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A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope.

For a prostate biopsy, a thin needle is inserted through the rectum (transrectal biopsy), through the urethra, or through the area between the anus and scrotum (perineum). A transrectal biopsy is the most common method used. The tissue samples taken during the biopsy are examined for cancer cells.

A biopsy may be done when a blood test shows a high level of prostate-specific antigen (PSA) or after a digital rectal examination finds an abnormal prostate or a lump.

Why It Is Done

A prostate biopsy is done to determine:

• If a lump found in the prostate gland is cancer.
• The cause of a high level of prostate-specific antigen (PSA) in the blood.

How To Prepare

Tell your doctor if you:

• Have had any bleeding problems.
• Are allergic to any medications, including anesthetics.
• Take any medications regularly. Be sure your doctor knows the names and doses of all your medications.
• Are taking any blood-thinning medications, such as warfarin (Coumadin), heparin, enoxaparin (Lovenox), aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).

You will need to sign a consent form that says you understand the risks of a prostate biopsy and agree to have the biopsy done. Talk to your health professional about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will indicate.

If a prostate biopsy is done under local anesthesia through the area between the anus and scrotum (perineum), no other special preparation is needed.

If the biopsy is done through the rectum, you may need to have an enema before the biopsy.

If the biopsy is done under general anesthesia, do not eat or drink anything for 8 to 12 hours before the biopsy. During preparation for the biopsy, an intravenous line (IV) is inserted in your arm, and a sedative medication is given about an hour before the biopsy.

How It Is Done

This biopsy is done by a doctor who specializes in men’s genital and urinary problems (urologist) in the doctor’s office, a day surgery clinic, or a hospital operating room.

Before your prostate biopsy, you may be given antibiotics to prevent infection. You may be asked to take off all of your clothes and put on a hospital gown.

Your skin at the biopsy site is cleaned with an antiseptic solution, and the area around it is covered with sterile cloth. Your doctor will wear sterile gloves. It is very important that you do not touch this sterile area.

Transrectal ultrasound (TRUS) is commonly used to guide the placement of the needle during a prostate biopsy.

Through the rectum (transrectal biopsy)

Several positions are possible for this method. You may be asked to kneel, lie on your side, or lie on your back with your feet resting in stirrups. Your doctor may inject a local anesthetic around the prostate gland before the biopsy is taken.

Transrectal ultrasound (TRUS) is generally used to guide the needle to the correct biopsy location. A prostate biopsy is usually done with a spring-loaded needle. The needle quickly enters the prostate gland and removes a tissue sample.

The biopsy can also be done with a needle guide attached to your doctor’s finger. He or she inserts the finger into the rectum. Then the needle is slid along the guide, through the wall of the rectum, and into the prostate gland. The needle is turned to collect a tissue sample and then pulled out.

A transrectal biopsy takes about 30 minutes. See an illustration of transrectal prostate biopsy.

Through the urethra (transurethral biopsy)

For this method, you will lie on your back with your feet resting in stirrups. General or local anesthesia may be used.

A lighted scope (cystoscope) is inserted into your urethra. It allows your doctor to look directly at the prostate gland. A cutting loop is passed through the cystoscope to remove small pieces of prostate tissue.

A transurethral biopsy usually takes about 30 to 45 minutes.

Through the perineum (transperineal biopsy)

Transperineal biopsy is not done as commonly as transrectal or transurethral biopsy. You will lie on an examining table either on your side or on your back with your knees bent. General or local anesthesia may be used.

A small incision is made in your perineum. Your doctor inserts a finger into the rectum to hold the prostate gland and then inserts the needle through the incision and into the prostate gland. To collect a sample of tissue, the needle is gently turned and then pulled out. Biopsy samples may be taken from several areas of the prostate. Pressure is applied to stop the bleeding, and a small bandage is placed over the cut. The biopsy usually takes about 15 to 30 minutes.

How It Feels

You may feel a slight sting when you receive an injection of medication to numb your skin. You may feel a dull pressure as the biopsy needle is inserted. For a transrectal biopsy, you may feel pressure in the rectum while the ultrasound probe or guiding finger is in place. You also may feel a brief, sharp pain as the biopsy needle is inserted into the prostate gland. Usually several biopsy samples are collected.

Following the biopsy, you will be asked to avoid strenuous activities for about 4 hours. You may have mild pain in the pelvic area and blood in your urine for up to 5 days. Also, you may have some discoloration of your semen for up to one month after the biopsy. If you had a transrectal biopsy, you may experience a small amount of bleeding from your rectum for 2 to 3 days after the biopsy.

If you have a transurethral biopsy, you may have a urinary catheter in place for a few hours after the biopsy. You also may need to take an antibiotic medication for several days after the biopsy.

If you have a general anesthetic, you will be in a recovery room for a few hours after the biopsy. You will need someone to drive you home when you are released. When you get home, your muscles may ache and you may feel tired for the rest of the day.

