Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Sign Up
PubMed This is a summary of 25 peer-reviewed journal articles Updated
Urology · Prostate Cancer

Why Are Prostate Biopsies Done? Risks and Methods Explained

At a Glance

Targeted samples test MRI-visible areas of the prostate, while systematic samples check the rest of the gland. Using both can find cancer the MRI misses and grade it more accurately. Most effects are temporary, but fever, inability to urinate, or heavy bleeding require urgent care.

In this answer

5 sections

01

Why Both Targeted and Systematic Samples Are Needed

02

Transrectal vs. Transperineal Approaches

03

Managing Blood Thinners Before the Biopsy

04

What to Expect: Side Effects vs. Severe Risks

05

When to Seek Urgent Medical Care

When an MRI shows a suspicious area in the prostate, a biopsy often combines targeted cores (samples aimed at the MRI-visible spot) and systematic cores (template-based samples from other regions of the prostate). Combining these methods usually improves the chance of detecting clinically significant cancer—cancer that is more likely to grow, spread, or need treatment—and helps determine its grade accurately [1][2]. While biopsies are highly effective at finding cancer, they carry risks such as temporary bleeding, infection, or difficulty urinating. Understanding these methods and their risks will help you prepare and know when to seek medical care.

Why Both Targeted and Systematic Samples Are Needed

An MRI highlights areas of suspicion but is not a definitive diagnosis; only a biopsy can confirm if cancer is present. Furthermore, prostate cancer is often multifocal, meaning it can grow in several different areas of the gland at once.

  • Targeted biopsy: The doctor aims the needle directly at the suspicious lesion seen on the MRI [1].
  • Systematic biopsy: The doctor takes samples in a planned pattern across the rest of the prostate.

Research shows combining these methods offers distinct advantages:

  • Catching invisible cancer: Systematic cores can detect significant cancer that the MRI missed or that sits just outside the targeted zone [3][4].
  • More accurate grading: Combining the two approaches improves the accuracy of grading the cancer (often reported as a Gleason score or Grade Group), which is critical for estimating risk and choosing the right treatment [5]. Relying only on targeted cores can sometimes underestimate the cancer’s grade [5].

Transrectal vs. Transperineal Approaches

The biopsy needle can reach the prostate through two routes. Cancer detection is generally similar between the two [6][7].

  • Transrectal (TR) biopsy: The needle passes through the wall of the rectum. Because the rectum naturally contains bacteria, there is a risk of introducing this bacteria into the prostate or bloodstream. To lower this risk, your center may prescribe preventative antibiotics and use an iodine cleansing swab [8][9]. This route has a slightly higher risk of temporary rectal bleeding [7].
  • Transperineal (TP) biopsy: The needle passes through the perineum (the skin between the scrotum and the anus). By avoiding the rectum entirely, this method generally lowers—though does not completely eliminate—the risk of severe infections and sepsis [7][10]. It also causes less rectal bleeding [7]. However, it may cause slightly more short-term pain or bruising at the perineum, and depending on your center’s technique, it might be performed under local anesthesia, sedation, or general anesthesia [11][12].

Managing Blood Thinners Before the Biopsy

If you take anticoagulants (blood thinners) or antiplatelet medications (like daily aspirin, clopidogrel, warfarin, or apixaban), you must have a coordinated plan. Studies suggest that continuing certain low-dose blood thinners might only slightly increase the risk of minor bleeding [13][14]. However, the exact plan depends on your kidney function, why you take the drug, and your specific risk of stroke or blood clots [13].

Never stop, skip, or “bridge” your medication without explicit written instructions from both your urologist and the prescribing doctor. Stopping medications independently can dangerously increase your risk of a stroke or blood clot.

What to Expect: Side Effects vs. Severe Risks

Most side effects after a biopsy are minor and temporary [15]. You can generally expect:

  • Blood in your semen (hematospermia), which can last for several weeks [15].
  • Minor blood in your urine (hematuria) or stool (spotting) for several days [15][11].
  • Mild discomfort, bruising, or soreness in the prostate or perineum area [12].

(Note: Depending on whether you receive sedation or general anesthesia, you may need someone to drive you home and monitor you for the first 24 hours.)

