What Is a Needle Biopsy of the Prostate?

A needle biopsy of the prostate is a procedure in which your doctor removes tiny pieces of tissue from your prostate gland. The bits of tissue are then studied under a microscope to see if there are any abnormalities.

Your prostate is a gland located just below your bladder. It wraps around the upper part of your urethra (the tube that carries urine from your bladder through your penis to the outside of your body). The prostate makes a fluid that nourishes and protects sperm.

Why Do I Need a Needle Biopsy of the Prostate?

A needle biopsy is done when your doctor has good reason to suspect that you may have prostate cancer. Your doctor will probably recommend that you have a needle biopsy if:

• A digital rectal exam has revealed abnormalities in the size, shape, or texture of your prostate, and/or

• Your prostate-specific antigen (PSA) level is abnormally elevated. PSA is a protein made by prostate cells. The PSA blood test is an important screening test for the early detection of prostate cancer.

These abnormalities may be the result of the normal aging process, or they may indicate that there is a problem with your prostate, such as an infection, a noncancerous (benign) tumor, or cancer.

How Do I Prepare for the Procedure?

Your doctor might prescribe an antibiotic for you to start taking before the biopsy and continue to take for a day or so afterwards. This will reduce your risk for infection.

Tell your doctor if you regularly take aspirin or any other drug that thins the blood. You may be instructed to stop using the aspirin or drug several days before the biopsy. This may help keep you from bleeding too much when the tissue samples are removed from your prostate.

Your rectum needs to be free of stools so your doctor can safely insert the instruments needed to perform the needle biopsy. A clean rectum will further reduce your risk for infection. In order to cleanse your lower bowel and rectum, you will have to give yourself an enema before you arrive at your doctor's office for the biopsy.

How Is a Needle Biopsy of the Prostate Done?

Your urologist can safely perform a prostate biopsy in his or her office.

Immediately before the biopsy, you may be given a sedative to help you relax. Your doctor may also inject a numbing medication into your prostate to keep you from feeling pain when the tissue samples are removed.

During the procedure, you will lie on an examination table on your left side with your knees drawn toward your chest. Your doctor will insert into your rectum an ultrasound probe that has been draped with a condomlike latex cover and lubricated with a special gel. The probe contains an ultrasound transducer, a device that releases and detects high-frequency sound waves. Attached to the side of the ultrasound probe is a small tube called a needle guide.

When the probe is inside your rectum, you will feel pressure similar to the feeling you have before a bowel movement. You won't feel the sound waves come out of the transducer, but you may feel the movement of the probe as your doctor adjusts its location. The sound waves will bounce off your prostate and other nearby structures, and the reflected sound waves—or echoes—will be detected by the transducer. A computer will convert the echoes into black-and-white images (called sonograms) that your doctor can view on a TV monitor. Your doctor will use the sonograms to pinpoint the exact location of your prostate, measure its size, and identify areas that look abnormal.

When your doctor is ready to remove a piece of tissue from your prostate, he or she will activate the needle guide to release a hollow, spring-loaded needle. Every time the doctor releases the needle, it will quickly enter and exit your prostate, removing a tiny sliver of tissue. Your doctor will remove 8 to 12 or more samples of tissue from your prostate in this way. You will hear a clicking or popping sound each time your doctor activates the needle guide. You will probably feel some discomfort each time the needle enters your prostate, but because the needle moves so quickly, the discomfort should be brief.

After your doctor has obtained all the necessary tissue samples, the ultrasound probe will be removed from your rectum.

What Happens After the Procedure?

You will be able to leave your doctor's office shortly after the procedure is over. You should avoid strenuous activities for the rest of the day. You may notice some blood in your urine, semen, or stools for a day or two (sometimes longer) after the procedure.

Although it is possible that you could develop a prostate infection following a prostate biopsy, the antibiotic medications prescribed by your doctor should help prevent this.

Call your doctor if you develop a fever, experience severe pain or bleeding, pass blood clots, or have any other unexpected symptoms within a few days after the procedure.

Your prostate tissue samples will be sent to laboratory, where they will be examined by a specially trained doctor called a pathologist. Once your diagnosis has been determined, the pathologist will report his or her findings to your doctor.

The pathologist will use the samples from the different areas of your prostate to create a map of the gland. If cancer or other abnormal cells are present, the map will show the location of those cells. This information will be useful to your doctor as he or she considers your treatment options.

If cancer is found in your prostate, the pathologist's report will provide information about the cancer's grade. The grade may give an indication of how aggressively the cancer will grow and spread.