Prostate Biopsy

January 7, 2026

This page was reviewed under our medical and editorial policy by Walter Stadler, M.D., professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Chicago

Just below the bladder in men sits a small, walnut-sized gland. This gland, called the prostate, wraps around the urethra, which carries urine out of the body. The prostate is responsible for producing semen, the fluid that carries sperm.

When there is a suspicion of prostate cancer, the health care team may recommend a prostate biopsy to evaluate further.

What Is a Prostate Biopsy?

A prostate biopsy is a medical procedure used to diagnose prostate cancer. A urologist, a doctor who focuses on the urinary system, performs the procedure.

It is usually recommended if initial tests, like a digital rectal exam (DRE), a prostate-specific antigen (PSA) blood test or imaging tests (such as ultrasound or magnetic resonance imaging), suggest the possibility of cancer.

In a prostate biopsy, small tissue samples are taken from the prostate and examined under a microscope. This is the only definitive way to determine if prostate cancer is present. If cancer is found, the biopsy will also help indicate how aggressive it might be, and how likely it is to grow and spread.

After the biopsy procedure, a specialized doctor called a pathologist examines the tissue samples. The pathologist then sends a detailed report to the patient’s doctor, providing a diagnosis for each sample. This information helps the care team develop an appropriate treatment plan.

How Is a Prostate Biopsy Procedure Done?

A prostate biopsy is usually an outpatient procedure, meaning patients are able to go home the same day. There are different types of prostate biopsy procedures, all seeking to obtain small samples of prostate tissue for examination.

During the biopsy, the doctor uses imaging tests like transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI), or a combination of both, to visualize the prostate. A thin, hollow needle is then quickly inserted into the prostate to collect tissue samples. This may be done through the wall of the rectum (transrectal biopsy) or the skin between the scrotum and anus (transperineal biopsy). 

Each time the needle is inserted and removed, it takes out a small cylinder, or core, of prostate tissue. Typically, about 12 core samples are taken from different parts of the prostate to ensure a comprehensive evaluation. 

While the procedure might sound painful, it generally causes only brief discomfort. This is because a special spring-loaded biopsy instrument inserts and removes the needle in a fraction of a second. Additionally, most doctors will numb the area first by injecting a local anesthetic alongside the prostate.

Transrectal Biopsy

A transrectal prostate biopsy is the most common method for obtaining prostate tissue samples. During the procedure, the patient lies on his side with knees bent and a finger-sized ultrasound probe is inserted into the rectum. This may cause some slight discomfort or pressure.

The ultrasound provides images of the prostate, guiding the provider to inject numbing medicine around the prostate. Using the ultrasound for precise guidance, the provider then inserts a biopsy needle through the rectum into the prostate to collect tissue samples. The procedure takes about 10 minutes.

Transperineal Biopsy

A transperineal prostate biopsy is performed through the perineum, the skin between the anus and the scrotum. The patient receives medicine to induce relaxation and prevent pain. Then the provider inserts an ultrasound probe into the rectum to visualize the prostate. Guided by the ultrasound, a needle is inserted through the perineum to collect tissue samples.

This method is being used more frequently because it may reduce the risk of infection while providing cancer detection accuracy similar to transrectal biopsies.

Prostate Fusion Biopsy

A prostate fusion biopsy combines MRI and ultrasound images to create a 3D view of the prostate. This enhanced imaging helps the doctor precisely guide the biopsy needle to abnormal tissue areas. During the procedure, a tissue sample is removed for examination under a microscope for signs of cancer, similar to other types of biopsy.

Fusion biopsies may detect cancer cells that other biopsy methods might miss, aiding in early cancer detection and treatment planning. This method is also known as an MRI ultrasound fusion-guided biopsy. The procedure is performed by a radiologist with training in this state-of-the-art technique.

How Long Does a Prostate Biopsy Take?

A prostate biopsy procedure itself only takes about 10 minutes, and is typically performed in a doctor's office. Depending on the method, additional time may be needed beforehand to numb the area or set up imaging.

Preparation

Preparing beforehand is key to ensuring that a prostate biopsy goes smoothly and reduces the risk of complications. The health care provider will discuss the risks and benefits of the biopsy with the patient, and a consent form may need to be signed.