Risks

A prostate biopsy has a slight risk of causing problems such as:

• Infection. This is more common in men who have undiagnosed prostatitis. Usually, taking antibiotic medication before the biopsy prevents an infection from developing.
• Bleeding into the urethra or bladder. This can cause a blood blister (hematoma), an inability to urinate, or a need to urinate often.
• Bleeding from the rectum. If you have a transrectal biopsy, you may experience a small amount of bleeding from your rectum for 2 to 3 days after the biopsy.
• An allergic reaction to the anesthetic medications used during the biopsy.

After the biopsy

Call your doctor immediately if you:

• Have heavy bleeding or bleeding continues longer than 2 to 3 days.
• Have increased pain.
• Have a fever.
• Are unable to urinate within 8 hours or have blood in the urine for longer than 2 to 3 days.

Results

A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope. Results are usually available within 10 days.

Normal:	The prostate gland tissue samples appear normal under the microscope, with no signs of infection or cancer.
Abnormal:	Cancer cells or signs of infection are found.
	Signs of an abnormal noncancerous enlargement of the prostate gland (benign prostatic hyperplasia, or BPH), tuberculosis, lymphoma, or rectal or bladder cancer are present.

If cancer cells are present, a grade (Gleason score) will be given, which your doctor will discuss with you. The Gleason score is considered a tool for predicting how aggressive the cancer is.

What Affects the Test

Factors that can interfere with your test or the accuracy of the results include:

• The biopsy may not contain enough tissue to make a diagnosis.
• A chance that a cancer may be missed since the biopsy takes a small amount of tissue.

What To Think About

• Normal prostate biopsy results do not rule out cancer.
• If the prostate biopsy results show cancer, other tests may be needed to determine the spread of the cancer. These tests may include a blood test (prostate-specific antigen), bone scan, lymph node biopsy, or computed tomography (CT) scan. For more information, see the medical tests Prostate-Specific Antigen (PSA), Bone Scan, Lymph Node Biopsy, and Computed Tomography (CT) Scan.
• Not all types of prostate cancer are treated. There are many factors to consider when deciding on a treatment plan. For more information, see the topic Prostate Cancer.
• A prostate gland biopsy does not cause problems with erections and will not make a man infertile.

A vasectomy is considered a permanent method of birth control. Vasectomy reversal (vasovasostomy) reconnects the tubes (vas deferens) that were cut during a vasectomy.

Vasectomy reversal is usually an outpatient procedure without an overnight stay in the hospital. Spinal or general anesthesia is commonly used to ensure that you remain completely still during the surgery.

The chances of vasectomy reversal success depend on how much time has passed between the vasectomy and the reversal. Over time, additional blockages can form, and some men develop antibodies to their own sperm.

The surgery is more complicated and takes more time when blockage between the vas deferens and the epididymis requires correction (vasoepididymostomy).

What To Expect After Surgery

Vasectomy reversal usually takes from 2 to 4 hours, followed by a few more hours for recovery from the anesthetic. You can expect to go home the same day.

Pain may be mild to moderate. You should be able to resume normal activities, including sex, within 3 weeks.

Why It Is Done

Vasectomy reversal is performed when you have had a vasectomy and now want to be fertile.

How Well It Works

Chances of a successful vasectomy reversal decline over time. Reversals are more successful during the first 10 years after vasectomy.

In general, vasectomy reversal:

• Leads to overall pregnancy rates of greater than 50%.
• Has the greatest chance of success within 3 years of the vasectomy.
• Leads to pregnancy only about 30% of the time if the reversal is done 10 years after vasectomy.

Risks

Risks of vasectomy reversal include:

• Infection at the site of surgery.
• Fluid buildup in the scrotum (hydrocele) that may require draining.
• Injury to the arteries or nerves in the scrotum.

What To Think About

Before a vasectomy reversal is performed, your doctor will want to confirm that you were fertile before your vasectomy.

You can have tests to see whether you have sperm antibodies in your semen before and after vasectomy reversal. If there are sperm antibodies in your semen after surgery, your partner is unlikely to become pregnant. In such a case, you may wish to try in vitro fertilization with intracytoplasmic sperm injection.

A vasectomy is considered a permanent method of birth control. A vasectomy prevents the release of sperm when a man ejaculates.

During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen that is ejaculated from the penis. An egg cannot be fertilized when there are no sperm in the semen. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. Because the tubes are blocked before the seminal vesicles and prostate, you still ejaculate about the same amount of fluid.

It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. You must use another method of birth control until you have a semen sample tested and it shows a zero sperm count. Otherwise, you can still get your partner pregnant.

During a vasectomy:

• Your testicles and scrotum are cleaned with an antiseptic and possibly shaved.
• You may be given an oral or intravenous (IV) medicine to reduce anxiety and make you sleepy. If you do take this medicine, you may not remember much about the procedure.
• Each vas deferens is located by touch.
• A local anesthetic is injected into the area.
• Your doctor makes one or two small openings in your scrotum. Through an opening, the two vas deferens tubes are cut. The two ends of the vas deferens are tied, stitched, or sealed. Electrocautery may be used to seal the ends with heat. Scar tissue from the surgery helps block the tubes.
• The vas deferens is then replaced inside the scrotum and the skin is closed with stitches that dissolve and do not have to be removed.

