BPH

Prostate Biopsy: Risks and Side Effects

Prostate cancer is the most common cancer in men.

It affects one in three American men during their lifetime. By the age of 50, many men start to get screened, usually undergoing a PSA test.

During this screening, if it seems that an individual has the possibility of cancer, a biopsy is recommended.

This is to confirm whether cancer is present, as to make a prostate cancer diagnosis and determine the aggressiveness of the disease.

But, mounting evidence suggests that biopsies have many dangerous and unpleasant side effects.

This article will discuss the safety of undergoing a prostate biopsy and the 5 side effects that could affect your quality of life.

What is a prostate biopsy?

A prostate biopsy is a procedure used to detect prostate cancer. Small samples of the prostate are removed and then observed under the microscope.

Doctors usually recommend a biopsy of your prostate gland based on certain findings. One is if your prostate-specific antigen (PSA) blood test results are higher than average for your age.

Another is if your doctor detects signs of a prostate problem during your digital rectal exam (DRE). Although the PSA and DRE or show a possible problem with your prostate, a biopsy is needed to confirm if it’s cancer.

A prostate biopsy involves:

  • Collecting minute samples of the prostate gland. The doctor passes a needle through the rectal wall or makes a small cut in the area between the anus and rectum to obtain the samples. A CT or MRI scan is also used to guide them through the procedure.
  • A prostate biopsy takes about 10 minutes and is usually done in the doctor’s office. The samples will be sent to a lab and will be looked at under a microscope to see if they contain cancer cells.
  • If cancer is detected in the patient, it will also be assigned a grade. The results are available after 1 to 3 days, but it can sometimes take longer.

Side effects of a prostate biopsy

Although one of the most common procedures for detecting prostate cancer, biopsies carry many potential risks and complications which we will discuss below.

1) Bleeding

Just like any invasive procedure, bleeding will occur. It’s normal to see a small amount of blood in your semen or urine for about two weeks. However, it becomes a significant problem if bleeding takes a long time or if it gets worse.

One study reviewed the safety of transrectal ultrasound-guided needle biopsy. It found that 58 patients (63%) experienced haematuria and experienced rectal bleeding 23 patients (25%).

Severe rectal bleeding is an uncommon complication yet in some instances can be life-threatening. So, both patients and practitioners should be aware of the risks.

2) Pain

After the biopsy, it is highly common for patients to experience discomfort and pain. This usually only lasts for a few days after the procedure, but the degree of pain will vary for each individual.

While some may find it very painful, other people only report a slight discomfort. This is because of the injury caused by the needle on your prostate cells.

A prospective cohort study measured the short-term outcomes of men undergoing a prostate biopsy. The participants were asked to complete a questionnaire, measuring the frequency and effect of symptoms related to pain, infection, and bleeding.

The results found that pain was reported by 43.6%, fever by 17.5%, haematuria (blood in urine) by 65.8%, hematochezia (anal bleeding) by 36.8%, and haemoejaculate (the presence of blood in a man’s ejaculate) by 92.6%)men during the 35 days after a biopsy.

Although the researchers concluded that most men well tolerate prostate biopsy, it is associated with significant symptoms in the minority and affects attitudes to repeat biopsy.

Pain is a very important symptom to monitor. Worsening and persistent pain may indicate a bigger problem. If this is the case, you need to see your doctor for a follow-up.

3) Infection

A further risk of having a prostate biopsy is an infection. Surgeons will usually prescribe strong antibiotics to reduce the risk of infection. However, infection almost always occurs.

Research indicates that resistance to antibiotics is increasing the likelihood. In some cases, the result of the infection is that there is long-term sexual dysfunction.

Occasionally, these infections can turn into life-threatening sepsis. This is as needles used to detect cancer are passed through the rectum.

As a result, if the needles transport bacteria from the bowel into the prostate, bladder, and the bloodstream, an infection can occur.

A study by John Hopkins researchers was published in The Journal of Urology. It found that men hospitalized as a result of a biopsy-related infection had a 12-fold higher chance of dying than those who did not undergo a biopsy.

4) Acute urine retention

The procedure does injure the prostate gland, causing it to swell. And this makes it hard for you to pass urine.

If the prostate is particularly enlarged (>50mL) or the man has pre-existing risk factors, e.g., a poor flow, a high residual volume or previous urinary retention, then the risks of biopsy-induced urinary retention are significant.

Acute urine retention is a medical emergency, and you need to seek help at once. The doctor often inserts a catheter to drain the retained urine, and it will take a few days for you to recover.

5) Sexual problems

Several studies have found that men develop erectile dysfunction after having a prostate biopsy. In 2015, BJUI International published a study involving 220 men who underwent transrectal prostate biopsy.

Overall the researchers reported an increased risk of temporary ED after biopsy of approximately 5%.

While this happens rarely and should improve over time, the study concluded that the effects of TRUS-guided prostate biopsy on ED have probably been underestimated.

It is important to be aware of these side effects so patients can be appropriately counseled. If sexual problems persist, you should consult your doctor.

