A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. The prostate is a small, walnut-shaped gland in men that produces fluid that nourishes and transports sperm.
During a prostate biopsy a needle is used to collect a number of tissue samples from your prostate gland. The procedure is performed by a doctor who specializes in the urinary system and men's sex organs (urologist).
Your urologist may recommend a prostate biopsy if results from initial tests, such as a prostate-specific antigen (PSA) blood test or digital rectal exam, suggest you may have prostate cancer. Tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly it's likely to progress and to determine your best treatment options.
Why it's done
A prostate biopsy is used to detect prostate cancer.
Your doctor may recommend a prostate biopsy if:
A PSA test shows levels higher than normal for your age
Your doctor finds lumps or other abnormalities during a digital rectal exam
You've had a previous biopsy that was normal, but you still have elevated PSA levels
A previous biopsy revealed prostate tissue cells that were abnormal but not cancerous
Risks associated with a prostate biopsy include:
Bleeding at the biopsy site. Rectal bleeding is common after a prostate biopsy.
Blood in your semen. It's common to notice red or rust coloring in your semen after a prostate biopsy. This indicates blood, and it's not a cause for concern. Blood in your semen may persist for a few weeks after the biopsy.
Blood in your urine. This bleeding is usually minor.
Difficulty urinating. In some men, prostate biopsy can cause difficulty urinating after the procedure. Rarely, a temporary urinary catheter must be inserted.
Infection. Rarely, men who have a prostate biopsy develop an infection of the urinary tract or prostate that requires treatment with antibiotics.
How you prepare
To prepare for your prostate biopsy, your urologist may have you:
Provide a urine sample to analyze for a urinary tract infection. If you have a urinary tract infection, your prostate biopsy will likely be postponed while you take antibiotics to clear the infection.
Stop taking medication that can increase the risk of bleeding such as warfarin (Coumadin), aspirin, ibuprofen (Advil, Motrin IB, others), and certain herbal supplements for several days before the procedure.
Do a cleansing enema at home before your biopsy appointment.
Take antibiotics 30 to 60 minutes before your prostate biopsy to help prevent infection from the procedure.
What you can expect
Types of prostate biopsy procedures
Prostate biopsy samples can be collected in different ways. Your prostate biopsy may involve:
Passing the needle through the wall of the rectum (transrectal biopsy). This is the most common way of performing a prostate biopsy.
Inserting the needle through the area of skin between the anus and scrotum (transperineal biopsy). A small cut is made in the area of skin (perineum) between the anus and the scrotum. The biopsy needle is inserted through the cut and into the prostate to draw out a sample of tissue. An MRI or CT scan is generally used to guide this procedure.
What to expect during transrectal prostate biopsy
You will be asked to lie on your side with your knees pulled up to your chest. You might be asked to lie on your stomach. After cleaning the area and applying gel, your doctor will gently insert a thin ultrasound probe into your rectum.
Transrectal ultrasonography uses sound waves to create images of your prostate. Your doctor will use the images to identify the area that needs to be numbed with an injection to reduce discomfort associated with the biopsy. The ultrasound images are also used to guide the prostate biopsy needle into place.
Once the area is numbed and the biopsy device is situated, your doctor will retrieve thin, cylindrical sections of tissue with a spring-propelled needle. The procedure typically causes a very brief uncomfortable sensation each time the spring-loaded needle takes a sample.
Your doctor may target a suspicious area to biopsy or may take samples from several places in your prostate. Generally, 10 to 12 tissue samples are taken. The entire procedure usually takes about 10 minutes.
After the procedure
Your doctor will likely recommend that you do only light activities for 24 to 48 hours after your prostate biopsy.
You'll probably need to take an antibiotic for a few days. You might also:
Feel slight soreness and have some light bleeding from your rectum.
Have blood in your urine or stools for a few days.
Notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen. This can last for several weeks.
Call your doctor if you have:
Prolonged or heavy bleeding
Pain that gets worse
A doctor who specializes in diagnosing cancer and other tissue abnormalities (pathologist) will evaluate the prostate biopsy samples. The pathologist can tell if the tissue removed is cancerous and, if cancer is present, estimate how aggressive it is. Your doctor will explain the pathologist's findings to you.
Your pathology report may include:
A description of the biopsy sample. Sometimes called the gross description, this section of the report might evaluate the color and consistency of the prostate tissue.
A description of the cells. Your pathology report will describe the way the cells appear under the microscope. Prostate cancer cells may be referred to as adenocarcinoma. Sometimes the pathologist finds cells that appear abnormal but aren't cancerous. Words used to describe these noncancerous conditions include "prostatic intraepithelial neoplasia" and "atypical small acinar proliferation."