The procedure takes about 20 to 30 minutes and can be done in an office or clinic. It may be done by a family medicine doctor, a urologist, or a general surgeon.

No-scalpel vasectomy is a technique that uses a small clamp with pointed ends. Instead of using a scalpel to cut the skin, the clamp is poked through the skin of the scrotum and then opened. The benefits of this procedure include less bleeding, a smaller hole in the skin, and fewer complications. No-scalpel vasectomy is as effective as traditional vasectomy.

In the Vasclip implant procedure, the vas deferens is locked closed with a device called a Vasclip. The vas deferens is not cut, sutured, or cauterized (sealed by burning), which possibly reduces the potential for pain and complications. Some studies show that clipping is not as effective as other methods of sealing off the vas deferens.

What To Expect After Surgery

Your scrotum will be numb for 1 to 2 hours after a vasectomy. Apply cold packs to the area and lie on your back as much as possible for the rest of the day. Wearing snug underwear or a jockstrap will help ease discomfort and protect the area.

You may have some swelling and minor pain in your scrotum for several days after the surgery. Unless your work is strenuous, you will be able to return to work in 1 or 2 days. Avoid heavy lifting for a week.

You can resume sexual intercourse as soon as you are comfortable, usually in about a week. However, you can still get your partner pregnant until your sperm count is zero. You must use another method of birth control until you have a follow-up sperm count test 2 months after the vasectomy (or after 10 to 20 ejaculations over a shorter period of time). Once your sperm count is zero, no other birth control method is necessary.

A vasectomy will not interfere with your sex drive, ability to have erections, sensation of orgasm, or ability to ejaculate. You may have occasional mild aching in your testicles during sexual arousal for a few months after the surgery.

Why It Is Done

A vasectomy is a permanent method of birth control. Only consider this method when you are sure that you do not want to have a child in the future.

How Well It Works

Vasectomy is a very effective (99.85%) birth control method. Only 1 to 2 women out of 1,000 will have an unplanned pregnancy in the first year after their partners have had a vasectomy.³

Risk of failure

Pregnancy may occur after vasectomy because of:

• Failure to use another birth control method until the sperm count is confirmed to be zero. It usually takes 10 to 20 ejaculations to completely clear sperm from the semen.
• Spontaneous reconnection of a vas deferens or an opening in one end that allows sperm to mix with the semen again. This is very rare.

Risks

The risk of complications after a vasectomy is very low. Complications may include:

• Bleeding under the skin, which may cause swelling or bruising.
• Infection at the site of the incision. In rare instances, an infection develops inside the scrotum.
• Sperm leaking from a vas deferens into the tissue around it and forming a small lump (sperm granuloma). This condition is usually not painful, and it can be treated with rest and pain medication. Occasionally, surgery may be needed to remove the granuloma.
• Inflammation of the tubes that move sperm from the testicles (congestive epididymitis).
• In rare cases, the vas deferens grows back together (recanalization), and the man becomes fertile again.

What To Think About

Advantages

Vasectomy is a permanent method of birth control. Once your semen does not contain sperm, you do not need to worry about using other birth control methods.

Vasectomy is a safer, cheaper procedure that causes fewer complications than tubal ligation in women.

Although vasectomy is expensive, it is a one-time cost and is often covered by medical insurance. The cost of other methods, such as birth control pills or condoms and spermicide, is likely to be greater over time.

Disadvantages

A vasectomy does not protect against sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV). Condoms are the most effective method for preventing STDs. To protect yourself and your partner from STDs, use a condom every time you have sex.

Other considerations

If you are considering a vasectomy, be absolutely certain that you will never want to father a child. Think through whether this might change after any of the following life events:

• One of your living children dies (if you are a father).
• You divorce and lose custody of your children.
• You have a new partner who wants children.
• Your financial situation improves and you can afford another child.
• Your children grow up and leave home.

A vasectomy is not usually recommended for men who are considering banking sperm in case they decide later to have children. Discuss other options with your partner and your health professional.

Surgery to reconnect the vas deferens (vasectomy reversal) is available. However, the reversal procedure is difficult. Sometimes a doctor can remove sperm from the testicle in men who have had a vasectomy or a reversal that didn’t work. The sperm can then be used for in vitro fertilization. Both vasectomy reversal and sperm retrieval can be expensive, may not be covered by insurance, and may not always work.

Some older studies showed a risk of prostate cancer in men who have had vasectomies. However, many years of research have found no clear evidence that vasectomy is linked to prostate cancer.

Some doctors or health insurance plans may require a waiting period from the time you request a vasectomy and the time the procedure is done. This time allows you to be certain about your decision.

Researchers are studying other male birth control methods, such as reversible vasectomy or hormonal methods. Reversible vasectomy involves plugging the vas deferens and then removing the plug when birth control is no longer wanted. Hormonal methods include pills or injections that the man would use to prevent sperm production. So far, no new method has been shown to be effective enough, with low side effects, to be marketed for men.