Types of prostate biopsy

A prostate biopsy may be done in several different ways:

  • Transrectal method

At the moment, most biopsies are done using transrectal ultrasound-guided (TRUS) technique. A TRUS prostate biopsy is where the needle goes through the wall of the back passage (rectum).

 

  • Perineal method

This is done through the skin between the scrotum and the rectum.

 

  • Transurethral method

This is a type of biopsy done through the urethra using a cystoscope (a flexible tube and viewing device).

 

  • Transperineal biopsy

Unlike the TRUS Guided Biopsy, this is where the doctor inserts a needle into the prostate through the skin between the testicles and the anus. This area is called the perineum.

 

The needle is inserted through a template or grid. This is a targeted biopsy, which can be target a specific area of the prostate using MRI scans. An advantage of the TP biopsy is that it can now be performed under local anesthesia.

Are prostate biopsies safe?

One of the main issues with prostate cancer screening tests is that they can lead to misdiagnosis and as a result, overtreatment.

Even if you take many samples, a biopsy can still sometimes miss cancer. This occurs if none of the biopsy needles pass through the rights areas. Thus, the biopsy will have a false-negative result.

In fact, one study found that biopsies detected only 67.8% of prostate cancers.

What is the alternative to a prostate biopsy?

Doctors have long relied on biopsies to determine prostate cancer. And biopsies are proven to be dangerous. Often, a prostate biopsy finds traces of low-grade cancer that don’t need to be treated.

MRI

But in recent years, doctors have found out that new imaging studies like high-resolution MRI and ultrasound can be alternatives to a prostate biopsy.

They have proven to be very accurate and safe. A multi-parametric MRI or a color Doppler ultrasound has a 95 to 98% chance of determining the location and grade of prostate cancer cells.

According to the Diagnostic Center for Disease, an MRI scan predicts and confirms the presence of prostate cancer more frequently than a biopsy.

A hi-res MRI features the most sensitive and specific imaging modality that allows it to produce a very clear picture of the entire prostate and pelvic region.

Experts claim that this is a quantum leap from the blind biopsy approach. It will minimize the need for biopsies, and could potentially save millions of dollars for the healthcare industry.

PCA3 Test

The PCA3 test is another alternative. PCA3 stands for “Prostate Cancer gene 3”, a protein that is produced by prostate cancer cells at much higher levels. PCA3 leaks into the urine when the prostate gland is stimulated.

Unlike the PSA test, a high PCA3 test can only result from cancer – not from an enlarged prostate, inflamed prostate or other non-cancerous prostate problem.

For this test, you need to undergo a DRE. This will stimulate PCA3 to leak into the urine.

A urine sample is then collected and sent to the lab. It takes about 1-2 weeks to get the results. The higher the PCA3 score, the more likely you have prostate cancer.

This test is also used to determine the effectiveness of cancer treatment. The higher the score, the more aggressive is the prostate cancer.

Conclusion

Before having a biopsy, do your research. Do not blindly agree to a procedure without being aware of the possible life-changing side effects it could have.

There are alternatives to a prostate biopsy, like MRI and the PCA3 test. These methods are non-invasive and accurate.

Plus, they don’t have the negative side effects that result from a prostate biopsy.

Sources

  1. Glaser, A, Downing, A, Wright, P, Hounsome, L. (2018). Life after prostate cancer diagnosis: One step beyond.. Journal of Clinical Oncology. 36 (6), p40-40 .
  2. Lee G, Attar K, Laniado M, Karim O.. (2006). Safety and detailed patterns of morbidity of transrectal ultrasound guided needle biopsy of the prostate in a urologist-led uni. International Urology and Nephrology. 38 (2), p281-285.
  3. Liau, J, Goldberg, D, Arif-Tiwari, H. (2019). Prostate Cancer Detection and Diagnosis: Role of Ultrasound with MRI Correlates. Current Radiology Reports. 7 (7), 0.
  4. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Is repeat prostate biopsy associated with a greater risk of hospitalization? Data from SEER-Medicare. J Urol. 2012;189(3):867–870. doi:10.1016/j.juro.2012.10.005
  5. Murray KS, Bailey J, Zuk K, Lopez-Corona E, Thrasher JB1. (2015). A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy.. BJU International . 116 (2), p90-95.
  6. Rosario DJ, Lane JA, Metcalfe C, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ. 2012;344:d7894. Published 2012 Jan 9. doi:10.1136/bmj.d7894

About Our Author Ben's Natural Health Team

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9 Comments Newest

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  1. chet Campbell

    my PSA is in the 20’s I am 73 YO don’t want chemo, Rad, or chemical castration and no biopsy !! I was diagnosed with cancer 11 years ago my tumor was about this size then. . My PSA has been high for years and is pretty stable , goes up a few points and comes down a few points. I know once they get their claws on me I will not have any quality of life.. I need something to slow the process down . I have been taking Total advanced prostrate I’m on my second bottle and don’t know if my PSA has gone down ? Perhaps I should try total health for the prostrate in stead ?