Cancer grading. If the pathologist finds cancer, it's graded on a scale of 2 to 10 called the Gleason score. Cancers with a high Gleason score are the most abnormal and are more likely to grow and spread quickly.
The pathologist's diagnosis. This section of the pathology report lists the pathologist's diagnosis. It may also include comments, such as whether other tests are recommended.
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Testicular biopsy is surgery to remove a piece of tissue from the testicles. The tissue is examined under a microscope.
How the Test is Performed
The biopsy can be done in many ways. The type of biopsy you have depends on the reason for the test. Your health care provider will talk to you about your options.
Open biopsy may be done in the provider's office, a surgical center, or at a hospital. The skin over the testicle is cleaned with a germ-killing (antiseptic) medicine. The area around it is covered with a sterile towel. A local anesthetic is given to numb the area.
A small surgical cut is made through the skin. A small piece of the testicle tissue is removed. The opening in the testicle is closed with a stich. Another stitch closes the cut in the skin. The procedure is repeated for the other testicle if necessary.
Needle biopsy is most often done in the provider's office. The area is cleaned and local anesthesia is used, just as in the open biopsy. A sample of the testicle is taken using a special needle. The procedure does not require a cut in the skin.
Depending on the reason for the test, a needle biopsy may not be possible or recommended.
How to Prepare for the Test
Your provider may tell you not to take aspirin or medicines that contain aspirin for 1 week before the procedure. Always ask your provider before stopping any medicines.
How the Test will Feel
There will be a sting when the anesthetic is given. You should only feel pressure or discomfort similar to a pinprick during the biopsy.
Why the Test is Performed
The test is most often done to find the cause of male infertility. It is done when a semen analysis suggests that there is abnormal sperm and other tests have not found the cause. In some cases, sperm obtained from a testicular biopsy can be used to fertilize a woman's egg in the lab. This process is called in vitro fertilization.
Testicular biopsy may also be done if you have found a lump during testicular self-examination. If tests such as testicular ultrasound suggest that the lump may be in the testicle, surgery may be needed to look at the testicle more closely.
A biopsy to determine whether the lump is cancerous or noncancerous (benign) may be done. If cancer is found or suspected, the entire testicle is removed.
Sperm development appears normal. No cancerous cells are found.
What Abnormal Results Mean
Abnormal results may mean a problem with sperm or hormone function. Biopsy may be able to find the cause of the problem.
In some cases, the sperm development appears normal in the testicle, but semen analysis shows no sperm or reduced sperm. This may indicate a blockage of the tube through which the sperm travel from the testes to the urethra. This blockage can sometimes be repaired with surgery.
Other causes of abnormal results:
A cyst-like lump filled with fluid and dead sperm cells (spermatocele)
Your provider will explain and discuss all abnormal results with you.
There is a slight risk for bleeding or infection. The area may be sore for 2 to 3 days after the biopsy. The scrotum may swell or become discolored. This should clear up within a few days.
Your provider may suggest that you wear an athletic supporter for several days after the biopsy. In most cases, you will need to avoid sexual activity for 1 to 2 weeks.
Using a cold pack on and off for the first 24 hours may lessen the swelling and discomfort.
Keep the area dry for several days after the procedure.
Continue to avoid using aspirin or medicines that contain aspirin for 1 week after the procedure.
A lymph node biopsy is the removal of lymph node tissue for examination under a microscope.
The lymph nodes are small glands that make white blood cells (lymphocytes), which fight infection. Lymph nodes may trap the germs that are causing an infection. Cancer can spread to lymph nodes.
How the Test is Performed
A lymph node biopsy is done in an operating room in a hospital or at an outpatient surgical center. The biopsy may be done in different ways.
An open biopsy is surgery to remove all or part of the lymph node. This is usually done if there is a lymph node that can be felt on exam. This can be done with local anesthesia (numbing medicine) injected into the area, or under general anesthesia. The procedure is typically done in the following way:
-You lie on the examination table. You may be given medicine to calm you and make you sleepy or you may have general anesthesia, which means you are asleep and pain-free.
-The biopsy site is cleansed.
-A small surgical cut (incision) is made. The lymph node or part of the node is removed.
-The incision is closed with stitches and a bandage or liquid adhesive is applied.
-An open biopsy may take 30 to 45 minutes.
