Before & After My Prostate Biopsy

The choice to undergo a biopsy of the prostate is an important decision. After a PSA blood test, and likely an MRI of the prostate gland, are performed, you and your doctor may come to the decision that a biopsy of the prostate gland is best for you. With this biopsy, several small samples of tissues are taken from the prostate gland. In this way, the doctor will get better idea of the presence or absence of prostate cancer or the aggressiveness of these cells are found. Let find out more about you can expect before and after your prostate biopsy.

The type of preparation you would need to undergo largely depends on the approach, or how, the urologist plans to obtain the biopsy. If the urologist, plans to obtain the biopsy through the rectum, typical sedation, or “twilight,” is not needed. A local numbing medication will be used. Obtaining a biopsy through the rectal, in a similar manner that a digital rectal exam is perform, is the most common approach in getting a prostate biopsy. This is called a transrectal biopsy. With this approach, you will asked be asked to use an enema the night before to help clear the rectal area of stool. An enema is a solution that is applied, or inserted, into the rectal to help stimulated the evacuation, or removal, of stool. Before the procedure you will also need to provide a urine sample to ensure urinary infection is not present. If an infection is found, it will need to be treated and your biopsy may be put off to a later date. Nonetheless, even if there is no infection found in the urine, you will receive antibiotics before the procedure as prophylaxis, or prevention, for any infection that may occur after the biopsy. The decision to hold aspirin, clopidogrel (Plavix), warfarin (coumadin), apixaban (Eliquis) or other blood thinners is a difficult and should be made in consideration with you urologist, cardiologist and primary care doctors together. (1)

During your procedure, there are several steps you should expect. After changing into a hospital gown, you may be asked to lay on your side of back with your knees bent. Especially if your biopsy is being obtain by a different approach other than the transrectal method, you may receive some medication to calm you for the moment, therefore it is important to have someone with to take you home. Your rectal area will be further cleaned and prepared for biopsy.  Local numbing medication is injection at the site of the biopsy. You may feel some discomfort initially as this medical is applied. Otherwise, you may feel about 12 “pinches” to the rectal area as the biopsies from different parts of the prostate are taken. (1) Afterwards the area is clean and you will have a recovery period to ensure you are safe to return home. (2,3)

After the procedure, there may be some complications, but the risk is low. The most common complication is having blood in the urine and semen. Blood can also be seen in the urine up to 84% of the time and found in the semen in 93% of the cases. (4, 5) You may also experience mild bleeding from the rectum in about 54% of the time (1,4). A urinary tract infection can occur in up to 11% of the cases, but its chance of occurring is decreased by the use of antibiotics before your procedure (1) There is a possibility that there may be come issues with urinating, also know a urinary retention, but again this risk is low.

Overall, a prostate biopsy may seem daunting and uncomfortable, but do not be afraid. Knowing more about what to expect during the day can help ease your concerns. In some cases, counseling before your biopsy can help alleviate any anxieties. Also, strongly consider getting an MRI of your prostate before the biopsy. This can not only void the need for a biopsy, but also help the doctor target the prostate gland more successfully Be strong and courageous. Do not be afraid (Joshua 1:9) If you doctor has determined a biopsy of your prostate is necessary, I would trust their assessment. The information obtained from a biopsy may not save your life, but also help prevent cancers in your sons and daughters if the biopsy leads to a genetic reason for its presence.

REFERENCES
1. Benway BM & Andriole GL. Prostate Biopsy. In: UpToDate, Richie JP & Chen Wenliang (Eds), UpToDate, Waltham, MA. (Accessed on January 16, 2022.0
2. Prostate Biopsy, John Hopkins Medicine, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/prostate-biopsy (Accessed on January 16, 2022)
3. Prostate Biopsy, Mayo Clinic, https://www.mayoclinic.org/tests-procedures/prostate-biopsy/about/pac-20384734 (Accessed on January 16, 2022)
4. Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol. 2013 Dec;64(6):876-92.
5. Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer Prostatic Dis. 2007;10(3):283-7.