Prostate Biopsy

Dr Png Keng Siang
Dr Png Keng Siang
Senior Consultant Urologist & Robotic Surgeon

A prostate biopsy is a medical procedure in which small samples of tissue are removed from the prostate gland to be examined under a microscope. This procedure is typically recommended when there are signs that suggest the presence of prostate cancer, such as elevated prostate-specific antigen (PSA) levels or abnormalities found during a digital rectal exam (DRE). The biopsy helps in diagnosing or ruling out prostate cancer, allowing for appropriate treatment planning if necessary.

Purpose of Prostate Biopsy

The primary purpose of a prostate biopsy is to diagnose or rule out prostate cancer. Here are the key reasons why a prostate biopsy might be performed:

When there are indicators such as elevated PSA levels or abnormalities detected during a digital rectal exam (DRE), a biopsy can confirm the presence of cancerous cells in the prostate.

By examining the biopsy samples, medical specialists can determine the grade of the cancer, typically using the Gleason score. This information helps in assessing how aggressive the cancer is and guiding treatment decisions.

The results of a prostate biopsy provide essential information for developing an appropriate treatment plan, whether it involves active surveillance, surgery, radiation therapy, or other treatments.

Besides cancer, a biopsy can help diagnose other prostate conditions, such as prostatitis or benign prostatic hyperplasia (BPH), which can mimic cancer symptoms.

Who Should Consider Prostate Biopsy?

A prostate biopsy may be recommended for several groups of people based on specific medical indications and risk factors:

Elevated PSA Levels

Men with elevated levels of prostate-specific antigen (PSA) in their blood may be advised to undergo a biopsy to investigate the cause, as elevated PSA can be a sign of prostate cancer.

Abnormal Digital Rectal Exam (DRE) Results

If a digital rectal exam reveals abnormalities in the size, shape, or texture of the prostate, a biopsy may be necessary to determine if these changes are due to cancer.

Previous Prostate Biopsy Results

Men who have had a previous biopsy with abnormal but non-cancerous results (such as atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia) may need follow-up biopsies.

Family History of Prostate Cancer

People with a strong family history of prostate cancer may be at higher risk and may consider biopsy screening based on their PSA levels and other factors.

Symptoms of Prostate Issues

Men experiencing symptoms such as difficulty urinating, pain during urination, or unexplained weight loss might undergo a biopsy if other tests suggest the possibility of prostate cancer.

Active Surveillance

Men diagnosed with low-risk prostate cancer who are under active surveillance might have periodic biopsies to monitor the progression of the disease.

Types of Prostate Biopsy

There are several types of prostate biopsy procedures, each chosen based on the patient’s health, previous biopsy results, and the urologist’s recommendation. The main types include:

Transrectal Ultrasound (TRUS)-Guided Biopsy

An ultrasound probe is inserted into the rectum to provide imaging guidance, and a needle is used to take multiple tissue samples from different areas of the prostate.

Transperineal Biopsy

In this method, the biopsy needle is inserted through the skin between the anus and scrotum (the perineum). This approach can be used when the transrectal method is not suitable or to access areas of the prostate that are difficult to reach via the rectum.

Preparation for Prostate Biopsy

Proper preparation for a prostate biopsy can help ensure the procedure goes smoothly and reduce the risk of complications. Here are the key steps patients should follow:

  • Medical Evaluation: Prior to the biopsy, patients will have a medical evaluation to assess their overall health and suitability for the procedure. This may include a review of medical history, medications, and any allergies.
  • Medication Adjustments: Patients should inform the urologist about all medications and supplements they are taking. Some medications, particularly blood thinners and anticoagulants, may need to be temporarily discontinued to reduce the risk of bleeding.
  • Antibiotics: To prevent infection, patients are often prescribed antibiotics to be taken before and after the biopsy. It is recommended to follow the urologist’s instructions regarding the antibiotic regimen.
  • Bowel Preparation: A bowel preparation, such as an enema, may be recommended to clear the rectum and lower bowel. This can help provide a clearer view during a transrectal biopsy and reduce the risk of infection.
  • Dietary Instructions: Patients can generally eat and drink as usual before the biopsy. However, they should follow any specific dietary instructions provided by their urologist.
  • Transportation Arrangements: After the biopsy, patients may feel some discomfort or have temporary side effects. It is advisable to arrange for someone to drive them home after the procedure.

How is Prostate Biopsy Conducted?

The entire procedure usually takes about 20 to 30 minutes. The process of conducting a prostate biopsy involves several steps:

  • Patient Positioning: The patient is positioned on their side with knees pulled up to their chest or on their back with legs raised and supported in stirrups, depending on the type of biopsy.
  • Anaesthesia: Local anaesthesia is administered to numb the area, reducing discomfort during the procedure.
  • Imaging Guidance: For transrectal biopsies, an ultrasound probe is inserted into the rectum to provide real-time imaging of the prostate.
  • Sample Collection: For a transperineal biopsy, the urologist will take multiple tissue samples from different areas of the prostate using a biopsy needle. Using the transperineal approach, the needle will be inserted through the perineum.
  • Number of Samples: Typically, 10 to 12 core samples are collected to provide a comprehensive evaluation of the prostate tissue. In some cases, more samples may be taken.
  • Post-Procedure Care: After the samples are collected, the patient will be monitored for a short period to ensure there are no immediate complications. The patient can usually go home the same day.
  • Laboratory Analysis: The collected tissue samples are sent to a laboratory where a pathologist examines them under a microscope to look for cancerous cells and other abnormalities.

