Treatment guide
Prostate Biopsy
Also known as: MRI-targeted prostate biopsy, Transperineal prostate biopsy, Transrectal prostate biopsy
In brief
A prostate biopsy takes small samples of prostate tissue so they can be examined for cancer. It is usually recommended after a raised PSA, an abnormal examination or a suspicious MRI, and is increasingly guided by MRI to target suspicious areas.
Medically reviewed by Dr. Atip Chatsudthipong, MD on
Written by Editorial teamPublished Updated
What is a prostate biopsy?
During a prostate biopsy, a fine needle takes several thin cores of tissue from the prostate. A pathologist examines them to determine whether cancer is present and, if so, its grade (Grade Group). This information is essential for deciding whether monitoring or treatment is needed.
Why might I need a biopsy?
- A raised or rising PSA, usually after a repeat test — see Understanding your PSA test
- An abnormal digital rectal examination
- A suspicious area on prostate MRI
- Monitoring of a known low-risk cancer on active surveillance
Current AUA/SUO guidance supports the use of prostate MRI before a first biopsy where available, as it can improve detection of significant cancers and help some men avoid an unnecessary biopsy.
How is a prostate biopsy performed?
| Transperineal biopsy | Transrectal biopsy | |
|---|---|---|
| Route | Through the skin between the scrotum and anus | Through the wall of the rectum |
| Infection risk | Lower | Higher; antibiotic precautions are essential |
| Anaesthesia | Local anaesthetic or general/sedation | Usually local anaesthetic |
| Targeting | Good access to all areas, including the front of the prostate | Some areas harder to sample |
In both approaches, an ultrasound probe guides the needle. With MRI-targeted (fusion) biopsy, the MRI images are overlaid on the ultrasound so that suspicious areas can be sampled precisely, usually together with systematic samples from the rest of the gland.
How should I prepare?
- Tell your doctor about blood thinners, diabetes medication and any allergies
- A urine test may be done to exclude infection
- Antibiotics may be given, particularly for transrectal biopsy
- Follow fasting instructions if sedation or general anaesthesia is planned
- Bring previous PSA results and MRI images or reports
What are the side effects and risks?
- Blood in the urine or stool for a few days — common
- Blood in the semen, which can persist for several weeks — common and harmless
- Discomfort or bruising in the perineum
- Infection — uncommon, and less likely with the transperineal approach
- Temporary difficulty passing urine — uncommon
Seek urgent medical care after a biopsy if you have:
- Fever, chills or shivering
- Inability to pass urine
- Heavy bleeding or large clots
Are there alternatives?
Depending on your risk, alternatives may include repeating the PSA, additional blood or urine biomarkers, or MRI with continued monitoring rather than an immediate biopsy. A biopsy remains the only way to confirm a diagnosis of prostate cancer.
Prostate biopsy with Dr. Atip
Dr. Atip routinely performs MRI-fusion targeted prostate biopsy at Bumrungrad International Hospital. He reviews your MRI beforehand, explains the procedure and anaesthesia options, and discusses the results with you in person — including what they mean and the next steps.
What is recovery like, and when are results available?
Most men return to normal activities within a day or two, avoiding strenuous exercise for a few days. Results are discussed at a follow-up appointment, including whether any cancer was found, its grade and what the next steps are.
Frequently asked questions
What is an MRI-fusion prostate biopsy?
An MRI-fusion biopsy combines a prostate MRI scan with real-time ultrasound, so that suspicious areas seen on MRI can be targeted precisely. It improves the detection of clinically significant cancers compared with a standard biopsy alone.
Is a prostate biopsy painful?
Anaesthesia is used to minimise discomfort. Most men describe a brief pressure or sting with each sample. Mild soreness afterwards is usually managed with simple pain relief.
Does a biopsy spread prostate cancer?
There is no good evidence that a prostate biopsy causes cancer to spread.
What is the difference between MRI-targeted and systematic biopsy?
A systematic biopsy samples the prostate in a standard pattern. An MRI-targeted biopsy aims specifically at areas that look suspicious on MRI. Combining both is common and improves detection of clinically significant cancers.
References
- 1.Wei JT, et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part II — Considerations for a Prostate Biopsy. J Urol. 2023;210(1):54–63. (opens in a new tab)
- 2.Wei JT, et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I — Prostate Cancer Screening. J Urol. 2023;210(1):46–53. (opens in a new tab)
- 3.European Association of Urology. EAU – EANM – ESTRO – ESUR – ISUP – SIOG Guidelines on Prostate Cancer. (opens in a new tab)
- 4.National Cancer Institute. Prostate-Specific Antigen (PSA) Test. (opens in a new tab)
This information is for general education and does not replace a consultation with a qualified doctor. If you have severe symptoms, seek emergency care (in Thailand, call 1669). See our medical disclaimer.