- What is prostate cancer?
- Finding prostate cancer early
- American Cancer Society recommendations for prostate cancer early detection
- What tests can detect prostate cancer?
- What if the test results aren`t normal?
- What are the signs and symptoms of prostate cancer?
- What are the risk factors for prostate cancer?
- Can prostate cancer be prevented?
- State efforts to ensure prostate cancer screening coverage
- Medicare coverage
- Additional resources
What if the test results aren`t normal?
If the results of early detection tests – the prostate-specific antigen (PSA) blood test and/or digital rectal exam (DRE) – suggest that you might have prostate cancer, your doctor will do a prostate biopsy to find out.
A biopsy is a procedure in which a sample of body tissue is removed and then looked at under a microscope. A core needle biopsy is the main method used to diagnose prostate cancer. It is usually done by a urologist, a surgeon who treats cancers of the genital and urinary tract, which includes the prostate gland.
Using transrectal ultrasound to "see" the prostate gland, the doctor quickly inserts a thin, hollow needle through the wall of the rectum into the prostate gland. When the needle is pulled out, it removes a small cylinder (core) of prostate tissue. This is repeated from 8 to18 times, but most urologists will take about 12 samples.
Though the procedure sounds painful, it usually causes only a brief uncomfortable sensation because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needle in a fraction of a second. Most doctors who do the biopsy will numb the area first with local anesthetic. You might want to ask your doctor if he or she plans to do this.
The biopsy itself takes about 10 minutes and is usually done in the doctor's office. You will likely be given antibiotics to take before the biopsy and possibly for a day or 2 after to reduce the risk of infection.
For a few days after the procedure, you may feel some soreness in the area and will probably notice blood in your urine. You may also have some light bleeding from your rectum, especially if you have hemorrhoids. Many men also see some blood in their semen or have rust colored semen. This can last for several weeks after the biopsy, depending on how frequently you ejaculate.
Your biopsy samples will be sent to a lab, where a pathologist (a doctor who specializes in diagnosing disease in tissue samples) will look at them under a microscope to see if they contain cancer cells. If cancer is present, the pathologist will also assign it a grade, also known as a Gleason score (or Gleason sum), which is number between 2 and 10. The higher your Gleason score, the more likely it is that your cancer will grow and spread quickly.
Getting the biopsy results usually takes at least 1 to 3 days, but it can take longer.
Even taking many samples, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false negative result. If your doctor still strongly suspects prostate cancer (due to a very high PSA level, for example) a repeat biopsy may be needed to help be sure.
Prostate biopsy results are sometimes called suspicious. The pathologist may use terms such as prostatic intraepithelial neoplasia (PIN), atypical small acinar proliferation (ASAP, or just atypia), or proliferative inflammatory atrophy (PIA). Suspicious results mean that the cells do not look quite normal, but they don't look like cancer, either. If your biopsy results come back suspicious, your doctor may want to repeat the biopsy.
More information about the possible results of prostate biopsies can be found in our document, Prostate Cancer.
Last Medical Review: 02/27/2012
Last Revised: 02/27/2012