Prostate biopsy

About transrectal ultrasound-guided prostate biopsy

A transrectal ultrasound-guided prostate biopsy is a procedure in which small samples of tissue are taken from your prostate gland. Your prostate is about the size of a walnut and lies at the base of your bladder. The back of your prostate presses against your rectum (back passage) and the front of your prostate surrounds your urethra (the tube that carries urine from your bladder and out through your penis).

Your doctor may recommend that you have a prostate biopsy to check for cancer if other tests show that you have a raised level of prostate-specific antigen (PSA) in your blood. PSA is a protein made by your prostate gland and having a raised PSA level can be a sign of prostate cancer or other conditions including inflammation of your prostate. Your doctor may also recommend you having a prostate biopsy because you have an enlarged prostate gland.

What are the alternatives to transrectal ultrasound-guided prostate biopsy?

An alternative to transrectal ultrasound-guided prostate biopsy is a transperineal prostate biopsy. This is carried out under general or spinal anaesthesia. In this procedure, your doctor will insert biopsy needles through the skin of the area between your testicles and rectum (your perineum). This is carried out under ultrasound guidance, using an ultrasound probe inserted into your rectum.

Preparing for your transrectal ultrasound-guided prostate biopsy

Transrectal ultrasound-guided prostate biopsy is routinely done in hospital as a day-case procedure. This means you have the procedure and go home the same day.

You will be given a local anaesthetic to ease any discomfort you may feel. This will completely block pain in your rectal area and you will stay awake during the procedure.

Usually, you can eat or drink as normal before having a prostate biopsy. If you take medicines to prevent blood clots (anticoagulants), such as warfarin, aspirin or clopidogrel, these could increase your risk of bleeding after the procedure. You may be asked to stop taking them before having your biopsy, but you will need to discuss the risks and benefits of this with your doctor carrying out the biopsy and the doctor who prescribed you the anticoagulant. If you’re unsure about taking any of your medicines, please contact the hospital.

It’s not recommended to have an enema (where liquid is injected into your rectum to empty your bowel) before the biopsy because no benefit has been found in having one. However, you will be given antibiotics before the biopsy to help prevent an infection. You may also be prescribed antibiotics to take for a few days after the procedure. It’s important that you complete any course of antibiotics you’re prescribed. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain relief you might need. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a transrectal ultrasound-guided prostate biopsy?

The procedure usually takes 10 to 15 minutes.

You will be asked to change into a hospital gown that opens at the back. You will need to lie down on your left side with your back to your doctor and your knees drawn up towards your chest.

Your doctor will carefully pass a lubricated ultrasound sensor through your anus and into your rectum. The sensor will be covered with a condom, therefore, let your doctor know beforehand if you’re allergic to latex so that a suitable alternative can be used. The sensor may feel uncomfortable but shouldn't be painful. Images of your prostate will be displayed on a monitor.

Your doctor will use these ultrasound images to look at your prostate. They will also help to guide him or her while taking biopsies of your prostate through the wall of your rectum.

Your doctor will pass a special port that contains biopsy needles down the shaft of the ultrasound sensor. The needles are used to collect about 10 to 12 samples of prostate tissue. The biopsy port has a trigger that will make a loud noise each time it’s fired, so you need to be prepared for this. Try to keep still during the procedure as this will help to ensure you won’t need a repeat procedure later. You may find having the biopsies taken is slightly uncomfortable or painful. After the procedure, your tissue samples will be sent to a laboratory for testing.

What to expect afterwards

You will usually need to stay at the hospital for at least 30 minutes after your biopsy to make sure you have made a good recovery. You will be asked to pass urine before you go home. You will be given a course of antibiotics to take and a date for a follow-up appointment.

It’s recommended that you arrange for someone to drive you home because you may be feeling a little uncomfortable after your procedure, which could distract you from driving.

Your results will be ready within about two weeks and will usually be sent in a report to the doctor who requested your biopsy. He or she will review the results and discuss them with you at your follow-up appointment.

Recovering from a transrectal ultrasound-guided prostate biopsy

If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Take it easy for the rest of the day. Try to drink enough fluids to help flush out any possible infection. It's common to have some blood in your urine, faeces and semen for several weeks afterwards.

It's important that you complete your course of antibiotics to try to prevent infection. However, you may still develop one so it’s important to contact your GP if you have:

  • severe pain or pain that lasts for more than 48 hours
  • difficulty in passing urine
  • a burning sensation on passing urine or if your urine starts to smell
  • increasing amounts of blood in your urine or faeces
  • a high temperature

What are the risks?