Severe Risks Requiring Prompt Care

While rare, severe complications require prompt medical assessment [16][17][18]:

  • Infection and Sepsis: Fevers, shaking chills, or feeling seriously unwell can indicate a serious infection that requires immediate medical evaluation to determine if you need cultures, urgent antibiotics, or hospital treatment [19][20][18]. Sepsis can worsen quickly.
  • Urinary Retention: In approximate ranges of 4% to 6% of cases (varying by prostate size and baseline symptoms), men may find themselves unable to urinate [21][22]. This may require prompt assessment and placement of a temporary catheter.
  • Severe Bleeding: Passing large amounts of thick blood or large clots (beyond minor spotting), continuous heavy bleeding, or experiencing dizziness and abdominal pain requires emergency care [16][23][24].

When to Seek Urgent Medical Care

Go to an emergency room or contact your urologist immediately if you experience:

  • A fever (typically over 100.4°F or 38°C), severe chills, or sudden marked weakness [19][20].
  • An absolute inability to urinate, or painful bladder pressure with only small amounts of urine coming out [22].
  • Passing large amounts of thick blood or large clots in your urine or stool, or bleeding that does not stop [16].
  • Dizziness, fainting, or severe new abdominal or lower back pain [24][25].

Common questions in this guide

Why does a prostate biopsy use both targeted and systematic samples?
Targeted samples are aimed at suspicious areas seen on MRI, while systematic samples check other parts of the prostate. Prostate cancer can occur in more than one area, and MRI can miss cancer outside the visible lesion. Using both approaches can improve detection and help doctors grade the cancer more accurately.
Is a transperineal biopsy safer than a transrectal biopsy?
Both routes detect prostate cancer at similar rates. A transperineal biopsy generally has a lower risk of serious infection and sepsis and causes less rectal bleeding, but it may cause more short-term pain or bruising in the area between the scrotum and anus. The type of anesthesia varies by center.
Which side effects are expected after a prostate biopsy?
Blood in the semen can last for several weeks, while small amounts of blood in the urine or stool and mild soreness or bruising usually improve over several days. These effects are generally temporary, but large amounts of blood, clots, or bleeding that does not stop need urgent care.
What symptoms after a prostate biopsy mean I need urgent medical care?
Seek immediate medical assessment for a fever of 100.4°F or 38°C or higher, severe chills, marked weakness, inability to urinate, heavy bleeding or clots, dizziness or fainting, or severe new abdominal or lower-back pain. These symptoms can signal infection, sepsis, urinary retention, or serious bleeding.
Should I stop aspirin or another blood thinner before my prostate biopsy?
Do not stop, skip, or change aspirin, clopidogrel, warfarin, apixaban, or another blood thinner on your own. Your urologist and the clinician who prescribed it should make a coordinated written plan based on your medication, kidney function, and risk of stroke or blood clots.
How many samples will be taken, and when will I receive my prostate biopsy results?
There is no single number of samples that applies to everyone; the plan depends on the MRI findings, prostate anatomy, and your clinician’s protocol. Ask how many targeted and systematic cores are planned, when the pathology report will arrive, and what follow-up is recommended if the biopsy is negative but your PSA remains high.

Questions For You

Answer a question to get research tailored to you. Your answers are private.

Related questions

What Do PI-RADS 3, 4, and 5 Mean on a Prostate MRI? What to Do After a Negative Prostate Biopsy With High PSA? How Long Is ADT With Radiation for Prostate Cancer? What Is the Next Step After a High PSA? Testing Path When Is PSMA PET/CT Needed for Prostate Cancer Staging?
Show more
How Are the Six Prostate Cancer Risk Groups Defined? Can Prostatitis, BPH, Sex, or Cycling Raise PSA Levels? Can You Have Prostate Cancer With a Negative MRI, High PSA? How Do Cribriform and IDC-P Affect Prostate Cancer Risk? Surgery or Radiation Better for High-Risk Prostate Cancer? How Often Is Low-Risk Prostate Cancer Actively Monitored? Can a Second Review Change Your Prostate Cancer Grade? What Do T, N, and M Stages Mean in Prostate Cancer? Should I Get Genetic Testing After Prostate Cancer? How Do Age and Health Affect Prostate Cancer Treatment? When to Leave Active Surveillance for Prostate Cancer? Are Genomic Tests Useful for Prostate Cancer Decisions? Can Testosterone or Supplements Worsen Prostate Cancer? When Should I Start Prostate Cancer Screening If High Risk?