    • Ben's Natural Health Team

      Hi Chet, very sorry to hear of your diagnosis. As discussed in the article, a prostate biopsy can have a number of negative side effects which should be taken into consideration. It might be best to get in touch with our team via our toll-free number so that we can discuss this with you in further detail. You can reach us on UK Tel:+44 (0) 845 423 8877 and USA Tel: 1-888-868-3554. You can also get in touch via [email protected]. We look forward to hearing from you. The Ben’s Natural Health Team.

  2. ronald siedler

    Analyzing prostate tissue after a HoLEP seems like a win win. More tissue is analyzed (the core of the prostate is removed for analysis) and there’s none of that hideous inserting a needle into the gland as with the standard biop. (I had never heard of the perineum method for a biop)
    Years ago, before my HoLEP I had the PCA3 test done and it came up positive for cancer. This obviously was false since the HoLEP analysis showed zero cancer.

  3. Eric Casey

    I foolishly trusted my (long-since prior) urologist and submitted to an invasive prostate biopsy in my about 5 years ago. He blatantly lied to me and said “my PSA (about 3) should be zero.” Out of sheer ignorance (I know now), I agreed to go through with it. Without a word of advance preparation from the urologist, the procedure was extremely uncomfortable and anxiety producing. The urologist never offered even the mildest form of sedation. I literally bent over and took it in anguish until he was done. Imagine a gun-like gas lighter shoved up there, but with a stapler on the end to snap and bite repeatedly at a place you never even knew existed. Then, I was sent home with no instructions as to what to expect. He only said “don’t ejaculate for two weeks.” Uh huh. At home, the first time I urinated, I thought I was bleeding to death and needed to get myself to an emergency room. I called the urologist’s office, and was told, “Oh, that’s normal.”
    Since then and all these years later, I am still plagued by “unexplained pelvic discomfort”, and “chronic non-bacterial prostatitis”, any term they use to whitewash the problem I know they caused. Hey guys, don’t ya know, chronic prostatitis is all in your head, according to these urologist quacks who caused it!
    Oh yeah, my biopsy results? Surprise, surprise, the “pathologist” was paid several hundred dollars to FIND something from a procedure by a urologist who was paid several hundred dollars to perform a (totally unneeded) procedure. Shazam! He found the smallest amount of possible prostate cancer in the smallest portion of the smallest sample taken from my prostate. Who’da thunk?! The recommendation? Change my body dramatically and give up my sex life by having my prostate ripped out on the 2-4% chance that what they found is gonna break bad. Oh, and the surgery costs $50,000…. details.
    Thank God, a good friend and young urologist took one look at my biopsy and said “This will never impact your life.”
    BTW, I’ve noticed only recently are urologists hinting at FINALLY admitting that prostatectomy ruins a guy’s sex life. No more ejacul,ations for sure (“Oh, but that doesn’t matter”, yeah right…) and truth be told lots of guys, never have an erection again.
    Bros, this IS what it’s like. I’m not exaggerating. Feel free to get in touch, if you want to know more about my experience.

    • Ben's Natural Health Team

      Hi Eric, thanks for sharing your experience. Although it was a bad, even shocking one, its good to hear that your friend/urologist advised you before you underwent unnecessary surgery, which could indeed have resulted in adverse side effects, including erectile dysfunction. (We will soon be publishing an article outling the treatment options for an enlarged prostate, so keep an eye on our site for this). Although one of the most common procedures for detecting prostate cancer, biopsies carry many potential risks and complications, as you yourself unfortunately experienced. If you have any questions about screening or about prostate enlargement in general, please feel free to get in touch with our team via [email protected] and we will be happy to help. Wishing you good health, The Ben’s Natural Health Team.

  4. Joseph Ofigberi

    How can you carried out test to determined postrate lever a person has through MRI or PCA3 without physically present.Maybe he can send some sample for test.

    • Ben's Natural Health Team

      Hi Joseph, thanks for getting in touch. Tests such as an MRI and PCA3 generally need to be performed in a doctor surgery. You can discuss other options with your doctor. The Ben’s Natural Health Team.

  5. Brian Kral

    Ben,

    Thank You. A very timely article for me. During my July physical my PSA was 6.24.My doctor was going to send me to the Urologist for a biopsy right away , I believe.I convinced him to do an MRI first. Unfortunately, they found a 1.79 mm lesion, so now I have to see the Urologist this Tuesday, August 27. I have read your articles, and am going to try to convince him to do The PCA3 or maybe the color doppler ultrasound you mention in the above article. I also have a few other articles from you and others on the subject to explain to him why I don’t like the idea of him basically shoving a needle inside of me and going on “a fishing trip”. I have purchased your last two prostate books, and found them to be very informative.

    Thanks

    • Ben's Natural Health Team

      Hi Brian, sorry to hear that, but good to hear that you are trying to avoid invasive procedures. Thank you for the great feedback, it is good to hear that you are finding both our books and articles informative. If you have any further questions about screening, please feel free to get in touch with our team via our toll-free number UK Tel:+44 (0) 845 423 8877, USA Tel: 1-888-868-355, we will be happy to help. Wishing you good health, The Ben’s Natural Health Team.