NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
Rising PSA levels and abnormal DRE findings may
suggest cancer is present. However, the only way to
know if you have prostate cancer is to remove tissue
from your body and have a pathologist look at it using
a microscope. A biopsy removes small samples of
tissue for testing. Biopsies can also help your doctor
assess how far the cancer has grown.
A prostate biopsy is a type of biopsy that removes
tissue from the prostate. To prepare for the biopsy,
your doctor may say to stop taking some medicines
and start taking others. Medicines to stop taking
include blood thinners like warfarin (Coumadin
antiplatelet drugs like aspirin or Plavix
. Your doctor
may prescribe antibiotics to try to prevent an infection
from the biopsy.
Right before the biopsy, local anesthesia may be
given to numb the area. You’ll feel a small needle stick
and a little burning with some pressure for less than
a minute. A numbing gel may also be applied to the
area. You may feel pressure and discomfort during the
biopsy but pain is often little or none.
The most common type of prostate biopsy is the
transrectal method. To make sure the best samples
are removed, a TRUS probe is inserted into your
rectum. The TRUS uses sound waves to make a
picture of your prostate that is seen by your doctor on
A newer method uses MRI along with TRUS. Before
the biopsy, images with MRI will be made. These
images will then be combined with TRUS during the
biopsy. This allows for better tracking of the movement
of your prostate. It also helps doctors pinpoint which
tissue to remove. At present, this use of MRI is not
common practice. More research is needed.
A spring-loaded needle will be inserted through
the TRUS. Your doctor will trigger the needle to go
through the rectal wall and into your prostate. The
needle removes tissue about the length of a dime
and the width of a toothpick. At least 12 samples—
called cores—are often taken. This is done to check
for cancer in different areas of the prostate. Prostate
biopsies aren’t perfect tests. They sometimes miss
cancer when it’s there. If no cause for the high PSA is
found, your doctor may order more biopsies.
Prostate biopsies often occur with no problems.
However, side effects are possible. Some people have
allergic reactions to anesthesia. Tell your doctor if
you’ve had any problems with anesthesia in the past.
The prostate biopsy may cause:
• Blood in your semen (hematospermia) or urine
• Rectal bleeding,
• Swelling of your prostate (prostatitis) or
• Inability to empty your bladder (urinary