What is a prostate biopsy?

A prostate biopsy is an elective procedure, typically done in the office, performed to evaluate prostate tissue and help determine the best treatment plan. It uses transrectal or transperineal ultrasound guidance to obtain tissue samples from the prostate.

There are two main approaches:

• Transrectal: The ultrasound probe and biopsy needle pass through the
• Transperineal: The biopsy needle passes through the skin of the perineum (the area between the scrotum and anus), with ultrasound guidance often via a rectal probe.

Your provider will discuss which approach is recommended for you based on your individual factors, such as infection risk, anatomy, or imaging results.

How do I prepare for the procedure?

1. Discontinue any blood thinners (including aspirin) as directed before the
2. Pick up and follow instructions for any prescribed antibiotic(s). Antibiotic use may vary depending on the biopsy approach.
3. Purchase and use a Fleets enema (or equivalent saline enema) 1-2 hours before the procedure to clear the rectum—this helps with ultrasound visualization and is recommended for both approaches.
4. You do not need to
5. Disclose all medications, allergies, medical history, and surgical history to your

*If you take any blood thinners on the following list, discuss with your provider. Do not stop these on your own unless instructed by your cardiologist or Dr. Trotter/Dr. McClintock.

• Plavix (Clopidogrel)
• Pradaxa (Dabigatran)
• Xarelto (Rivaroxaban)
• Eliquis (Apixaban)
• Effient (Prasugrel)
• Brilinta (Ticagrelor)
• Aspirin or Baby Aspirin
• Fish Oil
• Meloxicam

Medications Prescribed For Your Procedure: Please read the instructions on the bottle and below.

• Cipro/Ciprofloxacin, Levaquin/Levofloxacin, Keflex/Cephalexin, or another antibiotic: Start as directed. Complete the full course. It may cause GI upset.

What do I do the day before / the day of the procedure?

1. Start your antibiotic as
2. Use the Fleet enema 1-2 hours before the

How is it performed?

The procedure is performed in our office and usually takes less than 30 minutes. You will be awake with local anesthesia (lidocaine), with the option for nitrous oxide gas.

An ultrasound probe is typically inserted into the rectum to visualize the prostate. Tissue samples (usually 12 or more) are obtained using a small needle from different areas of the prostate, often guided by prior imaging if available. For transrectal, the needle enters through the rectum. For transperineal, the needle enters through the perineal skin.

What do I do after the procedure?

Our office will contact you the day after to check on you and address concerns.

1. Schedule a follow-up appointment about 1-2 weeks later to review pathology
2. Complete the prescribed antibiotic
3. Restart blood thinners if no significant blood in urine or semen after 7 days, or as directed by your physician.
4. Hydrate well with
5. Limit strenuous activity for a few

What to expect after the procedure?

• Blood in urine
• Blood in stool
• Blood in semen
• Testicular, penile, perineal/rectal discomfort or pain
• Irritative voiding or bowel symptoms

What are the risks?

• Infection
• Excessive bleeding
• Urinary retention
• Pain or discomfort

How do I follow-up?

Follow up with your provider approximately 1-2 weeks after the biopsy to review results—we ask all patients to do this regardless of outcome.

When do I call the office?

Call immediately if:

• Excessive pain
• Excessive bleeding
• Fever over 101°F or chills
• Flu-like symptoms
• Nausea or vomiting
• Blood clots in urine or bowel movements
• Difficulty urinating or inability to urinate
• Painful or very frequent urination

Important Contact Information

Midtown Urology

911 W. 38th Street, Suite 200

(512) 451-7935 phone

(512) 451-7965 fax

Hospital for Emergencies

Seton Main Medical Center

1201 W 38th St, Austin, TX 78705