What to expect from a prostate biopsy

Written by: Mr Simon Brewster
Published: | Updated: 06/02/2020
Edited by: Laura Burgess

A prostate biopsy is used to remove tissue samples from the prostate gland, which is then looked at under a microscope to check for prostate cancer. You may first have a magnetic resonance imaging (MRI) scan before the biopsy. We’ve asked one of our top urologists, Mr Simon Brewster who might need this procedure, how it's performed and what you can expect on the day.

Old man sat on a bench

What is an MRI-targeted prostate biopsy?

This is a prostate gland biopsy planned to check a particular region (or regions) that have been highlighted as suspicious for cancer according to a specialist radiology consultant, who has examined the results of a multi-parametric MRI scan of the prostate gland.

The MRI may or may not be correct with this diagnosis and only a biopsy, where small snips of tissue are removed for pathology analysis using a microscope, is able to make or exclude this diagnosis.

Who should have this biopsy?

Men who have a raised PSA blood test in the absence of a urinary tract infection (UTI), or an abnormal-feeling prostate gland on digital rectal examination, should be offered both an MRI and a biopsy of their prostate gland. Any suspicious regions are targeted.

An MRI that appears to show no focal region of suspicion will be missing a significant prostate cancer in 15% of men, according to published studies. To pick up these additional cancers, systematic biopsies of different regions of the gland may be taken for analysis.

Read more on the PSA test for prostate cancer

How is the procedure performed?

The biopsy procedure is usually performed under a local anaesthetic. In certain circumstances, it may be necessary to use a general anaesthetic.

Typically, 10 (range 4-20) snips of tissue are obtained using a hollow needle, which is uncomfortable. An ultrasound probe is inserted into the rectum to image the prostate gland to ensure the biopsies are taken from the correct part(s) of the prostate. Results take between one to two weeks to become available.

How should men prepare themselves for this procedure?

No specific preparation is required other than stopping any anticoagulant (blood-thinner drugs) at the appropriate time prior. Also, alcohol should be avoided because antibiotics are given 40 minutes before and for two days after the procedure to reduce the rare chance of an infection.

How long is this procedure?

It takes 5-10 minutes to perform an ultrasound-guided MRI-targeted prostate biopsy, having previously studied the MRI images to "fuse" with the real-time ultrasound images obtained during the procedure.

What are the advantages and disadvantages of this procedure?

The advantage is that the prostate biopsy gives the greatest confidence in ruling in or ruling out prostate cancer following a prostate MRI scan (whether it appears normal or abnormal). The disadvantage is that there is a rare risk of infection or significant bleeding.


Do not hesitate to visit Mr Brewster at his clinic if you are worried about prostate enlargement or need a regular check-up.

By Mr Simon Brewster

Mr Simon Brewster is a consultant urological surgeon with more than 30 years' experience of clinical practice in urology. With a private practice in Oxford running alongside his senior NHS consultant position, Mr Brewster offers state-of-the-art care for the diagnosis and management of prostate cancer, benign prostate enlargement symptoms, prostatitis, urinary tract infections (UTI), scrotal conditions and blood in the urine (haematuria).

After qualifying as a doctor from London's Charing Cross Hospital in 1986 with a first class degree in anatomy and honours in pathology, Mr Brewster undertook his training in surgery and a doctorate research thesis based in Bristol. In 1998 he was appointed as a consultant in Oxford and pioneered the prostate cancer and HoLEP services there. He has led the University Hospitals department with teaching, clinical management, clinical governance and as an elected staff governor for the NHS Foundation Trust. He is a Fellow and Tutor at Hertford College, Oxford. Nationally and internationally, Mr Brewster has influenced specialist training and auditing of surgical outcomes by organising two major conferences and has sat on committees of the British Association of Urological Surgeons (BAUS) and the Uro-oncology Board of the European Association of Urologists (EAU).

Mr Brewster performs MRI-targeted prostate biopsy, diagnostic bladder examinations (cystoscopy) and a wide range of surgery with a high level of patient satisfaction. For prostate and bladder symptoms he offers all medical options and recent surgical innovations including holmium laser enucleation (HoLEP) and Rezum steam ablation which have the advantages of reduced bleeding, side-effects and a very short hospital stay compared to traditional prostate surgery. He also has considerable experience with ultrasound-guided prostate brachytherapy, gel spacer implants prior to prostate radiotherapy and day-case injections to treat incontinence after prostatectomy.

Mr Brewster maintains an active interest in research and education; he has produced over 90 publications in books and peer-reviewed journals. He is a co-author of the very popular Oxford Handbook of Urology, now in its 4th edition. He undergoes annual appraisal and revalidates with the GMC every five years. With extensive experience in patient care and urological surgery when necessary, Mr Brewster offers a comprehensive evidence-based and personalised service to private patients within and beyond Oxfordshire.

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