A few days before the biopsy, the provider will likely instruct the patient to stop taking certain medications that may increase the risk of bleeding. These include prescription blood thinners or aspirin.

The patient may also need to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, as well as herbal supplements and certain vitamins.

The patient might be asked to eat only light meals the day before the biopsy.

The provider may recommend performing an enema at home to cleanse the rectum before the procedure. This helps provide a clearer view during the biopsy.

The patient will also be prescribed antibiotics to take before and after the biopsy to reduce the risk of infection. Typically, these antibiotics are started the day before the procedure, continued on the biopsy day, and for a day or two afterward.

Patients should continue their prescription medications unless the provider advises otherwise.

Recovery

Immediately after the procedure, patients may feel some soreness in the biopsy area, which usually subsides within a few days. Antibiotics prescribed by the health care provider should be taken as directed to prevent infection at the biopsy site.

It is common to notice blood in the urine for a few days. There may also be light bleeding from the rectum, especially in patients with hemorrhoids.

Patients may also notice blood in their semen or rust-colored semen for several weeks after the biopsy, depending on how often they ejaculate. This is normal and should gradually improve.

Prostate Biopsy Side Effects

After a prostate biopsy, patients commonly experience blood in the urine or semen during recovery. While the procedure is generally safe, there are some possible and less common risks to be aware of.

Infection: One potential side effect is urinary tract or prostate infection. Although rare, a severe blood infection (sepsis) may occur. Patients should monitor for signs of infection, such as fever, chills or unusual pain, and contact their health care provider if these symptoms arise.

Urinary issues: Some patients may have trouble passing urine after the biopsy. If difficulty urinating persists, it is important to seek medical attention.

Allergic reactions: There is a small risk of an allergic reaction to the medications used during the biopsy, such as local anesthetics or antibiotics. Patients should see a health care provider immediately if they think they are having an allergic reaction.

Excessive bleeding: Patients might notice bleeding or bruising at the biopsy site. This is usually mild and resolves on its own, but if bleeding is heavy or does not stop, patients should seek medical advice.

Rectal injury: The wall of the rectum may be harmed during the procedure.

Erectile dysfunction: Patients may find it hard to get or keep an erection after prostate biopsy. If it happens, it is usually temporary and resolves about three months after the procedure.

Results

After a prostate biopsy, the tissue samples are sent to a lab where a pathologist examines them under a microscope to check for cancer cells. The results in a pathology report usually take one to three days, though sometimes it may take longer.

The pathology report may have different outcomes, as detailed below.

Negative for cancer: No cancer cells are found in the samples.

Positive for cancer: Cancer cells are present in the samples.

Suspicious or atypical: Abnormal cells are detected, but it is unclear if they are cancerous.

If cancer is found, it is graded based on its appearance under the microscope. The grade indicates how abnormal the cancer cells look and helps predict how quickly the cancer might grow and spread.

The Gleason system assigns grades from 1 to 5 based on how much the cancer resembles normal prostate tissue. Since prostate cancers often have areas with different grades, the two most prevalent grades are combined to form a Gleason score between 2 and 10.

In recent years, Grade Groups ranging from 1 to 5 have complemented the Gleason score, as listed below.

• Grade group 1: Gleason score 6 or less, a very slow-growing lesion that is typically managed with surveillance
• Grade group 2: Gleason score 3+4, slow-growing, low risk for metastasis, may be managed with surveillance or local therapy
• Grade group 3: Gleason score 4+3, intermediate-growing, typically requires local therapy
• Grade group 4: Gleason score 4+4, fast-growing/aggressive, typically requires local therapy and evaluation for metastatic disease
• Grade group 5: Gleason score 4+5, 5+4, or 5+5, very aggressive, high risk for metastasis

The pathologist may include both the Gleason score and Grade Groups in the pathology report.

Other information that might also be on the pathology report includes:

• The number of biopsy samples that contained cancer cells out of the total samples taken
• The percentage of each sample that contained cancer cells
• Where the samples with cancer were located within the prostate (left, right or both sides)

Patients and their families should consult with the care team for help understanding the prostate pathology report and their treatment options.