Biopsy and Imaging

What Is a Prostate Biopsy?

A prostate biopsy removes small samples of tissue from the prostate so they can be examined for cancer. It is usually recommended after an elevated PSA test or an abnormal digital rectal exam. During the procedure, the doctor takes several “core” samples from different areas of the prostate using a fine needle. Ultrasound is used more and more often to guide the needle and limit damage to the surrounding tissue.

This is the point to remember: prostate cancer can only be confirmed with a tissue sample. The biopsy is the step that turns a suspicion into a clear answer, and that answer is what lets you and your doctor make a confident plan.

What Are the Side Effects of a Prostate Biopsy?

Most men tolerate a prostate biopsy well, but there are a few risks and after-effects worth knowing so nothing takes you by surprise.

• Infection. The most common risk. Rarely, a man develops a urinary tract or prostate infection that needs treatment with antibiotics.
• Bleeding at the biopsy site. Some rectal bleeding is common afterward. If you take blood thinners, ask your doctor how to manage them before and after the procedure.
• Blood in your semen. It is common to notice red or rust coloring in semen for a few weeks. This is normal and not a cause for concern.
• Difficulty urinating. Some men have temporary trouble passing urine after the procedure. Rarely, a short-term catheter is needed.

Because of these effects, it can be worth trying to rule out other causes of an elevated PSA or an abnormal DRE before moving to a biopsy. Your doctor can help you weigh whether a biopsy is the right next step for you.

What Types of Prostate Biopsy Are There?

There are three main ways to perform a prostate biopsy. Your doctor will recommend the approach that best fits your situation.

• Transrectal. The most common approach. Guided by ultrasound, the doctor passes needles through the wall of the rectum into the prostate to take six to twelve samples from different zones.
• Transurethral. A thin lighted scope is passed into the urethra so the doctor can see the prostate, then a small cutting loop is used to take tissue samples.
• Transperineal. The doctor makes a small incision in the perineum, the area between the scrotum and the anus, and inserts a needle to take tissue cores.

Newer Biopsy Techniques

Research keeps improving biopsy accuracy. One approach combines real-time ultrasound with MRI images to guide the needle; studies suggest MRI-ultrasound fusion produces better results while lowering the risk of infection, bleeding, and nerve damage. For men who have already had a negative biopsy, a test called ProMark can help predict whether a repeat biopsy is likely to be negative too, potentially sparing an unnecessary procedure.

What Happens After a Biopsy?

A negative biopsy means none of the samples showed cancer. That is usually good news, but it does not completely rule out prostate cancer, so your doctor may continue to monitor your PSA or suggest a repeat biopsy at some point.

A positive biopsy means cancer was found, which is a diagnosis of prostate cancer. You will also begin to learn the approximate location, size, and aggressiveness of the cancer. What happens next is a decision between you and your doctor, and additional genomic and tissue tests can sharpen the picture. Explore them on our additional testing page.

Tests That Can Refine a Diagnosis

Several tests can be run alongside or after a biopsy to help judge the risk and aggressiveness of the disease.

• ERG protein marker. Used on prostate tissue after a biopsy to help identify men who have the disease or pre-cancerous lesions that make prostate cancer more likely over time.
• SelectMDx. Estimates the risk of aggressive, high-grade prostate cancer.
• ConfirmMDx. For men with an initial negative biopsy, helps predict outcome beyond age, PSA, DRE results, race, and family history alone.
• Know Error. A DNA safeguard that matches biopsy samples to a cheek swab to confirm the tissue truly belongs to you.
• 4Kscore. A blood test that gives a patient-specific probability of finding aggressive prostate cancer at biopsy, so you and your doctor can decide whether to proceed.
• StoreMyTumor. Collects, processes, and stores viable tumor tissue so more personalized treatment and diagnostic options stay open.

Imaging Tests

Imaging such as MRI, PET/CT scans, and ultrasound helps doctors detect prostate cancer, locate it, and minimize the risk of side effects from treatment. Many of these methods are new or still developing, and they give doctors a clearer picture than was possible before.

MRI

An MRI (magnetic resonance imaging) uses a magnetic field to produce detailed images that an X-ray or ultrasound may not show clearly. It is painless and usually takes about 45 minutes. After cancer is confirmed by a biopsy, an MRI helps doctors pinpoint the areas involved, and some research suggests it can even help predict recurrence. Most MRI machines are enclosed, which is called a closed MRI. If you are claustrophobic, ask about an open MRI or about medication to ease anxiety before the test.

PET and PET/CT

A PET (positron emission tomography) scan is a noninvasive nuclear imaging test that uses small amounts of radioactive material to show whether, and how far, cancer has spread beyond the prostate. Combining PET with a CT scan adds detailed X-ray images from many angles, which increases the accuracy of the diagnosis.

A biopsy and imaging usually follow a PSA test and a digital rectal exam. If your results point to prostate cancer, the next step is often additional testing to understand how aggressive it is. Still deciding whether it is time to start screening? Read our guide on when you should get tested or review your personal risk factors.

Keep Learning

Biopsy and imaging are part of how prostate cancer is diagnosed. Explore the other steps and find out when you should start screening.