Preparing for a Prostate Biopsy: A Patient’s Guide

Prostate Biopsy Preparation: Essential Steps for Better Experience

If your doctor has recommended a prostate biopsy, you’re likely experiencing a mix of concern, uncertainty, and questions. That’s completely normal. As someone who’s been through this journey and spoken with hundreds of men about their experiences, I want to provide you with a straightforward, honest guide to help you prepare—both physically and mentally.

A prostate biopsy isn’t something any man looks forward to, but understanding what to expect can make the experience significantly less stressful. This guide will walk you through everything you need to know before, during, and after the procedure.

Before diving into preparation details, let’s briefly understand why you might need this procedure:

Elevated PSA levels: A blood test showing higher-than-normal prostate-specific antigen
Abnormal digital rectal exam (DRE): Your doctor felt irregularities during a physical examination
Suspicious areas on imaging: MRI or other scans revealed areas of concern
Active surveillance: Monitoring of previously identified low-risk prostate cancer
Follow-up after previous abnormal results: Even if a previous biopsy was negative

Remember, a biopsy recommendation doesn’t automatically mean you have cancer—it’s simply the most reliable way to find out for sure.

“About 75% of men with an elevated PSA do not have prostate cancer. The biopsy helps us identify who truly needs treatment and who doesn’t.” – Dr. James Thompson, Urologist

Types of Prostate Biopsies

There are two main approaches to prostate biopsy, and knowing which one you’ll undergo helps you prepare appropriately:

Transrectal Biopsy

This is the traditional and still most common approach. The doctor inserts an ultrasound probe into the rectum to visualize the prostate, then uses a needle to collect tissue samples through the rectal wall.

Key preparation differences:

Requires thorough bowel preparation (enema)
Higher risk of infection (requiring antibiotics)
Usually performed with local anesthesia

Transperineal Biopsy

This newer approach accesses the prostate through the perineum (the area between the scrotum and rectum). It’s gaining popularity due to lower infection rates.

Key preparation differences:

May not require bowel preparation
Lower infection risk
Often performed under general anesthesia or deeper sedation
May have less blood in stool afterward

Ask your doctor which approach they’ll be using, as this affects how you’ll prepare.

One Week Before Your Biopsy

Medication Adjustments

This is critical—certain medications can increase bleeding risk during and after your biopsy:

Blood thinners: Stop taking warfarin, clopidogrel, rivaroxaban, apixaban, or dabigatran as directed by your doctor (usually 5-7 days before)
Aspirin and NSAIDs: Discontinue aspirin products, ibuprofen (Advil, Motrin), naproxen (Aleve), and other anti-inflammatory medications 5-7 days before
Supplements: Stop vitamin E, fish oil, ginseng, garlic supplements, and other natural products that may thin blood

Important: Never stop prescription medications without consulting your doctor first. They’ll provide specific instructions based on your medical history and risk factors.

Medical Screening

Your doctor may order:

Urine test to check for urinary tract infection
Blood tests to assess clotting function
COVID-19 screening (depending on facility policies)

If you have a urinary tract infection, your biopsy will likely be postponed until the infection is treated with antibiotics.

Practical Preparations

Arrange for someone to drive you home after the procedure, especially if you’ll receive sedation
Plan to take 1-2 days off work if possible (though many men return to light duties the same day)
Purchase supplies you’ll need for recovery (see the recovery section below)
Fill any prescription medications (antibiotics, pain relievers) in advance

The Day Before Your Biopsy

Diet Modifications

Eat light meals
Avoid gas-producing foods (beans, broccoli, cabbage)
Stay well-hydrated with water
Stop eating solid foods 4-6 hours before the procedure if sedation is planned
Avoid alcohol for at least 24 hours before the biopsy

Bowel Preparation

For transrectal biopsies, cleaning the bowel is essential:

Use a saline enema (Fleet enema) the evening before and/or the morning of the procedure
Follow the specific timing instructions provided by your doctor
Complete the enema at least 2-3 hours before your appointment time

Start Antibiotics

Most doctors prescribe antibiotics to prevent infection:

Typically begin the day before the procedure
Common antibiotics include ciprofloxacin, cefixime, or sulfamethoxazole-trimethoprim
Take exactly as prescribed, even if you feel fine
If you have any allergies to antibiotics, make sure your doctor knows

Mental Preparation

It’s normal to feel anxious. Consider:

Reading about others’ experiences
Practicing deep breathing or meditation techniques
Talking with someone who has undergone the procedure
Writing down questions to ask your doctor

The Morning of Your Biopsy

Final Preparations

Take a shower (some doctors recommend using antibacterial soap)
Take your prescribed antibiotics as directed
Use the enema if instructed to do so that morning
Wear loose, comfortable clothing
Bring your insurance card and identification
Arrive early to complete paperwork

What to Bring

List of all medications and supplements you take
Names and contact information for your doctors
A bottle of water for after the procedure
A pad or liner if you’re concerned about light bleeding
Something to read or listen to while waiting
Your support person (if allowed under current policies)

What Happens During the Biopsy

Understanding the procedure itself can help reduce anxiety:

Check-in and preparation: You’ll change into a gown and review the procedure with the medical team
Positioning: You’ll lie on your side with knees drawn up toward your chest (for transrectal) or on your back with legs in stirrups (for transperineal)
Anesthesia: Local anesthetic will be injected to numb the area
Imaging: An ultrasound probe will be inserted to visualize the prostate
Tissue collection: A spring-loaded biopsy needle will collect 10-18 small tissue samples
Completion: The samples are prepared for laboratory analysis
Recovery: Brief monitoring before you’re cleared to go home

The entire procedure typically takes 20-30 minutes, with the actual sampling portion lasting about 10 minutes.

