Table of ContentsView AllTable of ContentsPurposeIndicationsPain and Side EffectsContraindicationsHow It Is DoneRecoveryBiopsy ResultsWhat’s Next?
Table of ContentsView All
View All
Table of Contents
Purpose
Indications
Pain and Side Effects
Contraindications
How It Is Done
Recovery
Biopsy Results
What’s Next?
A prostate biopsy has long been the standard of care for diagnosingprostate cancer. While it is generally considered safe, a prostate biopsy is an invasive procedure that some people are reluctant to undergo due to fear of pain and possible side effects.
In 2020, the American Urological Association (AUA) revised its guidelines and now recommends a noninvasivemagnetic resonance imaging (MRI)scan as the first step in the diagnosis. Should the MRI findings indicate the possibility of prostate cancer, a biopsy would then be performed to confirm the diagnosis.
This reduces the risk of a needless biopsy and has proven far more accurate in diagnosing prostate cancer.
This article explains why and when a prostate biopsy is performed, the possible side effects, and what to expect when undergoing the procedure. It also walks you through what the findings mean and what happens next if cancer is found.
Biopsy 101: What You Need to Know
Goals of Prostate Biopsy
By obtaining a sample of the cancerous tumor, the pathologist can diagnose the disease and begin the process ofstaging(determining how advanced the cancer is) andgrading(determining how aggressive the cancer is).
The two methods commonly used for a prostate biopsy are:
A transurethral biopsy (TUB) is an older, more invasive procedure no longer included in the AUA screening guidelines.It involves the insertion of a fiberoptic scope into theurethra(the tube through which urine exits the body) to access the prostate gland through the wall of the urethra.
Getting a Prostate Ultrasound for Prostate Cancer
When Is a Prostate Biopsy Needed?
A prostate biopsy is one of the steps involved in the diagnosis of prostate cancer and ultimately the one that can definitively diagnose the disease.
Your healthcare provider may recommend a prostate biopsy if any of the following apply:
If prostate cancer is suspected based on these findings and otherrisk factors—such as being over 50, having a family history of prostate cancer, or having Black ancestry—you would first undergo a special type of MRI called a multi-parametric MRI (mpMRI).
The mpMRI produces a more detailed, three-dimensional (3D) image of your prostate gland than a standard MRI would. It is used first not only because it is noninvasive but also because it visualizes the prostate as a whole rather than “poking around” for random samples with a biopsy.
While a biopsy would still be needed to confirm the diagnosis, the mpMRI better ensures that unnecessary biopsies are avoided.
A 2019 study in theCanadian Medical Association Journalfound that a mpMRI has a 93% accuracy in correctly diagnosing prostate cancer compared to 48% for a TRUS biopsy. This translates to a 38% reduction in unnecessary biopsies.
When Is a High PSA a Sign of Cancer?There is no hard-and-fast rule as to when a PSA is a sign of cancer. While a PSA of 4 nanograms per milliliter (ng/mL) is generally considered normal in a person with a prostate, 15% of people with prostate cancer have a PSA under 4.The odds of prostate cancer increase to 25% when the PSA is between 4 and 10, and to 50% when the PSA is over 10.
When Is a High PSA a Sign of Cancer?
There is no hard-and-fast rule as to when a PSA is a sign of cancer. While a PSA of 4 nanograms per milliliter (ng/mL) is generally considered normal in a person with a prostate, 15% of people with prostate cancer have a PSA under 4.The odds of prostate cancer increase to 25% when the PSA is between 4 and 10, and to 50% when the PSA is over 10.
There is no hard-and-fast rule as to when a PSA is a sign of cancer. While a PSA of 4 nanograms per milliliter (ng/mL) is generally considered normal in a person with a prostate, 15% of people with prostate cancer have a PSA under 4.
The odds of prostate cancer increase to 25% when the PSA is between 4 and 10, and to 50% when the PSA is over 10.
How Prostate Cancer Is Diagnosed
How Painful Is a Prostate Biopsy?
The prostate biopsy itself should cause little if any pain once the effects of the local anesthetic or nerve block have kicked in. You may feel pressure and even uncomfortable sensations, but no outright pain. If you do, let the surgeon know.
