If you have been advised to have a prostate biopsy, it is natural to wonder what you may experience afterwards. Temporary bleeding, soreness, bruising or changes when passing urine are common after a prostate biopsy and usually improve during recovery. Some effects, particularly blood in the semen, can remain noticeable for considerably longer.
More serious complications, such as infection, heavy bleeding or difficulty passing urine, can occasionally occur. Understanding what is normal and what needs medical attention can help you feel more prepared, while your individual risks will depend on factors such as the biopsy type, your health and any medicines you take.
Why Can a Prostate Biopsy Cause Side Effects?
During a prostate biopsy, your specialist takes small tissue samples from your prostate so they can be examined under a microscope. Several tissue samples are usually taken from different areas of the prostate. The needle passes through prostate tissue each time a sample is collected, which can cause temporary swelling, soreness and bleeding.
Because your prostate surrounds part of your urethra, swelling can also affect how easily you pass urine. You may notice a weaker flow or some difficulty emptying your bladder, although serious problems are less common.
Does the Type of Prostate Biopsy Affect the Risks?
Yes, the type of biopsy can affect your risk of complications. A transperineal biopsy takes samples through the skin between your scrotum and back passage, while a transrectal biopsy passes through the rectal wall to reach your prostate.
The transperineal approach generally has a lower risk of infection because the needle does not pass through the rectum. If you are considering a prostate biopsy in London, your consultant can explain which approach may be suitable for you and discuss your individual risks.
Research Insight
A major reason for the move towards transperineal biopsy is the lower infectious risk associated with avoiding passage of the biopsy needle through the rectal wall. In the 2024 PREVENT randomised clinical trial, no grade 2 or higher infections occurred among 372 patients receiving transperineal biopsy without antibiotic prophylaxis, compared with 6 infections among 370 patients undergoing transrectal biopsy with targeted antibiotic prophylaxis.
The study did not show that transperineal biopsy is free from every complication. Bleeding and urinary retention can still occur, so the choice of technique remains a balance of diagnostic needs and individual procedural risks.
What Side Effects Are Considered Normal After a Biopsy?
Some changes after your prostate biopsy are expected and usually settle as you recover. You may notice mild soreness, bruising, small amounts of blood in your urine or semen, or a temporary change in how easily you pass urine.
What matters is whether your symptoms gradually improve. Heavy bleeding, large blood clots, severe pain, fever or suddenly being unable to pass urine are not typical and should be assessed promptly.
How Common Are the Main Risks After a Transperineal Prostate Biopsy?
BAUS provides approximate frequencies for several after-effects of transperineal biopsy. These are general estimates rather than predictions of your individual risk.
| Side effect or complication | Approximate BAUS frequency |
| Blood in urine for up to 10 days | Almost all patients |
| Blood in semen for up to 6 weeks | Almost all patients |
| Perineal bruising | Between 1 in 2 and 1 in 10 |
| Discomfort from bruising | Between 1 in 2 and 1 in 10 |
| Temporary erection problems | Around 1 in 20 (5%) |
| Acute urinary retention | Around 1 in 20 (5%) |
| Clot retention preventing urination | Around 1 in 50 (2%) |
| Bleeding requiring emergency admission | Around 1 in 100 (1%) |
| Urinary infection requiring antibiotics | Around 1 in 100 (1%) |
| Septicaemia requiring emergency admission | Fewer than 1 in 100 |
Your individual risk can differ according to factors such as prostate size, number of samples, existing urinary symptoms, medicines and the precise biopsy technique.
Is Blood in Your Urine Normal After a Prostate Biopsy?
Yes, seeing some blood in your urine after a prostate biopsy is common. Your urine may look pink, red or slightly darker than usual, but the bleeding should generally become lighter as you recover.
Blood in the urine commonly settles over several days. Some UK patient-information leaflets describe visible blood for up to around 10 days or occasionally longer, so you should follow the timeframe given by the centre that performed your biopsy. If you notice heavy bleeding, large blood clots or difficulty passing urine, you should seek prompt medical advice.