Pain Management During the Procedure

Most men report mild to moderate discomfort rather than severe pain:

Local anesthesia significantly reduces pain
You’ll feel pressure from the ultrasound probe
Each biopsy sample feels like a quick snap or pinch
Breathing slowly and deeply helps manage discomfort
Some centers offer additional sedation if needed

Immediately After Your Biopsy

What to Expect

You’ll rest briefly in the recovery area
The medical team will check for excessive bleeding
You’ll receive instructions for at-home care
You may feel some soreness or urgency to urinate

Common Immediate Side Effects

Rectal discomfort or pressure
Light bleeding from the rectum
Blood in urine (often pink or rust-colored)
Difficulty urinating due to swelling
Fatigue from the procedure and any medications

Recovery at Home

The First 24 Hours

Rest and limit physical activity
Stay well-hydrated (aim for 8-10 glasses of water)
Take antibiotics exactly as prescribed
Use acetaminophen (Tylenol) for discomfort if needed
Avoid alcohol, which can increase bleeding risk
Monitor for signs of infection (fever, chills, increasing pain)

Normal Side Effects During Recovery

Blood in urine: May last 1-2 weeks, typically more noticeable at the beginning or end of urination
Blood in stool: Usually resolves within a few days
Blood in semen: Can persist for 6-12 weeks and may appear rust-colored or brownish
Urinary symptoms: Frequency, urgency, or mild burning when urinating
Rectal or perineal soreness: Usually improves within a few days

Activity Restrictions

Avoid strenuous exercise for 3-5 days
No heavy lifting (over 10 pounds) for 3-5 days
Avoid sexual activity for 3-7 days
Resume normal diet, but consider adding fiber to prevent constipation
Return to work when comfortable (typically 1-2 days for desk jobs)

When to Seek Medical Attention

Contact your doctor immediately if you experience:

Fever over 101°F (38.3°C) or chills
Inability to urinate for 6-8 hours
Heavy bleeding that doesn’t slow down
Severe pain not relieved by over-the-counter pain medication
Blood clots in urine
Increasing redness, swelling, or discharge from the biopsy site

These symptoms could indicate infection or other complications requiring prompt treatment.

Getting Your Results

The waiting period can be challenging emotionally. Here’s what to expect:

Results typically take 3-7 business days
Your doctor may call you or schedule an in-person appointment to discuss findings
The pathology report will classify tissue samples as:
- Benign: No cancer detected
- Suspicious/atypical: Abnormal cells that aren’t definitively cancerous
- Prostatic intraepithelial neoplasia (PIN): Precancerous changes
- Cancer: Classified by Gleason score and Grade Group

If Your Biopsy Shows Cancer

Remember that prostate cancer is often slow-growing, and you have time to make informed decisions. Your doctor will discuss:

The Gleason score and Grade Group (measures of cancer aggressiveness)
The extent of cancer in the samples
Additional tests that may be needed
Treatment options based on your specific situation

If Your Biopsy Is Negative

A negative result is good news, but doesn’t always mean you’re in the clear:

Your doctor may recommend continued monitoring of PSA levels
Follow-up biopsies might be needed if PSA continues to rise
MRI fusion biopsies might be considered for more targeted sampling
Lifestyle changes to support prostate health may be discussed

Men’s Experiences: What Real Patients Say

I’ve spoken with hundreds of men about their biopsy experiences. Here are some common reflections:

“The anticipation was much worse than the actual procedure. I worked myself up for weeks, but it was over before I knew it.” – Robert, 58

“I wish I’d known how common it is to see blood in your semen. The first time I saw it, I panicked and called the emergency room, only to find out it’s completely normal and can last for months.” – James, 62

“Taking the full course of antibiotics was crucial. A friend of mine stopped taking them when he felt fine and ended up with a serious infection.” – Michael, 55

“The best advice I got was to stay hydrated before and after. It seemed to help with the urinary symptoms and recovery time.” – David, 67

Frequently Asked Questions

Q: Will the biopsy be painful? A: Most men experience pressure and brief discomfort rather than severe pain. Local anesthesia significantly reduces pain during the procedure.

Q: How many samples will be taken? A: Typically 10-18 samples, depending on your prostate size and the reason for the biopsy.

Q: Will I be able to drive myself home? A: It’s recommended to have someone drive you home, especially if you receive sedation.

Q: How soon will I know if I have cancer? A: Results usually take 3-7 business days. Your doctor will contact you to discuss the findings.

Q: Can I take ibuprofen after the procedure for pain? A: Most doctors recommend acetaminophen (Tylenol) instead of NSAIDs like ibuprofen, which can increase bleeding risk.

Q: Is it normal to have blood in my ejaculate? A: Yes, this is very common and can last up to 12 weeks after the biopsy.

Conclusion

A prostate biopsy is an important diagnostic tool that helps your medical team make informed decisions about your health. While no one looks forward to the procedure, being well-prepared can make it more tolerable and reduce the risk of complications.

Remember that millions of men undergo this procedure each year, and the vast majority experience only temporary discomfort and minor side effects. By following your doctor’s instructions and the guidelines in this article, you’ll be well-positioned for a smooth experience and quick recovery.

Have you undergone a prostate biopsy? Share your experience and tips in the comments below to help other men in our community prepare for their procedure.

This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.

References:

American Urological Association. Guidelines for Prostate Biopsy Procedures.
Mayo Clinic. Prostate biopsy: What to expect before, during and after.
Johns Hopkins Medicine. Prostate Biopsy.
Memorial Sloan Kettering Cancer Center. About Your Prostate Biopsy with Ultrasound.
Harvard Health Publishing. How to make your prostate biopsy go better: Before, during, and after.

Diagnostic Procedures, Screening and Diagnosis