A prostate biopsy is an essential test that shows whether cancer cells are present in the prostate and how likely they are to spread outside of it. A biopsy also helps doctors decide what treatment options might be most appropriate.
During the procedure, doctors use an injection of local anesthetic to numb your groin and lower abdomen. They may also give you medicine to relax you or put you under light general anesthesia. The doctor can insert the needle through your rectum (transrectal biopsy) or through the area of skin between your anus and scrotum (transperineal biopsy). In some cases, doctors will use an image-guided technique that combines MRI with transrectal ultrasound, which provides images to guide the needle.
The doctor will use the needle to get 10 or 12 samples from different areas of the prostate gland. Each sample is called a core. Compared to the older “sextant” biopsy, which took only three cores from each side of the prostate, these newer biopsies remove more tissue.
Doctors will then examine the tissue under a microscope to look for cancerous cells. If they find any, your doctor will write a report that tells how serious the cancer is. The report will include a Gleason score, which is a pattern that cancerous cells can be classified as, and a grade. The higher the score, the more likely it is that the cancer will grow and spread if it is not treated.
In some cases, your doctor will find precancerous cells in the prostate that are not cancer but may lead to cancer later. These are known as prostatic intraepithelial neoplasia, or PIN. When a biopsy finds this, it’s important to follow up with your urologist to make sure the PIN isn’t growing faster than normal, which could lead to prostate cancer later.
When the results of your biopsy are available, your urologist will review them with you. If your doctor finds cancer, they will discuss the type and stage of the prostate cancer and explain what treatment options are best.
Your urologist may recommend that you have further tests before deciding on a course of action. These can include a PSA test, an MRI scan, or a CT scan.
Before your biopsy, ask your urologist about taking antibiotics to prevent infection. They will be given to you as tablets or an injection before the procedure, or they may give them to you afterward. These antibiotics reduce your chances of an infection by killing bacteria that live in the groin and penis.
Talk to your doctor about other medications you take, especially if you take daily low-dose aspirin or anticoagulants, such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), or apixaban (Eliquis). You may be advised to stop taking these medicines before the biopsy, but your doctor will weigh this against your need for them to prevent blood clots. Also, talk to your urologist about eating food and drinking liquids before the procedure.
