist to perform the biopsy. Clearing your bowels can also lower your risk of developing an infection. If you’ve never given yourself an enema before, ask your team to show you how to do it. You can refer to our guide on how to give yourself an enema if you need a refresher during the process.

Follow prebiopsy instructions

Your healthcare team may prescribe medications for you to use immediately before and after your prostate biopsy. This may include antibiotics to lower your risk of developing an infection, especially if you’re having a transrectal biopsy. Your team may also prescribe pain medication to take before and after your biopsy. Your team may also ask you not to eat or drink anything for at least 8 hours before your biopsy if you’re having general anesthesia. If you’re having local anesthesia, you may be able to eat and drink before your procedure. Make sure to follow your team’s instructions so that you’re prepared for your biopsy.

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Advocate for yourself 

Make sure to let your healthcare team know if you have concerns about pain or you’re feeling anxious. It’s also a good idea to let them know if you have a history of claustrophobia or don’t like enclosed spaces. 

Your team can offer options that can help to keep you comfortable during your procedure and MRI (if you’re having one). This can include medications to lessen anxiety and nonmedication options like headphones to listen to music during your MRI. They may also offer different options for anesthesia. Advocating for yourself helps your team meet your needs.

What to expect after a prostate biopsy

After your biopsy is finished, your team will give you specific instructions on dos and don’ts during recovery. But in general, here are some things you can expect to hear.

Urination

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 after your biopsy. Even if you’re able to pee after your biopsy, make sure to contact your healthcare team right away if you have any trouble going to the bathroom when you go home.  

Physical activity

It’s safe to do routine activities the day after your prostate biopsy. This includes things like walking, going up and down stairs, and bending over. But you should avoid vigorous activity for 5 days after your biopsy. This includes things like working out, playing sports, bicycling, or lifting anything heavier than 10 lbs.

Sex

You should wait 3 to 7 days to engage in any sexual activity after your biopsy. You should wait 2 weeks before having anal sex if you had a transrectal biopsy. 

Hydration 

You want to drink plenty of fluids for at least 3 days after your biopsy. This keeps you hydrated and helps flush your urinary system. Staying hydrated lowers your chance of an infection and lessens the amount of blood in your urine. You should avoid alcohol for at least 48 hours after your biopsy. Alcohol can cause dehydration and irritate your bladder. This may worsen blood in the urine and discomfort.

Driving

You won’t be able to drive for at least 24 hours if you receive general anesthesia. Make sure to arrange a ride home ahead of time. If you receive local anesthesia you can drive right away. But you may be uncomfortable while sitting immediately after your biopsy. Consider getting a cushion ahead of time. Or you can also arrange a ride home so you can lie down in the back seat.

Results

Your biopsy samples will be sent to the pathology lab for analysis. It will take several days for you to get the results back. 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 while you wait. 

What side effects might you experience after a prostate biopsy?

A prostate biopsy is a safe procedure, but you may experience some side effects. The most common side effects people experience after a prostate biopsy include: 

• Blood in your urine: This is normal for up to 10 days after the biopsy. 

• Blood in your semen: This is normal for up to 6 weeks after the biopsy. 

• 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. 

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

What complications may occur during a prostate biopsy?

In general, prostate biopsies are safe procedures, but sometimes complications occur.

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 isn’t normal, and you should get care right away. 

Acute urinary retention

Acute urinary retention is a situation where you can’t pee because a swollen prostate blocks the passage of urine from the bladder. This happens to about 1% of people. Having a larger prostate gland seems to increase this risk. If you can’t urinate — get care right away. You might need to have a catheter placed until your prostate is no longer swollen. 

Urinary tract infection

You can get a urinary tract infection after a prostate biopsy. This happens to 5% of people and is more common after a transrectal biopsy. Contact your healthcare team right away if you develop pain or burning when you pee or you need to pee more often than normal. You should get immediate care if you develop any of these symptoms:

• Fever

• Chills or shivering  

• Fast heart rate or fast breathing

• Confusion

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

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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