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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016


Cancer staging

Prostate biopsy

Prostate biopsy

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


) or

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 screen.

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,


• Infection,


• Swelling of your prostate (prostatitis) or

epididymis (epididymitis),

• Inability to empty your bladder (urinary

retention), and

• Hospitalization.