You Need a Prostate Biopsy: What to Expect and How to Prepare

By Dr. David Samadi

Suppose your PSA (prostate-specific antigen) levels have come back elevated or your doctor has noticed something unusual during a digital rectal exam. In that case, the next step may be a prostate biopsy. This procedure is essential for determining whether prostate cancer is present, helping guide treatment decisions if needed.

Hearing the word “biopsy” can understandably be unsettling. Some men react with concern, while others feel anxious about the unknown. However, the more you understand about the process and know what to expect, can ease fears and make the experience less stressful.

What Is a Prostate Biopsy?

A biopsy is necessary in order to allow examination under a microscope of a small sample of body tissue. Nearly all cancer diagnoses require a biopsy of tissue in the area of a questionable and abnormal mass to confirm the presence of abnormal cells that may be malignant. 

A prostate biopsy is a quick, 10- to 15-minute procedure, often performed in a urologist’s office, to check for cancerous changes in the prostate gland.

How to Prepare for a Prostate Biopsy

Before undergoing a prostate biopsy, there are a few important steps to take:

• Medication Review: Your doctor will review your medications and supplements. Blood thinners such as aspirin, warfarin, Xarelto, or Eliquis may need to be paused 7–10 days before a biopsy. This is necessary to help lower the risk of bleeding.
• Enema: A cleansing enema at home before your appointment helps reduce infection risk by clearing the rectal area.
• Antibiotics: Sometimes, your doctor may prescribe antibiotics about an hour before the biopsy to prevent infection.

What Happens During the Procedure?

Most prostate biopsies involve inserting a thin, spring-loaded needle into the prostate to collect tissue samples. Here’s a step-by-step look at what happens:

• Numbing the Area: A local anesthetic, used to minimize discomfort, is applied using an ultrasound-guided probe inserted into the rectum. 
• Tissue Sampling: A biopsy needle quickly removes 8 to 18 tiny tissue samples from different areas of the prostate, ensuring a thorough evaluation.
• Minimal Pain: While you may feel pressure, the procedure is generally well-tolerated with little to no sharp pain.

Types of Prostate Biopsies

While the transrectal biopsy (described above) is the most common, other approaches may be used:

• Transurethral Biopsy: A thin, camera-equipped tube is inserted through the urethra to access the prostate.
• Transperineal Biopsy: A small incision is made between the scrotum and anus to reach the prostate with a biopsy needle.
• MRI Fusion Biopsy: A cutting-edge technique that combines real-time ultrasound with MRI imaging for greater accuracy in detecting cancer. This method reduces the need for random sampling and helps pinpoint aggressive tumors.

What to Expect After a Prostate Biopsy

After the procedure, recovery is generally quick, but you should follow these precautions:

• Drink plenty of fluids
• Avoid heavy lifting for 24 hours
• Prevent straining during bowel movements for 48 hours

Common Side Effects:

• Mild soreness
• Blood in urine or semen (temporary)
• Light rectal bleeding

Call your doctor immediately if you experience:

• Difficulty or pain while urinating
• Heavy or prolonged bleeding
• Fever, swelling, or unusual discharge

Final Thoughts

A prostate biopsy is a crucial step in diagnosing prostate cancer, providing essential information to guide your health decisions. While the thought of the procedure may cause some anxiety, knowing what to expect and how to prepare can make it much more manageable. If you have concerns, don’t hesitate to talk to your doctor—they are there to help you through the process.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board-certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of two books, The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, and Prostate Cancer, Now What? A Practical Guide to Treatment, Diagnosis, and Recovery, both available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.