For some cancers, a special way of finding the best lymph node to biopsy is used. This is called sentinel lymph node biopsy, and it involves:
A tiny amount of a tracer, either a radioactive tracer (radioisotope) or a blue dye or both, is injected at the tumor site.The tracer or dye flows into the nearest (local) node or nodes. These nodes are called the sentinel nodes. The sentinel nodes are the first lymph nodes to which a cancer may spread.The sentinel node or nodes are removed.
Lymph node biopsies in the belly may be removed with a laparoscope. This is a small tube with a light and camera that is inserted through a small incision in the abdomen. One or more other incisions will be made and tools will be inserted to help remove the node. The lymph node is located and a piece of it is removed. This is usually performed under general anesthesia, which means the person having this procedure will be asleep and pain-free.After the sample is removed, it is sent to the laboratory for examination.A needle biopsy involves inserting a needle into a lymph node. This type of biopsy is done less often because the results are not as helpful as with an open biopsy.
How to Prepare for the Test
Tell your provider:
-If you are pregnant
-If you have any drug allergies
-If you have bleeding problems
-What medicines you are taking (including any supplements or herbal remedies)
Your provider may ask you to:
-Stop taking any blood thinners, such as aspirin, heparin, warfarin (Coumadin), or clopidogrel (Plavix) as directed
-Not eat or drink anything after a certain period of time before the biopsy
-Arrive at a certain time for the procedure
How the Test will Feel
When the local anesthetic is injected, you will feel a prick and a mild stinging. The biopsy site will be sore for a few days after the test.
After an open or laparoscopic biopsy, the pain is mild and you can easily control it with an over-the-counter pain medicine. You may also notice some bruising or fluid leaking for a few days. Follow instructions for taking care of the incision. While the incision is healing, avoid any type of intense exercise or heavy lifting that causes pain or discomfort. Ask your provider for specific instructions about what activities you can do.
Why the Test is Performed
The test is used to diagnose cancer, sarcoidosis, or an infection (such as tuberculosis):
-When you or your provider feel swollen glands and they do not go away
-When abnormal lymph nodes are present on a CT or MRI scan
-For some people with breast cancer or melanoma, to see if the cancer has spread (sentinel lymph node biopsy)
The results of the biopsy help your provider decide on further tests and treatments.
If a lymph node biopsy does not show any signs of cancer, it is more likely that other lymph nodes nearby are also cancer-free. This information can help the provider decide about further tests and treatments.
What Abnormal Results Mean
Abnormal results may be due to many different conditions, from very mild infections to cancer.
For example, enlarged lymph nodes may be due to:
-Cancers (breast, lung, oral)
-Cancer of the lymph tissue (Hodgkin or non-Hodgkin lymphoma)
-Infection (tuberculosis, cat scratch disease)
-Inflammation of lymph nodes and other organs and tissues (sarcoidosis)
Lymph node biopsy may result in any of the following:
-Infection (in rare cases, the wound may get infected and you may need to take antibiotics)
-Nerve injury if the biopsy is done on a lymph node close to nerves (the numbness usually goes away in a few months)
A liver biopsy is a procedure to remove a small piece of liver tissue, so it can be examined under a microscope for signs of damage or disease. Your doctor may recommend a liver biopsy if blood tests or imaging studies suggest you might have a liver problem. A liver biopsy is also used to determine the severity of liver disease. This information helps guide treatment decisions.
The most common type of liver biopsy is called percutaneous liver biopsy. It involves inserting a thin needle through your abdomen into the liver and removing a small piece of tissue. Two other types of liver biopsy one using a vein in the neck (transjugular) and the other using a small abdominal incision (laparoscopic) also remove liver tissue with a needle.
Why it's done
A liver biopsy may be done to:
Diagnose a liver problem that can't be otherwise identified
Obtain a sample of tissue from an abnormality found by an imaging study
Determine the severity of liver disease a process called staging
Help develop treatment plans based on the liver's condition
Determine how well treatment for liver disease is working
Monitor the liver after a liver transplant
Your doctor may recommend a liver biopsy if you have:
Abnormal liver test results that can't be explained
A mass (tumor) or other abnormalities on your liver as seen on imaging tests
Ongoing, unexplained fevers
A liver biopsy also is commonly performed to help diagnose and stage certain liver diseases, including:
Nonalcoholic fatty liver disease
Chronic hepatitis B or C
Alcoholic liver disease
Primary biliary cirrhosis
Primary sclerosing cholangitis
A liver biopsy is a safe procedure when performed by an experienced doctor. Possible risks include:
Pain. Pain at the biopsy site is the most common complication after a liver biopsy. Pain after a liver biopsy is usually a mild discomfort. If pain makes you uncomfortable, you may be given a narcotic pain medication, such as acetaminophen with codeine (Tylenol with Codeine).
