About Your Transperineal Prostate Biopsy with Ultrasound Under Anesthesia

This information will help you get ready for your tranperineal (TRANZ-PAYR-ih-NEE-ul) prostate biopsy with ultrasound under anesthesia (medication to make you sleep during a procedure). It will also help you know what to expect after your biopsy.

About your prostate

Your prostate is a small, firm gland about the size of a walnut. It works with other glands in your body to make semen.

Your prostate is in front of your rectum, below your bladder (see Figure 1). It surrounds your urethra, the tube that drains urine (pee) from your bladder.

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 certain parts of your prostate.

After your biopsy, your healthcare provider will send the pieces of tissue to an MSK pathologist. A pathologist is a doctor who uses a microscope to diagnose disease. They will check the tissue for abnormal (not normal) cells.

Getting ready for your prostate biopsy

Talk with your healthcare provider

Tell your healthcare provider if you:

• Take anticoagulants (blood thinners). These are medicines that affect the way your blood clots.
• Take steroids, such as prednisone (Deltasone®). A steroid is a medicine 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.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you.

7 days before your prostate biopsy

Follow your healthcare provider’s instructions for taking your medicines

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

For information about medicines that have 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 medicine 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 before your prostate biopsy

A staff member from the Admitting Office will call you after 2 p.m. the day before your biopsy. If your biopsy is scheduled for a Monday, they’ll call you the Friday before. If you don’t get a call by 7 p.m., call 212-639-5014.

The staff member will tell you what time to get to the hospital for your biopsy. They’ll also remind you where to go.

If you have any changes in your health or you need to cancel your biopsy for any reason, call your surgeon. Offices are usually open Monday through Friday from 9 a.m. to 5 p.m. After 5 p.m., during the weekend, and on holidays, call 212-639-2000. Ask for the doctor who is covering for your doctor.

Instructions for eating

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Stop eating at midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.

If your healthcare provider told you to stop eating earlier than midnight, follow their instructions. Some people need to fast (not eat) for longer before their surgery.

The day of your prostate biopsy

Instructions for drinking

Between midnight (12 a.m.) and 2 hours before your arrival time, only drink the liquids on the list below. Do not eat or drink anything else. Stop drinking 2 hours before your arrival time.

• Water.
• Clear apple juice, clear grape juice, or clear cranberry juice.
• Gatorade or Powerade.
• Black coffee or plain tea. It’s OK to add sugar. Do not add anything else.
  • Do not add any amount of any type of milk or creamer. This includes plant-based milks and creamers.
  • Do not add honey.
  • Do not add flavored syrup.

If you have diabetes, pay attention to the amount of sugar in these drinks. It will be easier to control your blood sugar levels if you include sugar-free, low-sugar, or no added sugar versions of these drinks.

It’s helpful to stay hydrated before surgery, so drink if you are thirsty. Do not drink more than you need. You will get intravenous (IV) fluids during your surgery.

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Stop drinking 2 hours before your arrival time. This includes water.

Give yourself a saline enema

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

Intravenous (IV) antibiotics

Your healthcare provider may decide you need IV antibiotics instead of oral antibiotics. If they do, you’ll get the IV medicine through a vein in your arm while you’re in the hospital.

Before you leave for your biopsy

• Do not wear any metal objects. Take off all jewelry, including body piercings. The equipment used during your biopsy can cause burns if it touches metal.
• Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
• Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
• If you wear contact lenses, wear your glasses instead. Wearing contact lenses during a procedure can damage your eyes. Remember to bring a case for them.

Get ready for your biopsy

• When it’s time to change for your procedure, your nurse will give you a hospital gown, robe, and socks to change into.
• Before you go into the operating room, you must take off your hearing aids, dentures, prosthetic devices, wig, and religious articles.
• To lower your risk of infection, we may give you antibiotic medicine through an intravenous (IV) line in 1 of your veins. It most often is in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room. An anesthesiologist (a-nes-THEE-zee-AH-loh-jist) is a doctor with special training in using anesthesia during a procedure. 
• 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’s a delay.

During the biopsy 

• You will get anesthesia before the biopsy starts.
• Your biopsy will take about 20 to 30 minutes.

Once biopsy is done

• When you wake up, you’ll be in the Post Anesthesia Care Unit (PACU)
• A nurse will be monitor your body temperature, pulse, blood pressure, and oxygen levels. You will need to urinate before you’re discharged.
• Your nurse will talk with you and your caregiver about your discharge instructions before you go home.

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. Most people do not 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 cannot urinate
• Bright red blood or large clots in your urine
• Shaking chills
• Dizziness
• Any other problems, questions, or concerns