If the tests you had at the GP surgery
suggest you have a prostate problem, they may refer you to the
hospital for further tests.
Hospital tests you may have include:
A prostate biopsy involves taking small pieces of prostate
tissue to be looked at under the microscope. You will usually have
a biopsy called a trans-rectal ultrasound (TRUS)
guided prostate biopsy.
A high PSA level alone doesn’t automatically mean that you need
a biopsy. Your doctor should talk to you about the pros and cons of
having a biopsy, and discuss any concerns you may have before you
decide whether to have it.
You might not need a biopsy if other tests, such as a bone scan, shows the cancer has
spread outside the prostate.
What are the pros and cons of a TRUS
- A biopsy is the most accurate way of finding out if you have
prostate cancer and how likely it is to spread.
- This can help you and your doctor or nurse decide which
treatment options may be suitable for you.
- A biopsy can pick up a faster growing cancer at an early stage
– when treatment might prevent it spreading.
- The biopsy can only show if there was cancer in the samples
taken. If your biopsy result is normal it can’t rule out cancer
completely – the biopsy takes tissue from small areas of the
prostate, so it might miss some cancer.
- A biopsy can pick up a slow growing cancer that might not cause
any symptoms or problems in your lifetime.
- A biopsy can also have side effects.
What does a TRUS biopsy
A TRUS biopsy involves using thin needles to take around 10 to
12 small pieces of tissue from the prostate.
Before the biopsy you should tell your doctor or nurse if you’re
taking any medicines, particularly drugs that thin the blood.
The biopsy is done through the back passage (rectum). You’ll
have a local anaesthetic injection into your back passage to ease
Your doctor or nurse will put an ultrasound probe into your back
passage, using gel to make it more comfortable. The ultrasound
probe scans the prostate and an image appears on a screen. A needle
is then inserted through the wall of the back passage into the
prostate – using the ultrasound image as a guide.
The biopsy will take 10 to 15 minutes. You might have to wait
until you’ve had a pee (passed urine) before going home. You’ll be
given antibiotics to help prevent infection. You will also be given
antibiotics to take at home – it’s important to follow the
instructions and take all of them.
Some men find the biopsy painful, but others have only slight
discomfort. If you have any pain, tell your nurse or doctor. You
may need mild pain-relieving drugs, such as paracetamol.
If you’re gay or bisexual you might need to
be careful when you have sex. If you have anal sex, you should
ideally wait around six weeks after a biopsy before you receive
anal sex. Ask your doctor or nurse at the hospital for further
What are the side effects of TRUS biopsy?
- You might see a small amount of blood in your urine or stools
for two weeks or in your semen for a couple of months. If it takes
longer to clear up, or gets worse, see a doctor straight away.
- Up to 3 in 50 men (6 per cent) may get a more serious
- A fever (high temperature), chills, pain or burning when you
pee, or difficulty in peeing are signs of an infection. This can
happen even if you’ve been taking antibiotics. If you have these
symptoms go to your nearest accident and emergency (A&E)
department straight away.
- A small number of men can’t pee after a biopsy (urine
retention). If this happens contact your doctor or nurse at the
hospital straight away, or go to the A&E department.
- Some men have discomfort or pain for a few days or weeks
afterwards. Speak to your doctor or nurse about pain relief.
- There’s a small chance of getting a urine infection after the
biopsy. Take the antibiotics your doctor gave you.
What is a template
A template biopsy involves taking more tissue samples than a
TRUS biopsy – usually around 30 to 50 samples are taken.
The biopsy needles are inserted through the skin between the
scrotum and the back passage (perineum). The biopsy is normally
done under general anaesthetic.
With a template biopsy, more of the prostate is looked at, so
there’s more chance of finding cancer. But this also means that
there’s more chance of finding a slow-growing cancer that might not
cause any symptoms or problems in your lifetime.
Template biopsy can have similar side effects to a TRUS biopsy.
But there’s less risk of a serious infection with a template
biopsy. There is more chance that you will have problems peeing
after a template biopsy. Your doctor will make sure you can pee
before you go home. If you can’t pee, you might need to have a
catheter for a few days. A catheter is a thin tube that’s passed
into your bladder to drain urine.
What is a transperineal biopsy?
Some men can’t have an ultrasound probe or biopsy needles
inserted into their back passage because of other medical
conditions. They will have the biopsy needles inserted through the
area of skin between the scrotum and the back passage
What do my biospy results mean?
The biopsy samples will be looked at under a microscope to check
for any cancer cells. Your doctor will be sent a report, called a
pathology report, with the results. The results will show:
- whether any cancer was found
- how many biopsy samples contain cancer
- how much cancer is present in each sample.