Immediately after the procedure, you may feel fine, but pain may soon develop as the effects of the anesthetic start to wear off. This is why you are likely to be advised to avoid driving yourself home after the biopsy.
How Long Do Local Anesthetics Last?The length of time that it takes for a local anesthetic to wear off depends on the type of anesthetic used. Some, like lidocaine gel, are relatively short-acting, with the numbing effects starting to wear off soon after the procedure.Nerve blocks generally last longer but can cause temporary leg numbness and weakness that can impair driving.
How Long Do Local Anesthetics Last?
The length of time that it takes for a local anesthetic to wear off depends on the type of anesthetic used. Some, like lidocaine gel, are relatively short-acting, with the numbing effects starting to wear off soon after the procedure.Nerve blocks generally last longer but can cause temporary leg numbness and weakness that can impair driving.
Once you are safely home, you can expect to have some rectal pain and pain with urination (dysuria). These side effects tend to be relatively manageable and persist for no more than a few days.
However, some people may experience severe post-biopsy pain. This may be due to physical factors such as:
Coping With Anxiety and Anticipatory Pain
While pain perception can be increased with strong negative emotions—referred to as thenocebo effect—it can also be decreased with strongly positive ones.
This is not to say that you should ask for someone to hold your hand during the procedure. But it does suggest there are ways to calm yourself and minimize the nocebo effect if you are scheduled to undergo a prostate biopsy.
As a general rule:
Other Short- and Long-Term Effects
While pain is the side effect many people associate with prostate biopsy, there are other, far more common ones like blood in the urine (hematuria), blood in sperm (hematospermia), and rectal bleeding.Even so, these side effects are typically mild and resolve on their own. Most do not require medical treatment.
With that said, up to 25% of people who have undergone a TRUS biopsy will experience a mild to moderateurinary tract infection (UTI), while less than 2% will experienceurinary retention(difficulty emptying the bladder).The risk of these complications is even lower with a TPB.
Rare complications include the risk ofurosepsiscaused when a severe, untreated UTI spreads into the bloodstream.Even rarer is nephrogenic systemic fibrosis caused when a reaction to the MRI contrast dyegadoliniumdamages the kidneys and other organ systems.
Can Prostate Biopsy Cause Erectile Dysfunction?A 2021 review involving 54 published studies found no association between prostate biopsy anderectile dysfunction (ED). While there may be a transient loss in the ability to get or sustain an erection during the first month, the difficulty almost invariably resolves itself within three months.
Can Prostate Biopsy Cause Erectile Dysfunction?
A 2021 review involving 54 published studies found no association between prostate biopsy anderectile dysfunction (ED). While there may be a transient loss in the ability to get or sustain an erection during the first month, the difficulty almost invariably resolves itself within three months.
Who Doesn’t Need a Prostate Biopsy?
According to the AUA, there are situations in which a prostate biopsy can be skipped and cancer treatment delivered as a matter of urgency. This includes:
What Are the Signs of Prostate Cancer?
Before the Procedure
While there are no food restrictions or extensive bowel preparations needed for a TRUS biopsy, your urologist will ask you to make the following special preparations before undergoing the procedure:
You will be asked to undress and change into a hospital gown, after which you will be escorted into the procedure room.
A prostate biopsy is performed on a procedure table while lying on your side or back.Localorregional anesthesiais most commonly used to reduce pain and discomfort.
Anesthesia options include:
Once the area is amply numbed, the procedure can begin.
During the Procedure
TRUS and TPB are two options for a prostate biopsy. While a TRUS biopsy is the more commonly used procedure, some health experts prefer the TPB for its lower rate of complications.
TheTRUS biopsyis performed in the following steps:
TheTPB procedureis performed in the following steps:
After the Procedure
After the biopsy is completed, you can usually get dressed and return home. Most urologists advise people not to drive themselves home due to the pain and lingering effects of certain anesthetics. If a pudendal nerve block was used, you should not drive.
Before leaving, you may be given an OTC painkiller likeTylenol (acetaminophen)to help manage pain, Some urologists will also prescribe a short course of analpha-blockerlikeFlomax (tamsulosin)to improve urine flow while you heal.