As with every procedure, there are some risks associated with transrectal ultrasound-guided prostate biopsy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.


These are the unwanted but mostly temporary effects of a successful procedure.

Common side-effects of prostate biopsy include:

  • some pain in your rectal area
  • blood-stained urine or faeces – this can last up to a week or two
  • blood-stained or discoloured semen – this may last for six weeks


This is when problems occur during or after the procedure. Most men are not affected. Complications include those listed below.

  • Your biopsy may need to be repeated because the samples are of poor quality or because your PSA levels continue to rise even though your initial biopsy shows no cancer. As many as two in 10 men will have prostate cancer that is missed in their first biopsy.
  • An infection. This may be caused when the biopsy needles pierce your rectal wall and bacteria from your bowel get into your urethra or bloodstream. Your doctor will prescribe you antibiotics to treat the infection.
  • Difficulty in passing urine. This can happen because of a blockage in your urethra caused by a blood clot or because your prostate is swollen. If you have difficulty passing urine after your biopsy, you will need to urgently go to hospital for treatment.

Why might I need to have a transrectal ultrasound-guided prostate biopsy?


If tests show that you have raised level of prostate-specific antigen (PSA) in your blood and an enlarged prostate gland, your doctor may recommend that you have a transrectal ultrasound-guided prostate biopsy to see whether or not you have prostate cancer.


Before recommending a transrectal ultrasound-guided prostate biopsy, your doctor is likely to do two tests. The first of these is a blood test to find out your PSA level. PSA is a protein that is made by both healthy and cancerous prostate cells. If you have a high level of PSA, it may indicate that you have prostate cancer. However, a high PSA level doesn't always mean that you have cancer. More often it’s caused by other, less serious prostate diseases and infections.

The second test is a digital rectal examination to check the size of your prostate. This involves your doctor inserting a gloved finger into your rectum to feel your prostate through your rectal wall. If your doctor thinks it’s harder than usual or knobbly, he or she may recommend that you have a transrectal ultrasound-guided biopsy.

As well as the results of these tests, your doctor will take into consideration other things that may increase your risk of prostate cancer. These include:

  • being over 50
  • having close relatives who have had prostate cancer
  • several women in your family who have had breast cancer – you may have inherited a faulty gene, which may increase your risk of prostate cancer
  • being African-Caribbean or African-American
  • eating a diet that is high in fat, meat and dairy products

If you’re concerned about prostate cancer, see your GP.

How accurate is a transrectal ultrasound-guided prostate biopsy?


Some men who have had a transrectal ultrasound-guided prostate biopsy that didn’t find prostate cancer are diagnosed with the disease in a repeat biopsy.


A transrectal ultrasound-guided prostate biopsy can sometimes miss cancers that are present in your prostate gland.

During the procedure, your doctor will take about 10 to 12 samples to see if you have cancer and if so, how much of your prostate is affected. It’s important to remember that a negative biopsy result means that the test didn’t find a cancer in the biopsy samples, rather than that no cancer is present at all. There could be a small cancer that the needles didn't reach.

Equally, a biopsy may pick up a slow growing cancer that wouldn’t cause you problems in your lifetime. Finding out that you have this type of prostate cancer may not benefit you and treatments you may be offered can have side-effects. These side-effects may, for some men, be worse than the effects of the cancer itself. It’s your decision whether to go ahead and have a biopsy done, so it’s important to discuss your options with your doctor first.

If your transrectal ultrasound-guided prostate biopsy doesn’t find a cancer, your doctor may continue to monitor your prostate with further prostate specific antigen (PSA) tests.

How soon can I resume exercise, such as golf, swimming and going to the gym, after having a transrectal ultrasound-guided prostate biopsy?


Transrectal ultrasound-guided prostate biopsy is a commonly performed procedure that won’t affect your ability to do most sports.


You may have a little pain and discomfort in your rectal area after having a transrectal ultrasound-guided prostate biopsy, so you may want to take it easy for a couple of days afterwards and not do sports straight away. Cycling and lifting heavy weights may be more uncomfortable and could cause any bleeding to continue for longer, so it may be best to do other exercises instead. Golf and swimming are unlikely to put any pressure on your prostate gland or rectal area so you can do these exercises as soon as you feel able.

If you have more pain or bleeding after exercising, see your GP.