You might be sent a copy of the pathology report. If you have
trouble understanding any of it, ask your doctor to explain it, or
call our Specialist Nurses.
If cancer is found
If your biopsy shows there is cancer present, you may hear your
doctor talk about your Gleason grade and Gleason
score. This can give an idea of how likely the cancer is to
grow and spread outside the prostate.Read more about your test
results, and what support is available.
If no cancer is found
If no cancer is found this is obviously reassuring. However,
this means ‘no cancer has been found’ rather than ‘no cancer is
present’. There could be some cancer that was missed by the biopsy
Your doctor may suggest keeping an eye on your prostate with PSA tests, DREs or an MRI scan. If your doctor still suspects
that cancer is present you may be offered another biopsy. You may
be offered either another TRUS biopsy or a
What else might the biopsy results show?
Sometimes the biopsy finds other changes to your prostate cells,
called PIN or ASAP.
Will I need to have a scan?
If you’re diagnosed with prostate cancer, you might need to have
a scan to find out whether it has spread outside the prostate. You
The results should help you and your doctor decide which
treatments might be suitable for you.
You might not need to have these scans if your PSA is low and
your Gleason score suggests that the
cancer is unlikely to have spread.
You might have an MRI (magnetic resonance imaging) scan to find
out if the cancer has spread and you’re thinking about treatments
such as radiotherapy or surgery.
The MRI scan uses magnets, so you will need to take off any
jewellery or metal items when you have the scan. Let the
radiographer know if you have metal implants such as a pacemaker
for your heart.
You will lie on a table which will move slowly into the scanner.
Some MRI scanners are doughnut-shaped. Others are shaped like a
long tunnel. If you have a fear of enclosed spaces
(claustrophobia), tell your radiographer.
The scan takes 30 to 40 minutes. The machine is very noisy but
you won’t feel anything.
The radiographer will leave the room but you’ll be able to speak
to them through an intercom, and they can see you at all times. You
may be able to listen to music through headphones.
A CT (computerised tomography) scan can show whether the cancer
has spread beyond the prostate for example to the lymph nodes or
nearby bones. You might have this scan if you’re thinking about
treatments such as radiotherapy or surgery.
The CT scanner is shaped like a large doughnut. You will lie on
a table which moves slowly through the hole in the middle of the
scanner. The radiographer will leave the room but you’ll be able to
speak to them through an intercom, and they can see you at all
times. You will need to keep still, and you might be asked to hold
your breath for short periods. The scan takes 10 to 20 minutes.
You might have a bone scan if there’s a chance your cancer has
spread outside the prostate to the bones. This is a common place
for prostate cancer to spread to.
Tell your doctor or nurse if you have arthritis or have ever had
any broken bones or fractures, or surgery to the bones, as these
will also show up on the scan.
You might be asked to drink plenty of fluids before and after
the scan. A small amount of a safe radioactive dye is injected into
a vein in your arm, and you’ll have the scan two to three hours
later. If there is any cancer in the bones, the dye will collect in
these areas and show up on the scan.
You will lie on a table while the scanner moves very slowly down
your body taking pictures. This takes around half an hour. The
camera will pick up any ‘hot spots’ where the radioactive dye has
collected. These ‘hot spots’ can show if the cancer has spread to
The doctor will look at the results of the scan carefully to see
whether any cancer is present. You may need to have X-rays of any
‘hot spots’ to check if they are definitely cancer. If it’s still
not clear, you may need to have an MRI scan.
You may be asked to avoid contact with children and pregnant
women for up to 24 hours after the scan.
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Researchers are looking at other tests that may help to diagnose
prostate cancer. These tests are not widely available and more
research is needed before we can be sure how useful they are.
Free and total PSA test
This test measures the amount of two different types of PSA in
the blood. It can help tell whether you have a high PSA level
because of prostate cancer, or because of a non-cancerous prostate
problem. But doctors don’t yet agree on what levels of the
different types of PSA show that a man has prostate cancer, so it’s
not used that often. The test is only suitable for men who have a
PSA level between 4 and 10ng/ml.
A urine test called a PCA3 test
Your doctor or nurse will massage your prostate then ask you to
give a urine sample. Cells from the prostate pass into the urine
where they can be looked at with a special test that looks at your
genes. This test might help specialists decide which men should
have a biopsy, or it might be useful for monitoring men who’ve
already had a biopsy. At the moment the PCA3 test is only available
in a few private hospitals and clinics, as we still need more
research about how good it is.
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