Recovery Time and Aftercare
Most urologists recommend getting plenty of rest 24 to 48 hours after the biopsy. If you were prescribed antibiotics, you would take the second and final dose 12 hours after the procedure.
For the first three days, drink extra amounts of fluid to help flush out the bladder, prevent infection, and minimize the amount of blood in your urine.Water is best. Coffee, alcohol, and high-sugar beverages can irritate the urinary tract and should either be avoided or kept to a minimum.
Sex should also be avoided for the first three days. Sports and heavy lifting (more than 10 pounds) should be suspended for five days as both can increase the risk of bleeding.
It is not uncommon for there to be traces of blood in your urine for up to 14 days. Your semen can also look rust-colored for up to 12 weeks as the prostate gland (which supplies fluids to semen) slowly heals itself.
If these symptoms worsen or you develop any new symptoms, call your healthcare provider.
When to Seek Medical CareSevere infections following a prostate biopsy are rare but can occur. Call your healthcare provider immediately if you experience:High fever with chillsIncreased blood in the urineIncreased rectal bleedingDifficulty or rapid breathingRapid heart rateSevere lower abdominal painNausea or vomitingInability to urinate
When to Seek Medical Care
Severe infections following a prostate biopsy are rare but can occur. Call your healthcare provider immediately if you experience:High fever with chillsIncreased blood in the urineIncreased rectal bleedingDifficulty or rapid breathingRapid heart rateSevere lower abdominal painNausea or vomitingInability to urinate
Severe infections following a prostate biopsy are rare but can occur. Call your healthcare provider immediately if you experience:
Prostate Biopsy Results
The results of your biopsy should be received within five to seven days. The pathology report will describe all of the lab’s findings, including thehistological findingsseen under the microscope.
Three possible outcomes of a prostate biopsy are:
Suspicious or Cancerous Prostate Biopsy Results: What Happens Next?
Additional action is needed if the pathology report returns anything but a negative result. In some cases, even a negative result needs follow-up.
Atypical or Suspicious Results
If your pathology report delivers an atypical finding, it may mean that you are at risk of developing prostate cancer, or it may mean nothing. In the end, a lot of things can look like cancer under the microscope and not actually be cancer.
In such cases, your urologist may recommend a repeat prostate biopsy in 3 to 6 months. Alternatively, you may be routinely monitored with blood, urine, and MRI tests. The decision is largely based on how abnormal the findings are and whether you have other risk factors for prostate cancer.
Positive Results
If your biopsy is positive, the next step is to grade the cancer based on how abnormal the cells look under the microscope. The traditional method is theGleason scoring system, which assigns a score of 3 to 5 from two different locations on the tissue sample. The numbers from each section are then added up to get the final score.
Gleason scores range from 6 to 10, with 6 being the least abnormal and 10 being the most abnormal. These findings will help establish how aggressive the tumor is and what cancer treatments are most appropriate.
Not every case needs immediate treatment. In some cases, a low Gleason score may warrant a watch-and-wait approach.
How Many Prostate Biopsies Are Cancer?A 2017 report in theEuropean Medical Journal: Urologyfound that 70% of prostate biopsies are negative but that 30% to 43% of these turn out positive after a repeat biopsy. Although MRIs have greatly improved the accuracy of prostate cancer screenings, they still have afalse negativerate of between 4% and 14%.What this suggests is that suspicious findings (such as rising PSA levels) should always be investigated, even if the initial biopsy result is negative.
How Many Prostate Biopsies Are Cancer?
A 2017 report in theEuropean Medical Journal: Urologyfound that 70% of prostate biopsies are negative but that 30% to 43% of these turn out positive after a repeat biopsy. Although MRIs have greatly improved the accuracy of prostate cancer screenings, they still have afalse negativerate of between 4% and 14%.What this suggests is that suspicious findings (such as rising PSA levels) should always be investigated, even if the initial biopsy result is negative.
A 2017 report in theEuropean Medical Journal: Urologyfound that 70% of prostate biopsies are negative but that 30% to 43% of these turn out positive after a repeat biopsy. Although MRIs have greatly improved the accuracy of prostate cancer screenings, they still have afalse negativerate of between 4% and 14%.
What this suggests is that suspicious findings (such as rising PSA levels) should always be investigated, even if the initial biopsy result is negative.
