What is the prostate gland?

The prostate is part of the male genitourinary tract, located just below the bladder neck. It plays a specific role in the reproductive process, producing proteins in the ejaculate that aid the survival of spermatocytes.


Prostatic enlargement is a natural part of aging, with most men above sixty years old experiencing lower urinary tract symptoms due to prostatic obstruction at some point. This may lead to frequent or poor urinary flow, urinary tract infections, bladder stones and/or renal failure.

Although prostate cancer is a common condition, the natural progression is usually a slow process, with symptoms only developing in advanced cases. Your physician or urologist may therefore advise a digital rectal examination of the prostate, as well as a PSA blood test, to exclude prostate cancer.


Why would your urologist recommend a prostate biopsy?

Prostate biopsies are usually performed after abnormal findings on digital rectal examinations of the prostate, and/or increased levels of PSA in the blood. It is important to note that rectal findings and PSA levels are not diagnostic of prostate cancer, and that histological evidence obtained by a prostate biopsy is needed to confirm or exclude the diagnosis.

How are prostate biopsies performed?

Prostate biopsies are performed under ultrasound guidance during local or general anaesthesia. Biopsies can be performed transrectally or via the perineum, and multiple cores of prostatic tissue are taken for histological evaluation.

What to expect during the biopsy?

Antibiotics will always be administered (orally and/or intravenously), before and after the procedure
– Remember to inform your urologist of any known allergies

Local anaesthetic
– A transrectal periprostatic block may be performed
– Local anaesthetic gel administered transrectally
– Multiple core biopsy of the prostate will be performed (usually 12 or more cores)

General anaesthetic
– As above, but with added effects of general anaesthesia
– Remember not to eat or drink anything for at least 8 hours before the procedure
– An overnight stay in hospital may be required


What to expect after the biopsy

1. Bleeding

– Blood may be seen in stools, urine and ejaculate, for up to 2 weeks after the biopsy
– If persistently passing fresh blood rectally, consult your urologist
– Usually mild and self-limiting

2. Pain

– Rectal and/or perineal tenderness is common
– Regular analgesics required initially
– Usually mild and self-limiting

3. Infection

– Post biopsy sepsis is a potentially life threatening condition
– If signs or symptoms of sepsis occur (including fever, rigors, lethargy, persistent pain)

CONTACT YOUR UROLOGIST IMMEDIATELY- Admission and intravenous antibiotics usually required

4. Urinary obstruction

– Post biopsy inflammation may cause obstructed urinary flow
– Usually self-limiting
– Contact your urologist should symptoms persist or worsen
– May need medical or surgical intervention to relieve obstruction

5. Histology

– The need for further management will be discussed when histology results are available
– Factors included into decision making regarding further treatment include

  • Histology
  • Rectal findings
  • PSA levels
  • Age and/or general performance status of patient
  • Likelihood of local and/or systemic spread of disease