Prostate Cancer Diagnosis

You do not need to take antibiotics beforehand; a single intravenous dose is given at the start of the procedure. The biopsy is performed under general anaesthetic, so you will need to fast for 6 hours beforehand. If your procedure is in the morning, have nothing to eat or drink from midnight (small sips of water with medications are permitted). If it is scheduled for the afternoon, a light breakfast at 6 am is acceptable, with nothing further after that.

Please inform us if you are taking blood thinners (aspirin is usually acceptable) or diabetic medications, as these may need adjustment. A Microlax enema will be administered at the hospital prior to the procedure.

Allow sufficient time for the visit. There is typically a wait of 1.5 to 2.5 hours from arrival to the procedure, followed by a few hours of recovery. Most patients are able to go home around lunchtime or shortly afterwards.

You will need to arrange for someone to drive you home, as you should not drive until the day after the anaesthetic.

Blood thinners (e.g. warfarin, clopidogrel [Plavix/Iscover], dabigatran [Pradaxa], rivaroxaban [Xarelto], apixaban [Eliquis], prasugrel [Effient], ticagrelor [Brilinta], or similar) are usually managed in advance—please contact the rooms if this has not been discussed. Aspirin and fish oil do not need to be stopped.

SGLT2 inhibitor medications (e.g. forxiga, Xigduo, Jardiance, Jardiamet) should be stopped three days before the procedure. If your diabetes is difficult to control, discuss alternatives with your GP.

If you are taking a GLP-1 receptor agonist—such as semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Mounjaro), dulaglutide (Trulicity), or liraglutide (Saxenda, Victoza)—please inform us. These medications delay gastric emptying, which may increase the risk of aspiration during anaesthesia. You do not need to stop the medication; however, you should follow a clear-fluid-only diet (no solid food) for 24 hours before the procedure. In addition, standard fasting applies: water only up to 6 hours prior, and nothing at all (including water) for the final 2 hours.

Under general anaesthetic, an ultrasound probe is inserted into the rectum to create a real-time 3D image of the prostate. This is fused with prior MRI or PSMA imaging to accurately localise any suspicious lesions.

Biopsy samples (typically 15–30 cores) are then taken through the perineal skin (between the scrotum and rectum) under real-time guidance. Sampling targets areas of concern identified on imaging, along with systematic cores from other regions of the prostate to detect any additional clinically significant disease.

The procedure takes approximately 40 minutes, followed by a period of observation for a few hours. A cystoscopy (brief inspection of the bladder via the urethra) may also be performed if indicated; these findings are usually discussed immediately, while biopsy results are available after several days.

It is common to notice some blood in the urine, bowel motions, or semen after the biopsy. Blood in the urine may come and go for a few weeks, while discolouration of semen can persist for a couple of months.

Urinary retention is uncommon (less than 5%). We confirm you are able to pass urine before discharge, although retention can occasionally occur later. If this happens, contact Buderim Private Hospital Emergency Centre on (07) 5452 0599.

If you develop a fever or shaking chills, attend your nearest emergency department promptly, as this may indicate infection, which can be serious after a biopsy.

Some men experience a temporary change in erectile function. This is usually mild and resolves within a few weeks to months; long-term problems are uncommon.

Mild discomfort in the perineum (between the scrotum and anus) is common for a few days and is usually managed with simple analgesia such as paracetamol. Bruising in the area may also occur and typically resolves over a few weeks.

Results are usually available within a few days. You should already have a follow-up appointment booked for the Monday after your procedure to review them; please contact the rooms if not. Many patients find it helpful to bring a partner or support person to this visit.

If cancer is detected, we will discuss the findings with you, provide written information, and arrange a PSMA scan if indicated. A further appointment is typically scheduled about two weeks later to discuss management options in more detail.

If no cancer is found, you will be given a request form for a repeat PSA test in approximately three months. An earlier review may be arranged if there are other findings that need discussion or follow-up.

If prostate cancer is detected, further imaging may be required to assess for spread, and treatment options will be discussed with you in detail. These may include surgery (prostatectomy), radiotherapy (sometimes combined with hormone therapy), active surveillance for low-risk disease, or hormone therapy—with or without chemotherapy—for more advanced cancer.

Most prostate cancers grow slowly and may take years to progress. If treatment is required, a short delay of several weeks to months is generally safe.