Prostate biopsy

When prostate cancer is suspected, either from the results of a digital rectal exam, a PSA test, or both, a prostate biopsy is performed. The procedure involves taking samples of prostate tissue and examining them under a microscope for the presence of cancer. Each year, about 800,000 men undergo prostate biopsy.

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The most common biopsy method is transrectal ultrasound-guided biopsy, also known as TRUS. The procedure is usually done in a urologist's office and takes about 20 minutes to perform. While the patient is lying on his side, an ultrasound probe is inserted into the rectum to visualize the prostate. Fitted to the probe is a biopsy gun that drives small needles through the wall of the rectum and into the prostate. In less than a second, the needle removes a small tissue sample. Usually, eight to 12 tissue samples are taken throughout the prostate.

After the procedure, the tissue samples are sent to the laboratory to be examined under a microscope by a pathologist. The results are usually ready in three to five days. Nearly 75 percent of the time, no prostate cancer is detected in the samples, usually because the elevated PSA levels that prompted the biopsy were due to another prostate condition (such as BPH or prostatitis) or a nonmedical reason (such as recent sexual activity). A second biopsy is required when the pathologist finds atypical cells (cells suspicious but not diagnostic of cancer) or when the biopsy does not indicate cancer but the results of the digital rectal exam or PSA test were highly suggestive of cancer.

Many men worry that prostate biopsy will be painful, but it usually causes only minor discomfort. Common side effects include minor rectal bleeding; blood in the stool, urine, or semen; and soreness in the biopsied area. All of these side effects disappear with time.