Based on the PSA and TRUS results, A.B. is scheduled for a prostate biopsy. He wonders

Question

what he needs to do to prepare for this test. Explain a prostate biopsy procedure and how to
prepare for the procedure.

What will be an ideal response?

Answer 1

• Patients preparing for a prostate biopsy should stop all medications that increase bleeding
time: warfarin (Coumadin), clopidogrel (Plavix), aspirin, or nonsteroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Naprosyn, Aleve). Warfarin should be
stopped 5 to 7 days prior; patients should talk to their provider before stopping this medication.
Other anticoagulants and antiplatelet medications should be stopped 1 week prior. Patients can
expect to find some blood in their bowel movements for up to 2 weeks after a biopsy. Herbal
products that may cause increased bleeding, such as gingko biloba, ginger, ginseng, and St. John's
wort, should also be stopped.
• The patient will probably be sedated for this procedure and will need a driver to take him home.
If sedation is used, he will need to fast before this procedure but can take his other medications
as usual. If not allergic, he will be medicated with an antibiotic the day before, the day of, and the
day after the procedure. In addition, he can have a Fleet enema the morning of the procedure. The
preprocedure treatment might vary with different facilities; check the practice in your area before
instructing patients about medications.
• A prostate biopsy is performed by inserting a large ultrasound probe into the rectum. Because the
prostate is located next to the rectum, the probe can be angled to visualize the prostate on the
US screen. A biopsy needle is inserted through the wall of the rectum into the prostate to obtain
a prostate tissue sample. The urologist will usually get six tissue samples from each side of the
prostate for a total of 12 samples.