Prostate Biopsy

A prostate biopsy is a short, focused procedure that helps your doctor determine if you have clinically significant prostate cancer.

During the biopsy, your urologist removes tiny tissue samples, called cores, from the prostate. A pathologist studies those cores under the microscope and assigns a grade that guides your next steps.

Prostate biopsies are available in the Charlotte, NC and West Columbia, SC areas.

Most men reach the biopsy step after an elevated PSA blood test, an abnormal digital rectal exam (DRE), or both.

Doctors may also order a multiparametric MRI first. MRI can do two helpful things:

• It may show that your risk is low enough to delay or avoid a biopsy
• If a biopsy is needed, it highlights the spots most likely to harbor significant cancer so your doctor can target them precisely

If an MRI reveals a problem area, your urologist will usually take targeted samples from that spot. They will also collect systematic samples from standard zones throughout the gland. That combination reduces the chance of missing something important.

There are two common routes to the prostate. Your doctor will recommend the approach that best fits your anatomy and MRI findings.

Transrectal (TRUS) prostate biopsy

For this procedure, an ultrasound probe is placed in the rectum to visualize the prostate. The biopsy needle passes through the rectal wall into the prostate. This has been the most common approach for many years.

Transperineal (TP) prostate biopsy

For this procedure, the ultrasound probe still sits in the rectum for imaging. The needles pass through the skin between the scrotum and anus, called the perineum, instead of the rectum. Some doctors favor TP because it reduces infection risk since the needle doesn’t pass through the rectal wall.

Sometimes, in cases with rising PSA and prior negative biopsies, your doctor may recommend a saturation biopsy. This means taking a larger number of samples to improve cancer detection.

You’ll change into a gown and usually lie on your side with knees gently bent. Most procedures take 15 to 30 minutes.

The ultrasound probe is placed in the rectum for real-time imaging, and your doctor injects a local anesthetic to numb the prostate.

Each core is obtained with a spring-loaded device that clicks as samples are taken. A first-time biopsy often includes 12 or more cores, plus extra targeted cores if an MRI lesion is present. Most men report pressure from the probe and brief pinches during the procedure.

You’ll be able to walk around the house, but plan for a quiet day. Drink fluids, and avoid strenuous exercise, heavy lifting, cycling, and sexual activity until your doctor says it’s okay.

You may notice:

• Blood in the urine for a day or two
• Spotting from the rectum, which is more common after a transrectal biopsy
• Blood-tinged semen, called hematospermia, is often the most noticeable change. It’s harmless and typically fades over several weeks.
• Temporary difficulty urinating due to swelling

Call your doctor right away for:

• Fever
• Chills
• Inability to urinate
• Heavy bleeding
• Worsening pain

A pathologist studies the samples and sends a detailed report to your urologist, usually within about a week. The results fall into one of a few broad categories:

• Negative, meaning no cancer is found. Your follow-up plan will depend on imaging results, how your PSA trends, and your personal risk factors.
• Atypical or suspicious means cells look concerning but not definitively cancerous. Your doctor may recommend additional testing or a repeat biopsy.
• Positive for cancer. The report includes a Gleason score or Grade Group 1-5. Combined with PSA and MRI stage, this helps determine whether close monitoring or treatment is the best fit.

A prostate biopsy is short and safe, and advanced imaging makes it more accurate than ever. Our specialists are here to walk you through each step so you feel informed and prepared.

1. Will a biopsy affect my erections or sex life long-term?

A standard biopsy does not damage the nerves responsible for erections. Temporary blood in the semen is common for a few weeks and can be surprising, but it’s harmless. Most men resume sexual activity once spotting settles and they feel comfortable, often after a week.

2. Can a biopsy spread prostate cancer?

With modern techniques and needles, tumor seeding is very rare. The route, needle design, and the tiny caliber of the cores are designed so that the benefits far outweigh the risks.

3. When can I work out or travel after a biopsy?

Most men feel up to light activity the same day and regular desk work the next day. Wait a couple of days before strenuous exercise. If you’re planning to fly, it’s reasonable to give yourself a couple of days and avoid heavy luggage.

4. Where can I schedule a consultation?

Consultations are offered in Concord, Denver, Fort Mill, Gastonia, Huntersville, Mint Hill, Mooresville, Pineville, Rock Hill, Shelby, and West Columbia.

5. How do I get started? 

Schedule an appointment online.

Consultations for Prostate Biopsies are available with all of our providers.