What should I expect after a prostate biopsy checking for prostate cancer because of an elevated PSA?

experience has been a great teacher for me....it allows me to recognize a mistake when I've made it the "second" time
  • There will blood places and that is normal. Blood at the tip of your penis, blood when you urinate, blood with bowel movements, and blood in your semen if you are sexually active. Blood is expected and rarely a problem and almost always limited in duration. As a rule, don’t worry about the blood. Urology tip: blood at the beginning of the urinary stream and then clears as you void is prostate in origin a rarely associated with complications or difficulty voiding because of clots. Spotting of blood on your underwear or pajamas in the morning when you awake is expected.
  • If you have trouble voiding to the point that you are uncomfortable, that is something to be concerned about. If you get really full and uncomfortable you need to make your way to an Emergency Room. This usually means you had some underlying early prostate enlargement that has been exacerbated by the biopsy. This is usually a simple matter of  placing a foley catheter, starting a med that helps the prostate open and allow the bladder to empty. If a catheter is necessary it is needed for only a few days.
  • If you develop a fever, now that is a problem. A prostate biopsy is obtained by the needle going through the rectal mucosa and into the prostate. This is associated with about a 3% chance of infection. Difficulty urinating, fever, burning to void, chills are a tip-off and this is a urologic emergency usually requiring I.V. antibiotics depending on the degree of your fever. Chills and fever usually mean there is bacteremia and this is something to call your doctor about or go to the Emergency Room.
  • About 17% of all biopsies result in the diagnosis of cancer. It is my opinion that a second opinion to review the path report is unnecessary as the diagnosis of prostate cancer is “bread and butter” for the average pathologist and missed diagnosis is rare. There is however an opinion difference between a particular Pathologist and another regarding whether the Gleason’s grade is a 6 or 7, as grading is somewhat subjective.
  • There is no evidence that biopsies “seed” the tract of the needle with cancer.
  • There is no evidence that the needle lets “air get to it” and allow for the spread of cancer.
  • You have to have a biopsy of the prostate to know if you have cancer or not. Once you get the results you and your doctor can gauge the aggressiveness of it by the Gleason’s and volume of disease i.e. how many cores are positive and have cancer in them. Armed with this information you then can make “informed ” decisions about what to do, if anything.
  • If you had your biopsy done because of an elevated PSA, then if your biopsy is negative (no cancer) then that level of PSA even if elevated becomes your “baseline” and another biopsy is not necessary unless your PSA goes up or your rectal exam changes.


11 Replies to “What should I expect after a prostate biopsy checking for prostate cancer because of an elevated PSA?”

  1. I had a biopsy 48 hours ago and was having trouble voiding. Went back to the doctor and had a very large amout of urine in the bladder. A catheter was placed in and pulled out an amazing amount of urine. Doc says it was because of my enlarged prostae. Now I am unplugging the catheter and large amounts of blood are coming out. Is this normal?


    1. If the urine inside tube clear and or it is draining well then blood around tube is normal. Even if some blood is in the tube but working well it should be fine. Increasing fluid intake is helpful. Sorry you are having troubles but this is not uncommon. Jm


  2. My friend had a biopsy on 20th June at 11am and was kept in the surgical assessment unit till 9pm when he was sent home with a catheter. Today 10th July he still has a catheter in place and no-one seems to want to remove this even though his consultant says he should not still have it. They say he cannot now have it removed as he is unable to pass urine naturally and may have to wait 5 wks for a letter to be sent out before he can go on a list for urgent prostate surgery. My friend still works although he is 66 yrs old and is getting very frustrated. What on earth is going on at St Peters Hospital and our NHS in England?


  3. This is one of the best lists on your site about what to expect from biopsy. Thanks so much! Blood in semen — well maybe phrased “a high probability of mostly bloody semen” — it wasn’t just a streak of blood in the white output my case. It was mostly bloody. Would have been very startling if I hadn’t been expecting it.

    This is the only place I saw the ‘blood at the tip of the penis’ warning and I saw that with anything that raises pressure down there for a week or two after the biopsy. Thanks for that!!


  4. Is hemotspermia (not after a biopsy) a symptom of prostate cancer? I’ve had two negative biopsies five years ago. My PSA has typically measured in a relatively narrow range of 4.3 to 5.1.


      1. Doctor: As a followup to my earlier question on hematospermia I just received the results from my annual physical. The urine analysis indicated microscopic hematuria. The PSA level was stable at 5.0 and DRE performed by my PCP was normal. I phoned my urologist who indicated that there was no need to move up an appointment scheduled for mid-October. You indicated that hematospermia was usually benign but now that it is combined with microscopic hematuria it is making me more concerned. Should I be insist on an earlier appointment?


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