Preparation for a Prostate Biopsy.
If you have been told you need a prostate biopsy, you are probably somewhere between wanting it done tomorrow and hoping it turns out to be unnecessary.
It is worth saying at the outset that a biopsy is not a diagnosis. It is how we find out. A significant proportion of the men I biopsy do not have cancer, and of those who do, many have disease that will never need aggressive treatment. The biopsy tells us which situation we are in.
This article covers what the procedure involves in my practice, how to prepare, and what is normal afterwards.
Why a biopsy is recommended
A biopsy is usually suggested after a combination of findings rather than a single result — most often a PSA that warrants investigation, sometimes a change on examination, and in most cases an MRI performed first.
The MRI matters. It tells us whether there is a lesion worth targeting and where it sits, which shapes how the biopsy is taken. I have written separately about what a prostate MRI shows and what happens next.
If it was a PSA result that started this, how to read a PSA result is worth reading too. A single figure means less than most people assume.
The approach I use
I perform transperineal biopsies.
The needle passes through the skin of the perineum — the area between the scrotum and the anus — rather than through the wall of the rectum. Both routes sample the same gland. The difference is what the needle passes through on the way, and that difference is why the transperineal approach has become standard in Australian practice: it avoids passing through the bowel, which substantially reduces the risk of serious infection.
It also gives better access to the front part of the prostate, which is harder to reach from behind and is where some cancers sit.
If you have read about bowel preparation or enemas before a prostate biopsy, that advice belongs to the transrectal approach and does not apply here.
Targeting. Where the MRI has shown a lesion, I review the images beforehand and target that area under real-time ultrasound guidance during the procedure. Samples are usually taken from the identified area and from the rest of the gland systematically, so nothing is missed elsewhere.
Anaesthetic
A transperineal biopsy is usually done under general anaesthetic, as a day procedure. You come in, have the procedure, and go home the same day.
It can also be performed under local anaesthetic. If a general anaesthetic is not suitable for you — because of other health conditions, previous anaesthetic problems, or a considered preference — say so. It can be arranged, and it means a biopsy remains available to men who have been told elsewhere that they cannot have one.
Which applies to you is a conversation to have at your consultation, not a decision to make from a website.
Preparing
Blood thinners. If you take aspirin, clopidogrel, warfarin, apixaban, rivaroxaban or anything similar, tell us well before the procedure. Some are stopped for a short period beforehand and some are not. Do not stop any of them on your own — the decision depends on why you are taking them, and stopping without advice carries its own risks.
Antibiotics. Antibiotics are not routinely needed for a transperineal biopsy. Where there is a reason you need them, they will be prescribed — we will tell you either way. If you have read that a course of antibiotics before and after is standard, that reflects the transrectal approach, where the needle passes through the bowel wall.
Fasting. If you are having a general anaesthetic you will need to fast beforehand. The hospital will give you the exact times. Follow their instructions rather than a general rule from anywhere else.
Getting home. If you have a general anaesthetic or sedation you cannot drive afterwards. Arrange for someone to take you home.
What to bring and wear. Comfortable, loose clothing. Bring your Medicare card, any imaging and your medication list.
On the day
The procedure itself is short — usually 15 to 30 minutes. Most of your day is admission, preparation and recovery rather than the biopsy itself.
You will be positioned with your legs supported. Under general anaesthetic you will be asleep for all of it. Under local, the area is numbed first and you will feel pressure rather than sharpness.
Afterwards you will be observed in recovery until you are ready to go home, and we will make sure you can pass urine before you leave.
What is normal afterwards
This is the part men most often ring about, so it is worth being specific.
Soreness and bruising in the perineal area for a few days. Sitting may be uncomfortable. Simple pain relief is usually enough.
Blood in the urine is common in the first few days and generally settles within a week or two. It often looks more dramatic than it is — a very small amount of blood discolours a lot of urine.
Blood in the semen is the one that catches people out. For most men it lasts only a few days. In some it goes on for six weeks or more, which is far longer than anyone expects if nobody has mentioned it.
It usually starts as bright red streaks and turns brown as it settles. Both are normal, and the change in colour is a sign it is resolving rather than a sign of anything new.
The reason it happens is straightforward: the biopsy needle passes into the prostate, and the prostate is the gland that produces seminal fluid. Some bleeding into that fluid is an expected consequence of taking the samples, not a sign that something has gone wrong.
If you are in a relationship, it is worth telling your partner to expect it. A lot of the distress this causes comes from nobody having mentioned it.
When to ring us
Some things are not part of normal recovery:
A fever, shivering or feeling generally unwell — this needs attention the same day, not the next morning
Inability to pass urine
Heavy or persistent bleeding, or passing clots
Increasing rather than settling pain
If any of these happen, contact the rooms. Out of hours, go to your nearest emergency department. Do not wait to see whether it improves.
Results
Samples go to a pathologist. Allow up to two weeks for the result. It is often quicker than that, but two weeks is the outside figure so you are not counting days against a deadline we did not set.
I go through the results with you in person rather than over the phone, because the conversation usually matters more than the headline.
There are broadly three outcomes.
No cancer found. This is a common result. Depending on what prompted the biopsy, we may continue monitoring your PSA rather than doing anything further.
A benign finding. Changes such as prostate enlargement or inflammation may explain your symptoms or your PSA, and we will talk about whether they need treating in their own right.
Cancer found. If cancer is present, the report describes how much and what it looks like under the microscope, graded as a Grade Group from 1 to 5 (you may also see the older Gleason score alongside it). That grading, together with your PSA and imaging, determines what happens next — which for many men is monitoring rather than immediate treatment.
Finding cancer does not automatically mean surgery. The prostate cancer pathway sets out the options and how the decision is approached.
The summary
A prostate biopsy is an uncomfortable few days in exchange for knowing where you stand. Most men find the waiting harder than the procedure.
If you have questions before yours, ring the rooms rather than sitting on them. More detail about the procedure is on the prostate biopsy page.
Clinical note: This article provides general information and is not a substitute for individual medical advice. Your own preparation instructions come from your treating team and the hospital, and they take precedence over anything written here.
Last reviewed: September 2026
About the author:
Dr Deanne Soares is a Melbourne urologist specialising in robotic prostate, kidney and bladder cancer surgery.