Advantages

• It can help detect whether you have prostate cancer.
• It can provide further information about how much cancer is present in the samples taken, how aggressive it might be and whether or not it may spread (measured by the Gleason score). This can help your specialist team decide which treatment options may be suitable for you.

Disadvantages

• It may 'miss' the cancer if it is in an area of the prostate where a sample was not taken.
• It can pick up a slow growing or non-aggressive cancer that may not cause any symptoms or problems in your lifetime. You may then have to make decisions about whether to have treatment.
• It can cause short-term side effects such as blood in your urine, faeces or semen.
• There is a risk of developing a serious infection called septicaemia but this is rare. About one out of 100 men (one per cent) will experience this. You will have antibiotics before your biopsy to help prevent infection.
• Some men may find it painful or uncomfortable.

The specialist lubricates an ultrasound probe with gel and passes it into your back passage (rectum). They then place a needle down the shaft of the probe and through the wall of the back passage into your prostate gland. The ultrasound image helps the specialist to guide the needle and to estimate the size of your prostate.

The specialist uses the needle to take around ten to 15 small samples of tissue from your prostate. If you have a bigger prostate, they may take more samples. Some men describe the biopsy as painful, but others have less discomfort. You should be given a local anaesthetic injection to help reduce any pain.

The actual biopsy takes about five minutes but it may take longer to prepare you for the procedure. After the biopsy, you may be given an antibiotic suppository in your back passage.

You may have to wait for about half an hour after the biopsy or until you have passed urine before going home.

You will be given antibiotics before the biopsy to help prevent infection. You will need to continue your course of antibiotics when you go home.

Short-term bleeding

You may see blood in your urine or bowel motions for up to two weeks after the biopsy. You may see blood in your semen for up to six weeks. If bleeding takes longer than this to clear up, or gets worse after a period of recovery, you should see a doctor straight away.

Urineretention

Some men are unable to pass urine after a biopsy. This is called urine retention. If this happens to you, it is important to contact your doctor or specialist team urgently or go to your nearest accident and emergency (A&E) department.

Infection

A small number of men (about one per cent) get an infection of the blood called septicaemia after a biopsy. This can cause symptoms similar to flu. It is very important to take all of the antibiotics that you have been given to help prevent this happening. If you have a high temperature, pain or burning when you pass urine, or difficulty passing urine, you should go to your nearest accident and emergency (A&E) department straight away. These symptoms may mean you have an infection, even if you have been taking antibiotics.

A doctor who specialises in examining cells using a microscope (pathologist) will examine your biopsy samples. It can take up to two weeks for the results to come back.

If no cancer is found

This is obviously reassuring. However, your specialist cannot say for certain that you do not have prostate cancer because there could be a small cancer that the needles did not hit. Your specialist team will want to monitor your prostate with further PSA tests and DREs.

If your PSA level stays higher than normal and the specialist cannot find any other cause, you may be offered another biopsy in the future.

If no cancer is found in further biopsies but your specialist team still thinks you may have prostate cancer, you may be offered a template or saturation biopsy.

Sometimes, when a man has a biopsy to look for prostate cancer, he may instead be diagnosed with prostatic intrapithelial neoplasia (PIN). PIN is the name given to certain changes in the cells that line the prostate gland. It is not the same as prostate cancer.

The pathologist will tell your specialist how many samples are affected and how much cancer is present in each sample. The pathologist will also 'grade' the cancer to show how active it is, using a system called Gleason grading. You can read more about what happens when you are diagnosed with prostate cancer and the help and support available to you on our page Getting the results.

This involves taking more tissue samples than a TRUS guided biopsy. You may have this test if your TRUS guided biopsy result was negative but your specialist still thinks you might have prostate cancer.

You will usually have a general anaesthetic so that you are asleep during the biopsy, or a spinal anaesthetic (epidural) so that you are awake but cannot feel anything. Occasionally, it can be carried out under a local anaesthetic.

The specialist passes an ultrasound probe into your back passage so that they can see where to place the needles. The specialist then passes the needles through a grid (or template), through the area of skin between the scrotum and back passage (perineum), and into the prostate gland. The specialist usually takes about 32 samples from different areas of your prostate gland.

There is more chance of finding prostate cancer if you have this type of biopsy because more of the prostate is examined. However, it may pick up a cancer that is small or very slow growing that might not cause any symptoms or problems in your lifetime. Your specialist should discuss the advantages and disadvantages of this type of biopsy with you to help you decide whether or not to have the test.

If a sample from your biopsy contains cancer, the pathologist will 'grade' it to show how active the cancer is. This involves looking at the pattern made by the cancer cells and giving that pattern a grade from 1 to 5.

The grades of the two most common patterns seen in the biopsy samples are added together to give the Gleason score. The higher the Gleason score, the more aggressive the cancer and the more likely it is to spread. Gleason scores run from 2 to 10. Most men with prostate cancer will have a Gleason score between 6 and 10.

For example, if the most common pattern seen in biopsy samples is grade 3, and the second most common pattern is grade 4, the Gleason will be 3+4. This gives a Gleason score of 7. A Gleason of 4+3 still gives a Gleason score of 7 but shows that the cancer is slightly more aggressive. This is because a Gleason of 3+4 means that more cancer is graded as 3, whereas a Gleason of 4+3 means that more cancer is graded as the higher grade 4.

• Will I need a biopsy?
• What are the risks and side effects of having a biopsy?
• How many biopsy samples will you take?
• When will I get the results of my biopsy?
• If no cancer is found, will I need a template or saturation biopsy?
• What is my Gleason score? What does this mean?
• Will I need any other tests?