How to Treat Gleason 6 Prostate Cancer
Summary
A prostate biopsy is performed when there is a suspicion of prostate cancer. It involves the extraction of tissues either through the rectum (transrectal ultrasound-guided biopsy, or TRUS) or the perineum (transperineal biopsy, or TPB). The outpatient procedure takes 15 to 30 minutes to complete, typically under local or regional anesthesia.
Side effects tend to be mild and transient. Rectal pain and pain with urination tend to ease within several days.
In 2020, the American Urological Association recommended that people suspected of having prostate cancer first undergo a magnetic resonance imaging (MRI) scan before a prostate biopsy is considered.
The MRI cannot diagnose cancer but is able to detect abnormalities consistent with cancer with a high degree of accuracy. Performing the MRI first reduces the risk of unnecessary biopsies while increasing the accuracy of prostate cancer screening.
Is It Time to Get a Prostate Exam?
29 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bjurlin MA, Carroll PR, Eggener S, et al.Update of the standard operating procedure on the use of multiparametric magnetic resonance imaging for the diagnosis, staging, and management of prostate cancer.J Urol.2020;203(4):706-712. doi:0.1097/JU.0000000000000617Eklund M, Jaderling F, Discacciati A, et al.MRI-targeted or standard biopsy in prostate cancer screening.N Engl J Med. 2021; 385:908-920. doi:10.1056/NEJMoa2100852National Cancer Institute.Cancer fast stats: prostate cancer.Wei JT, Barocas D, Carlsson S, et al.Early detection of prostate cancer: AUA/SUO guideline part I: prostate cancer screening.J Urol. 2023;210(1):45-53. doi:10.1097/JU.0000000000003491Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J.Prostate-specific antigen-based screening for prostate cancer: evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2018;319(18):1914-1931. doi:10.1001/jama.2018.3712Cheung DC, Finelli A.Magnetic resonance imaging diagnosis of prostate cancer: promise and caution.Can Med Assoc J.2019;191(43):E1177–E1178. doi:10.1503/cmaj.190568American Cancer Society.Screening tests for prostate cancer.Lee HS.Recent advances in topical anesthesia.J Dent Anesth Pain Med.2016;16(4):237–244. doi:10.17245/jdapm.2016.16.4.237Xu J, Zhou R, Su W, et al.Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial.BMJ Open.2020;10(8):e035887. doi:10.1136/bmjopen-2019-035887Prostate Cancer UK.What are the side effects of a biopsy?Rempega G, Rajwa P, Kepinski M, et al.The severity of pain in prostate biopsy depends on the biopsy sector.J Pers Med.2023;13(3):431. doi:10.3390/jpm13030431Li W, Mao Y, Gu Y, et al.Effects of hand holding on anxiety and pain during prostate biopsies: a pilot randomized controlled trial.Patient Prefer Adherence.2021;15:1593–1600. doi:10.2147/PPA.S321175Manai M, van Middendorp H, Veldhuijzen DS, Huizinga TWJ, Evers AWM.How to prevent, minimize, or extinguish nocebo effects in pain: a narrative review on mechanisms, predictors, and interventions.Pain Rep.2019;4(3):e699. doi:10.1097/PR9.0000000000000699Efesoy O, Bozlu M, Cayan S, Akbay E.Complications of transrectal ultrasound-guided 12-core prostate biopsy: a single center experience with 2049 patients.Turk J Urol.2013;39(1):6–11. doi:10.5152/tud.2013.002Loeb S, Vellekoop A, Ahmed U, et al.Systematic review of complications of prostate biopsy,Europ Urol, 2013;64(6):876-892. doi:10.1016/j.eururo.2013.05.049Berry B, Parry MG, Sujenthiran A, et al.Comparison of complications after transrectal and transperineal prostate biopsy: a national population-based study.BJU Int.2020;126(1):97-103. doi:10.1111/bju.15039Ramalho J, Semelka RC, Ramalho RH, AlObaidy M, Castillo M.Gadolinium-based contrast agent accumulation and toxicity: an update.AJNR Am J Neuroradiol.2016;37(7):1192-1198. doi:10.3174/ajnr.A4615Mehta A, Kim WC, Aswad KG, Brunckhorst O, Ahmed HU, Ahmed K.Erectile function post prostate biopsy: a systematic review and meta-analysis.Urology. 