For Patients · University Urology, PC
Transrectal Prostate Biopsy — Preparation & Recovery
Instructions for before and after your transrectal prostate biopsy. Following these steps carefully reduces your risk of complications and helps ensure an accurate result.
About the Procedure
What a Transrectal Biopsy Involves
A transrectal prostate biopsy uses a thin needle passed through the rectal wall to obtain tissue samples from the prostate for pathological analysis. Ultrasound guidance is used to visualize the prostate and direct the needle accurately. The procedure is performed in the office under local anesthetic.
Before Your Procedure
How to Prepare
Take your prescribed antibiotic
An antibiotic will be prescribed before your biopsy. Take it exactly as directed — typically beginning the day before or the morning of the procedure. Completing the full antibiotic course as instructed is essential to reduce the risk of infection.
Perform a bowel prep the evening before
Use a Fleet enema 1–2 hours before your procedure to clear the lower rectum. This reduces the bacterial burden and lowers infection risk. Enema kits are available over the counter at any pharmacy. Follow the instructions on the package.
Eat and drink normally
You may eat and drink normally before your biopsy. No fasting is required.
Arrange a driver
You must have someone drive you home. Post-procedure discomfort and the rare possibility of a vasovagal response make driving after this procedure inadvisable.
Blood Thinner / Anticoagulation Medications
Contact your prescribing physician before stopping any blood thinner or anticoagulant. Do not stop these medications without medical guidance, particularly if you are on anticoagulation for a high-risk condition such as atrial fibrillation, a mechanical heart valve, or a recent blood clot. Standard hold durations for reference:
- Aspirin — hold 7 days
- Clopidogrel (Plavix) — hold 5–7 days
- Apixaban (Eliquis) — hold 48 hours
- Rivaroxaban (Xarelto) — hold 48 hours
- Warfarin (Coumadin) — contact prescribing physician for INR guidance
After Your Procedure
Recovery & What to Expect
Normal after transrectal biopsy
Drink extra fluids after the procedure. Avoid strenuous activity for 24–48 hours. Most patients return to normal activity the following day.
Results take 10–14 business days
Biopsy pathology is processed by an outside lab. Your provider will contact you directly when results are available and reviewed. Do not call before the 10–14 business day window has passed. See our results & follow-up page for more detail.
Call us immediately or go to the ER if you experience:
Call (865) 305-9254 during office hours. After hours, follow prompts for the on-call provider. If severely ill, go to the nearest emergency room.
Common Questions
Frequently Asked Questions
Is the biopsy painful?
Local anesthetic is used to numb the prostate before needle sampling. Most patients experience a brief sharp sensation with each sample but find the overall procedure tolerable. The rectal ultrasound probe causes mild pressure. The procedure typically takes 15–20 minutes.
Why do I need a bowel prep?
The needle passes through the rectal wall to reach the prostate, which means rectal bacteria can be introduced into the prostate and bloodstream. The bowel prep reduces the bacterial load in the rectum, lowering your risk of post-biopsy infection. The antibiotic provides additional protection.
How long will blood in my urine or semen last?
Blood in the urine typically resolves within 1–2 weeks. Blood in the semen can persist for 4–6 weeks and is completely normal — it does not require treatment and is not a sign of a problem.
When will I get my results?
Biopsy pathology takes 10–14 business days from the procedure date. Your provider will contact you directly once results are available and reviewed. Please do not call before this window has passed. Visit our results & follow-up page for more information.
What is the difference between transrectal and transperineal biopsy?
Transrectal biopsy accesses the prostate through the rectal wall. Transperineal biopsy accesses the prostate through the perineum (the skin between the scrotum and rectum), avoiding the rectum entirely. Transperineal biopsy has a significantly lower infection risk and is the preferred approach for many patients. Your provider will discuss which approach is best for your situation.
Questions Before Your Biopsy?
Send a Klara message or call us. Our team is happy to walk you through what to expect.