Get notified when new evidence is published on prostate adenocarcinoma.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Which biopsy route (transrectal or transperineal) do you recommend for my specific case, and which anesthesia will I receive?
  2. 2.What are your exact instructions for managing my specific blood thinner or antiplatelet medication leading up to the biopsy?
  3. 3.What is your center's protocol for preventing infection, and will you do a pre-biopsy culture if we use the transrectal approach?
  4. 4.How many targeted and systematic cores do you plan to take?
  5. 5.When and how will I receive the pathology report, and what is the plan if the biopsy is negative but my PSA stays high?
  6. 6.What should I do and who should I contact if I develop a fever or cannot urinate after hours or over the weekend?

References

References (25)
  1. 1

    Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study.

    Rouvière O, Puech P, Renard-Penna R, et al.

    The Lancet. Oncology 2019; (20(1)):100-109 doi:10.1016/S1470-2045(18)30569-2.

    PMID: 30470502
  2. 2

    Comparison of Targeted vs Systematic Prostate Biopsy in Men Who Are Biopsy Naive: The Prospective Assessment of Image Registration in the Diagnosis of Prostate Cancer (PAIREDCAP) Study.

    Elkhoury FF, Felker ER, Kwan L, et al.

    JAMA surgery 2019; (154(9)):811-818 doi:10.1001/jamasurg.2019.1734.

    PMID: 31188412
  3. 3

    Targeted Prostate Biopsy: Umbra, Penumbra, and Value of Perilesional Sampling.

    Brisbane WG, Priester AM, Ballon J, et al.

    European urology 2022; (82(3)):303-310 doi:10.1016/j.eururo.2022.01.008.

    PMID: 35115177
  4. 4

    Clinically significant prostate cancer detected by systematic biopsy in patients with MRI lesions.

    Fletcher SA, Alshak MN, Lee S, et al.

    BJU international 2025; (136(4)):669-674 doi:10.1111/bju.16816.

    PMID: 40506262
  5. 5

    MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis.

    Ahdoot M, Wilbur AR, Reese SE, et al.

    The New England journal of medicine 2020; (382(10)):917-928 doi:10.1056/NEJMoa1910038.

    PMID: 32130814
  6. 6

    Clinically Significant Prostate Cancer Detection Following Transrectal and Transperineal Biopsy: Results of the Prostate Biopsy Efficacy and Complications Randomized Clinical Trial.

    Mian BM, Feustel PJ, Aziz A, et al.

    The Journal of urology 2024; (212(1)):21-31 doi:10.1097/JU.0000000000003979.

    PMID: 38700844
  7. 7

    Meta Analysis of Efficacy and Safety of Prostate Biopsy: A Comparison Between Transperineal and Transrectal Approach.

    Mirsya Warli S, Rizky Valentino Torry S, Dharma Kadar D, et al.

    Urology research & practice 2025; (50(4)):208-218 doi:10.5152/tud.2025.24094.

    PMID: 39873401
  8. 8

    Fosfomycin Trometamol for the Prevention of Infectious Complications After Prostate Biopsy: A Consensus Statement by an International Multidisciplinary Group.

    Bjerklund Johansen TE, Kulchavenya E, Lentz GM, et al.

    European urology focus 2022; (8(5)):1483-1492 doi:10.1016/j.euf.2021.11.007.

    PMID: 34920977
  9. 9

    Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis.

    Pradere B, Veeratterapillay R, Dimitropoulos K, et al.

    The Journal of urology 2021; (205(3)):653-663 doi:10.1097/JU.0000000000001399.

    PMID: 33026903
  10. 10

    Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial.

    Mian BM, Feustel PJ, Aziz A, et al.

    The Journal of urology 2024; (211(2)):205-213 doi:10.1097/JU.0000000000003788.

    PMID: 37976319
  11. 11

    Comparisons of efficacy and complications between transrectal and transperineal prostate biopsy with or without antibiotic prophylaxis.

    He J, Guo Z, Huang Y, et al.

    Urologic oncology 2022; (40(5)):191.e9-191.e14 doi:10.1016/j.urolonc.2022.01.004.

    PMID: 35168882
  12. 12

    MRI/US fusion transperineal versus transrectral biopsy of prostate cancer: Outcomes and complication rates, a tertiary medical center experience in the Middle East.

    El-Achkar A, Abou Heidar N, Labban M, et al.

    Turkish journal of urology 2022; (48(2)):98-105 doi:10.5152/tud.2022.21248.