2021;155:1-8. doi:10.1016/j.urology.2021.01.035Harvey CJ, Pilcher J, Richenberg J, Patel U, Frauscher F.Applications of transrectal ultrasound in prostate cancer.Br J Radiol.2012;85(Spec Iss 1):S3–S17. doi:10.1259/bjr/56357549Canadian Cancer Society.Transrectal ultrasound (TRUS).Memorial Sloan Kettering Cancer Center.About your prostate biopsy with ultrasound.Sahin A, Ceylan C, Gazel E, Odabas O.Three different anesthesia techniques for a comfortable prostate biopsy.Urol Ann.2015;7(3):339–344. doi:10.4103/0974-7796.152014Hong A, Hemmingway S, Wetherell D, Dias B, Zargar H.Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible.ANZ J Surg.2022;92(6):1480–1485. doi:10.1111/ans.17593Thomson A, Li M, Grummet J, Sengupta S.Transperineal prostate biopsy: a review of technique.Transl Androl Urol.2020;9(6):3009–3017. doi:10.21037/tau.2019.12.40Alberta Health Services.Sympathetic nerve block: before your procedure.American Cancer Society.Your prostate pathology report: cancer (adenocarcinoma).American Cancer Society.Tests to diagnose and stage prostate cancer.American Urological Association.Clinically localized prostate cancer: AUA/ASTRO/SUO guideline.Rivas JG, Alvarez-Maestro M, Czarniecki M, Czarniecki S, Rodriguez Socarras M, Loeb S.Negative biopsies with rising prostate-specific antigen. What to do?.Eur Med J Urol. 2017;5(1):76-82. doi:10.33590/emjurol/10314704
29 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bjurlin MA, Carroll PR, Eggener S, et al.Update of the standard operating procedure on the use of multiparametric magnetic resonance imaging for the diagnosis, staging, and management of prostate cancer.J Urol.2020;203(4):706-712. doi:0.1097/JU.0000000000000617Eklund M, Jaderling F, Discacciati A, et al.MRI-targeted or standard biopsy in prostate cancer screening.N Engl J Med. 2021; 385:908-920. doi:10.1056/NEJMoa2100852National Cancer Institute.Cancer fast stats: prostate cancer.Wei JT, Barocas D, Carlsson S, et al.Early detection of prostate cancer: AUA/SUO guideline part I: prostate cancer screening.J Urol. 2023;210(1):45-53. doi:10.1097/JU.0000000000003491Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J.Prostate-specific antigen-based screening for prostate cancer: evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2018;319(18):1914-1931. doi:10.1001/jama.2018.3712Cheung DC, Finelli A.Magnetic resonance imaging diagnosis of prostate cancer: promise and caution.Can Med Assoc J.2019;191(43):E1177–E1178. doi:10.1503/cmaj.190568American Cancer Society.Screening tests for prostate cancer.Lee HS.Recent advances in topical anesthesia.J Dent Anesth Pain Med.2016;16(4):237–244. doi:10.17245/jdapm.2016.16.4.237Xu J, Zhou R, Su W, et al.Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial.BMJ Open.2020;10(8):e035887. doi:10.1136/bmjopen-2019-035887Prostate Cancer UK.What are the side effects of a biopsy?Rempega G, Rajwa P, Kepinski M, et al.The severity of pain in prostate biopsy depends on the biopsy sector.J Pers Med.2023;13(3):431. doi:10.3390/jpm13030431Li W, Mao Y, Gu Y, et al.Effects of hand holding on anxiety and pain during prostate biopsies: a pilot randomized controlled trial.Patient Prefer Adherence.2021;15:1593–1600. doi:10.2147/PPA.S321175Manai M, van Middendorp H, Veldhuijzen DS, Huizinga TWJ, Evers AWM.How to prevent, minimize, or extinguish nocebo effects