The Prostatitis Foundation

Needle Biopsy


If your doctor has reason to suspect you may have prostate cancer, a biopsy may be called for. In this procedure, a rectally-inserted device inserts a needle through the intestinal wall into your prostate gland to gather cell samples. Usually the needle is placed in a number of locations, hoping to get a sample of any cancer cells which are there. Want some contrasting viewpoints?
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The cells are then examined in the laboratory. If any cancer cells are found, the biopsy was definitely worth it, because then your doctors can proceed to try to help you find the cancer. However, if no cancer cells are found, you're still in the dark about whether you have cancer. You could have a small area of cancer cells that was not located where the needle went, and so you have recieved a "false negative."

The risks of biopsy are several, and biopsy should not be done without good reason. One, the needle, in passing through the intestinal wall, can carry bacteria deep into your prostate gland, actually causing or worsening prostatitis. Two, the needle causes scarring in the prostate tissue. Sometimes there is blood in urine or semen after a biopsy.

Whether to have a needle biopsy or not is one of those decisions that have pluses and minuses. You and your doctor need to decide together. In all medical decisions, it's your right as a patient to have full information, and to understand and agree to the decision fully before anything is done.

See also the biopsy complications abstract...

Doctor's comments on biopsy:

Doctor Comment: All links have unfortunately expired.

Dr. Brad HennenfentI would like to suggest that if anyone has a biopsy, they have it transperineal not transrectal, and that one should only have a biopsy if PCR analysis is going to be done.

David L. Casey, MDExperience with TRUS and biopsy for elevated PSA/ abnormal DRE suggests that the rate of positive biopsy drops way off after the 3rd biopsy or so. This means that the first two biopsies are the most likely to demonstrate cancer if it is there, and the third has a lower yet still significant rate of detection. Subsequent biopsies are very frequently negative, and as such, probably are not likely to be helpful unless there is some major change in the clinical scenario--i.e. sudden PSA rise or new nodule development.

Russell L. Kerschmann, M.D.On rare occasion, prostatic enlargement clinically diagnosed as typical acute prostatitis will prove unresponsive to therapy and a biopsy will be performed. Parks, report one such case where the pathologic diagnosis was nonHodgkin's lymphoma confined to the prostate.

Dr. Brad HennenfentIn a study of 1,687 transrectal biopsies 71 patients developed fever within 10 days, 6 were so ill they were admitted for intravenous antibiotics, three had signs of sepsis, 1 had sepsis and shock, three others had signs of both bladder infection and prostatitis. About 50% of men get bloody semen after biopsy, about 25% of men have bloody urine after biopsy, most of the last two usually resolving but permanent cases of bloody semen and bloody urine have occurred. About 1% of men, maybe less, suffer acute urinary retention, and as one follower of the newsgroup noted his father ended up permanently catheterized after his biopsy. Side effects of biopsy are made worse by the fact that many men have no symptoms at all prior to biopsy. Reference: Rietbergen JBW, Kruger AEB, Kranse R, Schroder FH: Complications of transrectal ultrasound-guided systematic sextant biopsies of the prostate: evaluation of complication rates and risk factors within a populatin-based screening program. UROLOGY 1997;49:875-880.

David L. Casey, MDInfectious complications from TRUS/biopsy for evaluation of an elevated PSA are rare...maybe 1-2% occurrence...certainly not USUAL.

Antonio Novak Feliciano, M.D., F.P.C.S.

An enlarged prostate may be due to chronic prostatitis (in most cases), benign prostatic hyperplasia (complication of chronic prostatitis?), and cancer of the prostate.

Before a biopsy is done to rule out cancer of the prostate, the other two conditions must first be ruled out. There are some patients who have undergone repeated biopsies of the prostate even after negative results. Many of these patients turn out to be BPH and/or chronic prostatitis. Most of these cases have elevated PSA, which is not diagnostic of cancer.

PSA may also be elevated in C.P.

Cancer of the prostate may be felt as a localized indurated mass in the prostate by DRE. and ultrasound cannot distinguish cancer in most cases. BPH is usually felt as a uniform hard mass affecting the entire palpated prostate, while in C.P. the prostate is soft and boggy, which a massage may drain and shrink the prostate.

You should get another opinion from a urologist.


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