Bleeding. Bleeding can occur after a liver biopsy. Excessive bleeding may require you to be hospitalized for a blood transfusion or surgery to stop the bleeding.
Infection. Rarely, bacteria may enter the abdominal cavity or bloodstream.
Accidental injury to a nearby organ. In rare instances, the needle may stick another internal organ, such as the gallbladder or a lung, during a liver biopsy.
In a transjugular procedure, a thin tube is inserted through a large vein in your neck and passed down into the vein that runs through your liver. If you have a transjugular liver biopsy, other infrequent risks include:
Collection of blood (hematoma) in the neck. Blood may pool around the site where the catheter was inserted, potentially causing pain and swelling.
Temporary problems with the facial nerves. Rarely, the transjugular procedure can injure nerves and affect the face and eyes, causing short-term problems, such as a drooping eyelid.
Temporary voice problems. You may be hoarse, have a weak voice or lose your voice for a short time.
Puncture of the lung. If the needle accidentally sticks your lung, the result may be a collapsed lung (pneumothorax).
How you prepare
Before your liver biopsy, you'll meet with your doctor to talk about what to expect during the biopsy. This is a good time to ask questions about the procedure and make sure you understand the risks and benefits.
Stop taking certain medications
When you meet with your doctor, bring a list of all medications you take, including over-the-counter medications, vitamins and herbal supplements. Before your liver biopsy, you'll likely be asked to stop taking medications and supplements that can increase the risk of bleeding, including:
Aspirin, ibuprofen (Advil, Motrin IB, others) and certain other pain relievers
Blood-thinning medications (anticoagulants), such as warfarin (Coumadin)
Certain dietary supplements that may increase risk of uncontrolled bleeding
Your doctor or nurse will let you know if you need to temporarily avoid any of your other medications.
Undergo blood tests
Before your biopsy, you'll have a blood test to check your blood's ability to clot. If you have blood-clotting problems, you may be given a medication before your biopsy to reduce the risk of bleeding.
Stop eating and drinking before the procedure
You may be asked not to drink or eat for six to eight hours before the liver biopsy. Some people can eat a light breakfast.
Prepare for your recovery
You may receive a sedative before your liver biopsy. If this is the case, arrange for someone to drive you home after the procedure. Have someone stay with you or check on you during the first night. Many doctors recommend that people spend the first evening within an hour's driving distance of the hospital where the biopsy is done, in case a complication develops.
What you can expect
What you can expect during your liver biopsy will depend on the type of procedure you'll undergo. A percutaneous liver biopsy is the most common type of liver biopsy, but it isn't an option for everyone. Your doctor may recommend a different form of liver biopsy if you:
Could have trouble holding still during the procedure
Have a history of or likelihood of bleeding problems or blood-clotting disorders
Might have a tumor involving blood vessels in your liver
Have an abnormal amount of fluid in your abdomen (ascites)
Are very obese
Have a liver infection
Before the procedure
A liver biopsy is done at a hospital or outpatient center. You'll likely arrive early in the morning. Your health care team will review your medical history, including the medications you take.
Just before your biopsy you will:
Have an IV line placed, usually into a vein in your arm, so that you can be given medications if you need them
Possibly be given a sedative to help you relax during the procedure
Use the toilet if needed because you'll need to remain in bed for a few hours after the procedure
During the procedure
The steps involved in liver biopsy vary according to the type:
Percutaneous biopsy. To begin your procedure, your doctor will locate your liver by tapping on your abdomen or using ultrasound images. In certain situations, ultrasound might be used during the biopsy to guide the needle into your liver. You'll lie on your back and position your right hand above your head on the table. Your doctor will apply a numbing medication to the area where the needle will be inserted. The doctor then makes a small incision near the bottom of your rib cage on your right side and inserts the biopsy needle. The biopsy itself takes just a few seconds. As the needle passes quickly in and out of your liver, you'll be asked to hold your breath.
Transjugular biopsy. You'll lie on your back on an X-ray table. Your doctor applies a numbing medication to one side of your neck, makes a small incision and inserts a flexible plastic tube into your jugular vein. The tube is threaded down the jugular vein and into the large vein in your liver (hepatic vein). Your doctor then injects a contrast dye into the tube and makes a series of X-ray images. The dye shows up on the images, allowing the doctor to see the hepatic vein. A biopsy needle is then threaded through the tube, and one or more liver samples are removed. The catheter is carefully removed, and the incision on your neck is covered with a bandage.