in pain: a narrative review on mechanisms, predictors, and interventions.Pain Rep.2019;4(3):e699. doi:10.1097/PR9.0000000000000699Efesoy O, Bozlu M, Cayan S, Akbay E.Complications of transrectal ultrasound-guided 12-core prostate biopsy: a single center experience with 2049 patients.Turk J Urol.2013;39(1):6–11. doi:10.5152/tud.2013.002Loeb S, Vellekoop A, Ahmed U, et al.Systematic review of complications of prostate biopsy,Europ Urol, 2013;64(6):876-892. doi:10.1016/j.eururo.2013.05.049Berry B, Parry MG, Sujenthiran A, et al.Comparison of complications after transrectal and transperineal prostate biopsy: a national population-based study.BJU Int.2020;126(1):97-103. doi:10.1111/bju.15039Ramalho J, Semelka RC, Ramalho RH, AlObaidy M, Castillo M.Gadolinium-based contrast agent accumulation and toxicity: an update.AJNR Am J Neuroradiol.2016;37(7):1192-1198. doi:10.3174/ajnr.A4615Mehta A, Kim WC, Aswad KG, Brunckhorst O, Ahmed HU, Ahmed K.Erectile function post prostate biopsy: a systematic review and meta-analysis.Urology. 2021;155:1-8. doi:10.1016/j.urology.2021.01.035Harvey CJ, Pilcher J, Richenberg J, Patel U, Frauscher F.Applications of transrectal ultrasound in prostate cancer.Br J Radiol.2012;85(Spec Iss 1):S3–S17. doi:10.1259/bjr/56357549Canadian Cancer Society.Transrectal ultrasound (TRUS).Memorial Sloan Kettering Cancer Center.About your prostate biopsy with ultrasound.Sahin A, Ceylan C, Gazel E, Odabas O.Three different anesthesia techniques for a comfortable prostate biopsy.Urol Ann.2015;7(3):339–344. doi:10.4103/0974-7796.152014Hong A, Hemmingway S, Wetherell D, Dias B, Zargar H.Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible.ANZ J Surg.2022;92(6):1480–1485. doi:10.1111/ans.17593Thomson A, Li M, Grummet J, Sengupta S.Transperineal prostate biopsy: a review of technique.Transl Androl Urol.2020;9(6):3009–3017. doi:10.21037/tau.2019.12.40Alberta Health Services.Sympathetic nerve block: before your procedure.American Cancer Society.Your prostate pathology report: cancer (adenocarcinoma).American Cancer Society.Tests to diagnose and stage prostate cancer.American Urological Association.Clinically localized prostate cancer: AUA/ASTRO/SUO guideline.Rivas JG, Alvarez-Maestro M, Czarniecki M, Czarniecki S, Rodriguez Socarras M, Loeb S.Negative biopsies with rising prostate-specific antigen. What to do?.Eur Med J Urol. 2017;5(1):76-82. doi:10.33590/emjurol/10314704
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bjurlin MA, Carroll PR, Eggener S, et al.Update of the standard operating procedure on the use of multiparametric magnetic resonance imaging for the diagnosis, staging, and management of prostate cancer.J Urol.2020;203(4):706-712. doi:0.1097/JU.0000000000000617Eklund M, Jaderling F, Discacciati A, et al.MRI-targeted or standard biopsy in prostate cancer screening.N Engl J Med. 2021; 385:908-920. doi:10.1056/NEJMoa2100852National Cancer Institute.Cancer fast stats: prostate cancer.Wei JT, Barocas D, Carlsson S, et al.Early detection of prostate cancer: AUA/SUO guideline part I: prostate cancer screening.J Urol. 2023;210(1):45-53. doi:10.1097/JU.0000000000003491Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J.Prostate-specific antigen-based screening for prostate cancer: evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2018;319(18):1914-1931. doi:10.1001/jama.2018.3712Cheung DC, Finelli A.Magnetic resonance imaging diagnosis of prostate cancer: promise and caution.Can Med Assoc J.2019;191(43):E1177–E1178. doi:10.1503/cmaj.190568American Cancer Society.Screening tests for prostate cancer.Lee HS.Recent advances in topical anesthesia.J Dent Anesth Pain Med.2016;16(4):237–244. doi:10.17245/jdapm.2016.16.4.237Xu J, Zhou R, Su W, et al.Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial.BMJ Open.2020;10(8):e035887. doi:10.1136/bmjopen-2019-035887Prostate Cancer UK.What are the side effects of a biopsy?Rempega G, Rajwa P, Kepinski M, et al.The severity of pain in prostate biopsy depends on the biopsy sector.J Pers Med.2023;13(3):431. doi:10.3390/jpm13030431Li W, Mao Y, Gu Y, et al.Effects of hand holding on anxiety and pain during prostate biopsies: a pilot randomized controlled trial.Patient Prefer Adherence.2021;15:1593–1600. doi:10.2147/PPA.S321175Manai M, van Middendorp H, Veldhuijzen DS, Huizinga TWJ, Evers AWM.How to prevent, minimize, or extinguish nocebo effects in pain: a narrative review on mechanisms, predictors, and interventions.Pain Rep.2019;4(3):e699. doi:10.1097/PR9.0000000000000699Efesoy O, Bozlu M, Cayan S, Akbay E.Complications of transrectal ultrasound-guided 12-core prostate biopsy: a single center experience with 2049 patients.Turk J Urol.2013;39(1):6–11. doi:10.5152/tud.2013.002Loeb S, Vellekoop A, Ahmed U, et al.Systematic review of complications of prostate biopsy,Europ Urol, 2013;64(6):876-892. doi:10.1016/j.eururo.2013.05.049Berry B, Parry MG, Sujenthiran A, et al.Comparison of complications after transrectal and transperineal prostate biopsy: a national population-based study.BJU Int.2020;126(1):97-103. doi:10.1111/bju.15039Ramalho J, Semelka RC, Ramalho RH, AlObaidy M, Castillo M.Gadolinium-based contrast agent accumulation and toxicity: an update.AJNR Am J Neuroradiol.2016;37(7):1192-1198. doi:10.3174/ajnr.A4615Mehta A, Kim WC, Aswad KG, Brunckhorst O, Ahmed HU, Ahmed K.Erectile function post prostate biopsy: a systematic review and meta-analysis.Urology. 2021;155:1-8. doi:10.1016/j.urology.2021.01.035Harvey CJ, Pilcher J, Richenberg J, Patel U, Frauscher F.Applications of transrectal ultrasound in prostate cancer.Br J Radiol.2012;85(Spec Iss 1):S3–S17. doi:10.1259/bjr/56357549Canadian Cancer Society.Transrectal ultrasound (TRUS).Memorial Sloan Kettering Cancer Center.About your prostate biopsy with ultrasound.Sahin A, Ceylan C, Gazel E, Odabas O.Three different anesthesia techniques for a comfortable prostate biopsy.Urol Ann.2015;7(3):339–344. doi:10.4103/0974-7796.152014Hong A, Hemmingway S, Wetherell D, Dias B, Zargar H.Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible.ANZ J Surg.2022;92(6):1480–1485. doi:10.1111/ans.17593Thomson A, Li M, Grummet J, Sengupta S.Transperineal prostate biopsy: a review of technique.Transl Androl Urol.2020;9(6):3009–3017. doi:10.21037/tau.2019.12.40Alberta Health Services.Sympathetic nerve block: before your procedure.American Cancer Society.Your prostate pathology report: cancer (adenocarcinoma).American Cancer Society.Tests to diagnose and stage prostate cancer.American Urological Association.Clinically localized prostate cancer: AUA/ASTRO/SUO guideline.Rivas JG, Alvarez-Maestro M, Czarniecki M, Czarniecki S, Rodriguez Socarras M, Loeb S.Negative biopsies with rising prostate-specific antigen. What to do?.Eur Med J Urol. 2017;5(1):76-82. doi:10.33590/emjurol/10314704
Bjurlin MA, Carroll PR, Eggener S, et al.Update of the standard operating procedure on the use of multiparametric magnetic resonance imaging for the diagnosis, staging, and management of prostate cancer.J Urol.2020;203(4):706-712. doi:0.1097/JU.0000000000000617
Eklund M, Jaderling F, Discacciati A, et al.MRI-targeted or standard biopsy in prostate cancer screening.N Engl J Med. 2021; 385:908-920. doi:10.1056/NEJMoa2100852
National Cancer Institute.Cancer fast stats: prostate cancer.
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