About Your Transperineal Prostate Biopsy with Ultrasound

Time to Read: About 4 minutes

This information will help you get ready for your transperineal (TRANZ-PAYR-ih-NEE-ul) prostate biopsy with ultrasound at Memorial Sloan Kettering (MSK).


About your prostate

Your prostate is a small, firm gland about the size of a walnut. It’s in front of your rectum, below your bladder (see Figure 1). Your prostate works with other glands in your body to make semen. It surrounds your urethra, the tube that drains urine (pee) from your bladder.

Figure 1. Your prostate and surrounding organs

Figure 1. Your prostate and surrounding organs

About your prostate biopsy

A prostate biopsy is a procedure to collect small pieces of tissue from your prostate. Your healthcare provider will use a thin needle to collect the tissue. They will put the needle into your prostate through the area between your scrotum and anus. This area is called your perineum (PAYR-ih-NEE-um).

An ultrasound is an imaging scan that uses sound waves to make pictures of the inside of your body. Your healthcare provider will use ultrasound imaging during your biopsy. It will help them take tissue from specific parts of your prostate.

After your biopsy, your healthcare provider will send the pieces of tissue to an MSK pathologist. The pathologist will use a microscope to check the tissue for abnormal cells.

Getting ready for your prostate biopsy

Talk with your healthcare provider

Tell your healthcare provider if you:

  • Take anticoagulants (blood thinners). These are medications that affect the way your blood clots.
  • Take steroids, such as prednisone (Deltasone®). A steroid is a medication that helps with inflammation (swelling).
  • Take any other prescription or over-the-counter medications, including patches and creams.
  • Take any dietary supplements, such as vitamin E, multivitamins, and herbal or home remedies.

Buy your supplies

Buy these supplies before your biopsy.

  • 1 saline enema (such as a Fleet® saline enema). You can buy this at your local pharmacy without a prescription.
  • Your healthcare provider may send a prescription for tamsulosin (Flomax®) 0.4 milligram (mg) tablets to you pharmacy. Pick up this medication at least 2 days before your scheduled biopsy.

Plan how you’re getting home

Some people feel lightheaded after their biopsy. It’s best to have someone take you home afterward. They can help you if needed.

7 days before your prostate biopsy

Follow your healthcare provider’s instructions for taking your medications

You may need to stop taking some of your medications before your biopsy. Examples include anticoagulants, aspirin, medications that contain aspirin, multivitamins, and vitamin E. Talk with your healthcare provider about which medications are safe for you to stop taking. Follow their instructions.

For information about medications that contain aspirin and vitamin E, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

4 days before your prostate biopsy

Start taking Flomax®

Your healthcare provider may send a prescription for tamsulosin (Flomax) 0.4 milligram (mg) tablets to your pharmacy. This medication can make it easier for you to urinate after your biopsy. You will start taking Flomax 4 days before your biopsy. Take it for a total of 14 days (2 weeks).

2 days before your prostate biopsy

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), can cause bleeding. Stop taking them 2 days before your procedure. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

The day of your prostate biopsy

Get ready at home

  • Eat breakfast like usual. You should not skip this meal.
  • Drink plenty of water.

Give yourself a saline enema

Give yourself a saline enema 2 hours before your biopsy. Follow the directions on the box.

Arrive at MSK

  • Refer to top of page to see what MSK location you should go to. 

Get ready for your biopsy

  • Staff will review the procedure and check your vital signs before we start the procedure.
  • If blood work is needed, it will be drawn before the biopsy.
  • A gown will be provided to you in the procedure room to change into. 

During the biopsy 

The exact starting time of your biopsy may depend on the length of the procedure scheduled before yours. Your nurse will talk with you about what time your biopsy will start and if there are any delays.

You will be brought to the procedure room and helped onto the procedure table. You will lie on your back and your feet will be placed in stirrups. Your healthcare provider will gently insert a probe into your rectum. They will put an anesthetic (numbing) lubricant on it to help it slide in easily.

Once the probe is in place, they will also give you an anesthetic injection (shot) near your prostate to numb the biopsy site. The probe uses ultrasound to make images of your prostate.

During the biopsy, you will hear a snapping sound. This sound is like snapping a rubber band to your wrist. The biopsy takes about 10 to 15 minutes to get the tissue samples.

When the biopsy is done, the staff will assess you for dizziness or lightheadedness. When it is safe you will be helped off the table to get dressed. You will need to urinate before leaving your appointment.

After your prostate biopsy

24 hours after 

  • Talk with your nurse
    • Tell your nurse if you will be more than 2 hours away from MSK during the first 24 hours after your biopsy. If you have problems such as fever or heavy bleeding, we may tell you to go to MSK’s Urgent Care Center (UCC).
  • Manage any discomfort
    • It’s normal to be sore or uncomfortable after your biopsy, but most people don’t have pain. If you feel sore, you can take acetaminophen (Tylenol®). If that does not help, call your doctor’s office.
  • Shower like normal.

For 3 days after 

  • Do not have sex
    • You can start having sex 3 days after your biopsy
  • Drink plenty of water
    • For 3 days, try to drink 8 to 10 cups (2 liters) of liquid each day. This will help flush out your bladder, prevent infection, and lower the amount of blood in your urine.

5 to 7 days after 

  • Do not exercise for the next 5 days, including
    • Playing any sports.
    • Working out in a gym or outside.
    • Riding a bicycle.
    • Lifting anything heavier than 10 pounds (4.5 kilograms).
  • Get your results
    • Your test results will be ready 5 to 7 days after your biopsy. Your healthcare provider will contact you and explain the results. You can also ask for a copy of your results.

1 to 12 weeks after

Up to 2 weeks

  • Expect blood in urine
    • This bleeding may come and go for the next 1 to 2 weeks.
    • Call your healthcare provider if you have bright red blood or large clots in your urine.

Up to 12 weeks

  • Your semen can look rust-colored
    • Your semen can look rust-colored for up to 12 weeks. This is because there may be a little blood in it.


When to call your healthcare provider

Call your healthcare provider right away if you have any of these things.

  • A fever of 101 °F (38.3 °C) or higher.
  • Heavy bleeding from your rectum.
  • Bleeding from your rectum that will not stop.
  • You can’t urinate.
  • Bright red blood or large clots in your urine.
  • Shaking chills.
  • Dizziness.
  • Any other problems, questions, or concerns.

Last Updated

Monday, April 15, 2024

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