PSA test for prostate cancer

Biopsy of the prostate

If any of the initial tests (rectal examination, PSA) show the possibility of cancer, the urologist may recommend a biopsy, in which a sample of tissue is taken from the prostate to be examined through a microscope. The biopsy is usually done through the back passage (rectum). It is usually done in the urology out-patient department. The procedure itself takes about 5-10 minutes. 

During a trans-rectal ultrasound (TRUS) guided biopsy an ultrasound scanner is used to guide the placement of a needle. The needle is then passed through the wall of the rectum to take the sample of prostate tissue. Some men we talked to had wanted to see the process on screen, but had not been able to do so. It is usual to take approximately ten to twelve biopsy samples at any one time. Because there is a chance of infection, men are routinely given an antibiotic before the procedure.  

The men we talked to had very variable experiences. Some had been worried about the procedure, anticipating pain, particularly if waiting for a second biopsy. One man said he was 'frightened to death' and another man described the tense atmosphere in the waiting room. 

Men described vividly what having a biopsy felt like. One man, for example, said it was like “a paper clip going into you”, another likened it to a “huge wasp or bee sting”. The sound of the biopsy was like “a gun going off” or “an air rifle firing” or “a clicking noise”. Some said that the procedure was undignified and uncomfortable but not painful. A few mentioned being given a local anaesthetic. Local anaesthetic is now routinely given during the procedure.

Pain is a complex experience, which is difficult to measure. Men's discomfort may vary according to the number of samples taken. In Britain, prostate biopsies can sometimes be performed without pain relief (analgesia) or sedation. However, over the past five years there has been a growing awareness of the need to use some form of anaesthetic when taking a prostate biopsy, and most urologists now use a local anaesthetic, such as lignocaine, which is injected around the prostate through the rectal wall. A pain relieving gas, such as nitrous oxide (Entonox) may also be used if required. Additionally, some urologists offer glyceryl trinitrate paste for men with very 'tight backsides' who find insertion of the transrectal probe uncomfortable. 

In contrast to the men who experienced very little pain, a few men said they had found the biopsy extremely painful. A man who had a biopsy several years ago (in 1996) found the procedure very painful. 

A man diagnosed in 2005 said he had received an information sheet from the hospital which said that some men find the biopsy a “little unpleasant”, but he found it very painful and needed 'gas and air' (Entonox). An elderly man was told that he wouldn't feel pain but he recalled that he “broke out in a bad sweat”. He recalled that the doctor told him that the local anaesthetic hadn't had time to work. 

After the biopsy some men said that they felt a bit sore. One man said that he looked pale and felt as though he'd been 'though a bit of an experience' but went back to work that afternoon. Another man said he felt 'shaken', but two hours later felt fine. Some men passed blood in their urine or sperm for few days. Others had discomfort or slight bleeding when they opened their bowels. It is normal to see some blood in the stools or urine for up to two weeks.

More serious side effects can follow a biopsy. Occasionally men find it hard to pass urine. Infection may also occur in spite of prophylactic antibiotics. One man said he developed severe cystitis after his first biopsy. 

This man went on to have another biopsy. In total 22 samples were taken over a two week period. Afterwards he passed blood in his sperm. Although it is normal for men to find blood in the semen for up to a month or two, he did not remember being warned that this might happen. His wife said that she wished someone had advised her husband to use a condom in order to 'contain the drama'. They both said that the traumatic experience had affected their sexual relationship for months.  

One man had particular worries about the biopsy. His doctors put his mind at rest to some extent.

If the results of the biopsy indicate prostate cancer is present the consultant will discuss treatment options (see 'Choosing a treatment if prostate cancer is diagnosed' and 'Biopsy' in our prostate cancer section). If, however, cancer is not diagnosed the consultant will probably suggest an MRI to see if a repeat biopsy is needed.

Last reviewed May 2016.
Last updated May 2016.

 

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