What to expect from a prostate biopsy

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.

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.

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.