Understanding Prostate Biopsy Results

The results of a prostate biopsy provide important information about the presence and nature of any abnormalities in the prostate tissue. Here’s how the results are typically understood and interpreted:

Pathology Report

The biopsy samples are examined by a medical specialist, who prepares a detailed report. This report includes information about the presence of cancer cells, the type of cancer (if any), and the grade of the cancer.

Gleason Score

For prostate cancer, the Gleason score is a key part of the pathology report. This score ranges from 6 to 10 and is based on the appearance of cancer cells under the microscope. It helps determine how aggressive the cancer is:

  • Gleason 6: Indicates low-grade cancer that is less likely to spread.
  • Gleason 7: Intermediate-grade cancer with a moderate risk of spreading.
  • Gleason 8-10: High-grade cancer that is more likely to grow and spread quickly.

Cancer Staging

The results also contribute to determining the stage of the cancer, which describes its extent and whether it has spread beyond the prostate. Staging helps guide treatment decisions.

Benign Conditions

If no cancer is found, the biopsy may still reveal other conditions, such as benign prostatic hyperplasia (BPH) or prostatitis (inflammation of the prostate), which can cause similar symptoms.

Follow-Up Recommendations

Based on the biopsy results, the urologist will recommend the next steps, which may include active surveillance, further testing, or treatment options such as surgery, radiation, or hormone therapy.

Risks and Considerations

While a prostate biopsy is generally safe, it is important to be aware of the potential risks and considerations associated with the procedure. Here is what to expect:

Infection

There is a risk of infection following a prostate biopsy, particularly a urinary tract infection or prostatitis. To mitigate this risk, patients are usually prescribed antibiotics before and after the procedure.

Bleeding

Some bleeding is common after a biopsy. Patients might notice blood in their urine (hematuria), stool, or semen. This typically resolves within a few days to a week. If bleeding is heavy or persists, medical attention is required.

Pain or Discomfort

The biopsy procedure can cause some pain or discomfort in the rectal or perineal area. This is usually mild and temporary, but over-the-counter pain relievers can be used if necessary.

Urinary Issues

Some patients may experience difficulty urinating or increased frequency and urgency. These symptoms usually resolve on their own, but persistent problems should be discussed with a urologist.

Recovery and Aftercare

Recovery and aftercare following a prostate biopsy are recommended to ensure proper healing and to monitor for any potential complications. Here are the key aspects of recovery and aftercare:

  • Rest and Activity: Patients are generally advised to rest for the remainder of the day after the biopsy. Normal activities can usually be resumed the next day, but strenuous activities and heavy lifting should be avoided for at least 24-48 hours.
  • Managing Discomfort: Mild pain or discomfort in the biopsy area can be managed with over-the-counter pain relievers, such as acetaminophen or ibuprofen. Applying a warm compress to the area can also help alleviate discomfort.
  • Hydration: Drinking plenty of fluids can help flush out the urinary system and reduce the risk of infection. Patients should aim to drink at least eight glasses of water a day.
  • Antibiotics: To prevent infection, patients should complete the prescribed course of antibiotics and follow the urologist’s instructions regarding antibiotic use.
Dr Png Keng Siang

Dr Png Keng Siang

Senior Consultant Urologist & Robotic Surgeon

Dr Png is a United States fellowship-trained urologist who received his urology specialist board certification from Singapore. He is the first and only urologist in Singapore to be inducted into the Fellow, American College of Surgeons (FACS) after completing a minimally invasive surgery fellowship in the USA at the Indiana University School of Medicine, where he sub-specialised in robotic and laparoscopic surgery for urological cancers.

  • Joint Committee of Specialist Training Site Accreditor, Urology Residency Program
  • President of the Robotic Surgery Society of Singapore
Prior To Private Practice:
  • Director of the Robotic Urological Surgery Fellowship Program, Tan Tock Seng Hospital
  • Director of the National Healthcare Group Urology Residency Program & Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine
  • Member of the American Urological Association, Endourological Society (USA)
  • Executive Committee of the Singapore Urological Association, 2013 to 2020
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    Prostate Biopsy

    Frequently Asked
    Questions

    How should I prepare for a prostate biopsy?

    Preparation includes informing your urologist about all medications and supplements you are taking, as some may need to be temporarily discontinued. You may be prescribed antibiotics to prevent infection and might need to undergo bowel preparation. Follow any specific instructions given by your urologist.

    Is the biopsy painful?

    Most patients experience only mild discomfort during the procedure, thanks to local anaesthesia. Some may feel pressure or a slight pinch as the samples are taken.

    How long does it take to recover?

    Recovery time is usually short. Patients are advised to rest for the day and can typically resume normal activities the following day. Strenuous activities should be avoided for a few days.

    What should I do after the biopsy?

    Follow post-procedure instructions provided by your urologist, including completing any prescribed antibiotics, drinking plenty of fluids, and monitoring for signs of infection or excessive bleeding.

    When will I get the results?

    Biopsy results are usually available within a few days to a week. Your urologist will discuss the results and their implications with you at a follow-up appointment.