    PMID: 35420051
  13. 13

    Haemorrhagic risk of transperineal ultrasound-guided prostate biopsy performed under continued antithrombotic therapy.

    Akagi N, Kinoshita T, Fujita M, et al.

    BJUI compass 2026; (7(8)):e70260 doi:10.1002/bco2.70260.

    PMID: 42553613
  14. 14

    Safety of 12 core transrectal ultrasound guided prostate biopsy in patients on aspirin.

    Vasudeva P, Kumar N, Kumar A, et al.

    International braz j urol : official journal of the Brazilian Society of Urology 2015; (41(6)):1096-100 doi:10.1590/S1677-5538.IBJU.2015.0053.

    PMID: 26742966
  15. 15

    Antimicrobial Lubricant Did Not Reduce Infection Rate in Transrectal Biopsy Patients in a Large Randomized Trial Due to Low Complication Rates.

    Salomon G, Prues S, Saul J, et al.

    European urology focus 2019; (5(6)):992-997 doi:10.1016/j.euf.2018.06.005.

    PMID: 29941389
  16. 16

    Emergency attendances and hospitalisations for complications after transrectal ultrasound-guided prostate biopsies: a five-year retrospective multicentre study.

    Cheng KC, Lam WC, Chan HC, et al.

    Hong Kong medical journal = Xianggang yi xue za zhi 2019; (25(5)):349-355 doi:10.12809/hkmj197825.

    PMID: 31601774
  17. 17

    Morbidity following transperineal prostate biopsy: Our experience in 8.500 men.

    Pepe P, Pennisi M

    Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica 2022; (94(2)):155-159 doi:10.4081/aiua.2022.2.155.

    PMID: 35775338
  18. 18

    An Update of the American Urological Association White Paper on the Prevention and Treatment of the More Common Complications Related to Prostate Biopsy.

    Liss MA, Ehdaie B, Loeb S, et al.

    The Journal of urology 2017; (198(2)):329-334 doi:10.1016/j.juro.2017.01.103.

    PMID: 28363690
  19. 19

    Infectious and non-infectious complications associated with transrectal MRI-guided prostate biopsy using an alternative antibiotic regimen with oral cefixime.

    Laura W, Mladen S, Joao M

    Journal of infection prevention 2026; 17571774261449132 doi:10.1177/17571774261449132.

    PMID: 42180177
  20. 20

    A significant percentage of patients with transrectal biopsy-related infections have positive blood cultures but negative urine cultures. A literature review and meta-analysis.

    Karakonstantis S, Kalemaki D

    Infectious diseases (London, England) 2018; (50(11-12)):791-803 doi:10.1080/23744235.2018.1508882.

    PMID: 30372643
  21. 21

    Transrectal prostate biopsy complications: a prospective single center study in a mid-income country.

    Schollemberg AJ, Heldwein FL, Santos SD, et al.

    Einstein (Sao Paulo, Brazil) 2025; (23()):eAO1437 doi:10.31744/einstein_journal/2025AO1437.

    PMID: 40900469
  22. 22

    Risk factors for infection and acute urinary retention following transperineal prostate biopsy.

    Sandberg M, Whitman W, Greenberg J, et al.

    International urology and nephrology 2024; (56(3)):819-826 doi:10.1007/s11255-023-03854-0.

    PMID: 37902926
  23. 23

    The management of rectal bleeding following transrectal prostate biopsy: A review of the current literature.

    Quinlan MR, Bolton D, Casey RG

    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 2018; (12(3)):E146-E153 doi:10.5489/cuaj.4660.

    PMID: 29283091
  24. 24

    Intraperitoneal Bleeding After Ultrasound-Guided Transperineal Prostate Biopsy.

    Chapman L, Keihani S, Sanchez A

    Case reports in urology 2024; (2024()):8819291 doi:10.1155/2024/8819291.

    PMID: 39544307
  25. 25

    A Rare Infectious Complication Following Transrectal Prostate Biopsy: Spondylodiscitis With Contiguous Psoas Muscle Abscess.

    Carlos L, Mayta R, Vega M, et al.

    Cureus 2026; (18(1)):e102560 doi:10.7759/cureus.102560.

    PMID: 41769440

This page is for informational purposes only and does not constitute medical advice. Your urologist and prescribing clinician should give you individualized instructions about biopsy preparation, blood thinners, and when to seek urgent care.