What Is a Prostate Biopsy?

Written by Lisa Guthrie
Medically Reviewed by Shruthi N, MD on August 13, 2025
6 min read

A prostate biopsy is when a doctor removes small samples of tissue from your prostate to test for cancer. Your doctor will order one if the results from a screening (a blood test or a digital rectal exam) show you might have prostate cancer.

This type of cancer is very common. An estimated 174,000 men will be diagnosed with it this year, and about 31,000 will die from it. But for most men, it often causes no problems or can be easily treated. A diagnosis of prostate cancer cannot be made without a biopsy.

Your doctor will suggest one of two ways to get the tissue for testing:

Transrectal biopsy. A thin ultrasound (imaging) probe will be put in your rectum. Your doctor will use the images from the probe to guide them to the right place to get the tissue samples. This is the most common kind of prostate biopsy.

Transperineal biopsy. The perineum is the area between your anus and scrotum. For the biopsy, a small cut is made in the perineum, and the biopsy needle goes into the cut to take out the tissue samples. The doctor will use an ultrasound probe to guide them to the right area. Sometimes, the doctor may use other types of imaging, such as an MRI or CT scan.

The prostate is beneath the bladder and in front of the rectum. It’s a walnut-shaped gland that surrounds part of the urethra — the tube that carries pee and semen out of the penis. Here’s what the prostate does:

  • It makes fluid for semen, which includes sperm produced in the testicles.
  • It prevents urine from being included during ejaculation.

If it gets too big, your prostate can block pee from passing through the urethra and out the penis.

Your doctor may order a biopsy if the level of prostate-specific antigen (PSA) in your blood is high or if an abnormal lump is found during a digital rectal exam. During a digital rectal exam, your doctor inserts a finger up your bottom to feel if your prostate is enlarged or has bumps. Another option before a biopsy is an ultrasound. Instead of a finger, a small probe is inserted to take pictures of the prostate.

An MRI-guided prostate biopsy may be used in patients who have a rising PSA level but a negative ultrasound-guided biopsy. It may also be used in situations where a diagnostic prostate MRI, performed because of rising PSA, shows a very small abnormality that may not be easily targeted by ultrasound. Using an MRI image to guide a biopsy can improve the ability to find prostate tumors that may require treatment.

Once your doctor decides to do a prostate biopsy, it's a simple procedure that usually lasts less than 30 minutes. The biopsy normally causes only mild discomfort. Your doctor will use medicine to numb the area to reduce that. 

For a transrectal biopsy , they use a thin ultrasound probe to help pinpoint where to get the samples of tissue. Then, they insert a needle through the wall of your rectum and into the prostate to take out tissue for testing.

In some cases, doctors do the biopsy by making a small cut in the skin between the scrotum and the anus and inserting a needle through it to the prostate. That is a transperineal biopsy. It gives doctors a different angle of the prostate than they can see in a transrectal biopsy.

Doctors usually take a dozen or so samples from various parts of the prostate. The samples will be sent to a lab, where they’ll be looked at under a microscope. It takes a few days to get results back. If there’s cancer, you’ll be given something called a Gleason score. The higher your score, the more likely it is that your cancer will grow and spread quickly, requiring more aggressive treatment.

Since biopsies can miss the cancerous parts of the prostate, sometimes a repeat is ordered to be sure.

You'll be able to continue with your normal activities the day of your biopsy. But your doctor will tell you not to exercise too hard for a day or two. 

If you have any pain or discomfort in the biopsy area, your care team will suggest an over-the-counter pain reliever.

You can expect some symptoms after you have a prostate biopsy. Most are very common and not serious:

  • Rectal bleeding
  • Blood in your semen, which can last several weeks
  • A hard time peeing
  • Blood in your pee
  • Blood in your poop

In rare cases, you might get an infection in your urinary tract or the prostate itself. Your doctor would give you antibiotics to treat it.

When to call the doctor

If you have more serious symptoms, call your doctor right away. These may include:

  • Bleeding for a long time or heavy bleeding
  • Fever
  • Pain that gets worse over time
  • A very hard time peeing that could require a catheter to empty the bladder

If you and your doctor decide treatment is necessary, surgery to remove the prostate and nearby tissue is common if the cancer hasn't spread.

Other treatment options include:

  • Radiation
  • Cryotherapy (using very cold temperatures to freeze cancer cells)
  • Hormone therapy
  • Chemotherapy

Some men with the disease might only need "active surveillance," also called "watchful waiting." This means having regular blood tests, rectal exams, and possibly biopsies to keep an eye on things. If the cancer gets worse, you might discuss treatment options with your doctor.

  • Your doctor may suggest a prostate biopsy if the level of prostate-specific antigen (PSA) in your blood is high or if they find an abnormal lump during a digital rectal exam.
  • The two main types of prostate biopsies both involve inserting a needle into the prostate — either through the rectum or through the skin between your scrotum and anus — and taking tissue samples for testing.
  • Common side effects after the biopsy are rectal bleeding, blood in your semen, pee, or poop, and trouble peeing.
  • Your doctor will discuss treatment options if your biopsy shows cancer or another prostate condition.

Does insurance cover prostate biopsies? 

Check with your insurance company to see whether it covers prostate biopsies. Many states have laws requiring coverage of prostate cancer screenings, including the PSA test and the digital rectal exam.

What is an alarming PSA level?

Prostate-specific antigen is a protein made by the prostate. There's not a single "normal" PSA level. Doctors will think about other factors, including your health history and general health, when looking at PSA levels. "Abnormal" PSA levels can range from higher than 3.5 to higher than 5.5 nanograms per milliliter (ng/ml) of blood, depending on age. A PSA level of 10 ng/ml or higher means your risk of prostate cancer is greater.

Can you drive home after a prostate biopsy?

It depends. Sometimes doctors give a mild sedative for the biopsy. If you are sedated, you won't be able to drive. But if not, you might not need to ask someone to drive you. Ask your doctor leading up to the biopsy and see what they suggest.