Laparoscopic biopsy. During a laparoscopic biopsy, you'll likely receive general anesthetics. You'll be positioned on your back on an operating table and your doctor will make one or more small incisions in your abdomen. Special tools are inserted through the incisions, including a tiny video camera that projects images on a monitor in the operating room. The doctor uses the video images to guide the tools to the liver to remove tissue samples. The tools are removed and the incisions are closed with stitches.
After the procedure
After the biopsy, you can expect to:
Be taken to a recovery room, where a nurse will monitor your blood pressure, pulse and breathing
Rest quietly for two to four hours, or longer if you had a transjugular procedure
Feel some soreness where the needle was inserted, which may last as long as a week
Have someone drive you home, since you won't be able to drive until the sedative wears off
Avoid lifting more than 10 to 15 pounds for one week
Be able to get back to your usual activities gradually over a period of a week
Your liver tissue goes to a laboratory to be examined by a doctor who specializes in diagnosing disease (pathologist). The pathologist will look for signs of disease and damage to the liver. Your biopsy report should come back from the pathology lab within a few days to a week.
At a follow-up visit, your doctor will explain the results. You may be diagnosed with a liver disease, or your liver disease may be given a stage or grade number based on the severity mild, moderate or severe. Your doctor will discuss what treatment, if any, you need.
What is an ultrasound?
An ultrasound scan is a medical test that uses high-frequency sound waves to capture live images from the inside of your body. It’s also known as sonography.
The technology is similar to that used by sonar and radar, which help the military detect planes and ships. An ultrasound allows your doctor to see problems with organs, vessels, and tissues without needing to make an incision.
Unlike other imaging techniques, ultrasound uses no radiation. For this reason, it’s the preferred method for viewing a developing fetus during pregnancy.
Why an ultrasound is performed?
Most people associate ultrasound scans with pregnancy. These scans can provide an expectant mother with the first view of her unborn child. However, the test has many other uses.
Your doctor may order an ultrasound if you’re having pain, swelling, or other symptoms that require an internal view of your organs. An ultrasound can provide a view of the:
brain (in infants)
An ultrasound is also a helpful way to guide surgeons’ movements during certain medical procedures, such as biopsies.
How to prepare for an ultrasound?
The steps you will take to prepare for an ultrasound will depend on the area or organ that is being examined.
Your doctor may tell you to fast for eight to 12 hours before your ultrasound, especially if your abdomen is being examined. Undigested food can block the sound waves, making it difficult for the technician to get a clear picture.
For an examination of the gallbladder, liver, pancreas, or spleen, you may be told to eat a fat-free meal the evening before your test and then to fast until the procedure. However, you can continue to drink water and take any medications as instructed. For other examinations, you may be asked to drink a lot of water and to hold your urine so that your bladder is full and better visualized.
Be sure to tell your doctor about any prescription drugs, over-the-counter medications, or herbal supplements that you take before the exam.
It’s important to follow your doctor’s instructions and ask any questions you may have before the procedure.
An ultrasound carries minimal risks. Unlike X-rays or CT scans, ultrasounds use no radiation. For this reason, they are the preferred method for examining a developing fetus during pregnancy.
How an ultrasound is performed?
Before the exam, you will change into a hospital gown. You will most likely be lying down on a table with a section of your body exposed for the test.
An ultrasound technician, called a sonographer, will apply a special lubricating jelly to your skin. This prevents friction so they can rub the ultrasound transducer on your skin. The transducer has a similar appearance to a microphone. The jelly also helps transmit the sound waves.
The transducer sends high-frequency sound waves through your body. The waves echo as they hit a dense object, such as an organ or bone. Those echoes are then reflected back into a computer. The sound waves are at too high of a pitch for the human ear to hear. They form a picture that can be interpreted by the doctor.
Depending on the area being examined, you may need to change positions so the technician can have better access.
After the procedure, the gel will be cleaned off of your skin. The whole procedure typically lasts less than 30 minutes, depending on the area being examined. You will be free to go about your normal activities after the procedure has finished.
After an ultrasound
Following the exam, your doctor will review the images and check for any abnormalities. They will call you to discuss the findings, or to schedule a follow-up appointment. Should anything abnormal turn up on the ultrasound, you may need to undergo other diagnostic techniques, such as a CT scan, MRI, or a biopsy sample of tissue depending on the area examined. If your doctor is able to make a diagnosis of your condition based on your ultrasound, they may begin your treatment immediately.