How Long Can Blood in Your Semen Last?
Blood in your semen, known as haematospermia, is a common side effect after a prostate biopsy. Your semen may look red, pink, rust-coloured or brown as small amounts of blood gradually clear from the prostate.
Blood in the semen commonly lasts longer than blood in the urine. Some UK guidance describes it for up to six weeks, while other current NHS information notes that it may remain visible for as long as three months. If the bleeding becomes heavier, continues beyond the timeframe you were given or occurs with pain or fever, you should contact your clinical team.
Can You Bleed From the Biopsy Area or Back Passage?
If you have a transperineal biopsy, you may notice a small amount of bleeding or bruising around the needle-entry points. Your perineum may also feel tender, particularly when you sit, walk or move around, but these symptoms should gradually improve.
If you have a transrectal biopsy, you may notice a small amount of bleeding from your back passage during early recovery. Heavy or persistent bleeding, feeling faint or passing large clots should not be ignored, so you should seek prompt medical advice.
How Likely Is Infection After a Prostate Biopsy?
Infection is a possible complication after a prostate biopsy, although the risk is generally lower with a transperineal approach. BAUS states that urinary infection requiring antibiotics occurs in around 1 in 100 people after a transperineal biopsy, although your individual risk may vary.
Contact your clinical team promptly if you develop fever, shivering, worsening pain when passing urine, marked urinary symptoms or feel generally unwell after your biopsy. Do not assume infection is impossible because you were given antibiotics, as symptoms can still require medical assessment.
What Is the Risk of Sepsis?
Sepsis is a serious reaction to an infection and is uncommon after a prostate biopsy, particularly with a transperineal approach. BAUS reports that septicaemia requiring emergency hospital admission occurs in fewer than 1 in 100 people after transperineal biopsy.
Sepsis is a medical emergency. Seek urgent emergency help if you become severely unwell after your biopsy, particularly if you develop confusion or slurred speech, uncontrollable shivering, severe breathlessness, blue, pale or blotchy skin, a very high or low temperature or very little urine. Call 999 or attend A&E if severe symptoms suggest sepsis. Do not wait for your symptoms to become more severe before seeking assessment.
Can a Biopsy Make It Painful or Difficult to Pass Urine?
You may notice a slower urine flow, mild stinging or a greater need to pass urine after your biopsy. This can happen because your prostate may be temporarily swollen and irritated, and these symptoms should usually improve as you recover.
If you develop worsening pain, fever, cloudy urine or increasing difficulty passing urine, you should contact your clinical team. If you already had urinary problems before the biopsy, tell your specialist because you may be more likely to experience noticeable changes afterwards.
What Is Acute Urinary Retention?
Acute urinary retention means you suddenly cannot pass urine even though your bladder is full. After a prostate biopsy, swelling around your prostate can temporarily narrow the urethra and make it difficult for you to empty your bladder.
You may feel increasing pressure or pain in your lower abdomen and a strong urge to urinate without being able to do so. If this happens, you should seek urgent medical attention, as you may need a temporary catheter until the swelling settles.
Is Pain, Bruising or Swelling Normal?
Yes, some tenderness, bruising or mild swelling can be normal after a prostate biopsy, particularly around your perineum following a transperineal procedure. You may feel uncomfortable when sitting down, but these symptoms should gradually improve over the following days.
You may be advised to take a simple painkiller such as paracetamol if it is suitable for you. If your pain becomes severe, swelling increases quickly or you also develop fever, heavy bleeding or difficulty passing urine, you should seek medical advice promptly.
Can a Prostate Biopsy Affect Erections or Sexual Activity?
A prostate biopsy does not usually cause permanent problems with your erections, although temporary changes can occur. Temporary difficulty getting or maintaining an erection has been reported after prostate biopsy. Pain, bruising, anxiety and the wider experience of investigation may contribute, but persistent erectile difficulties should be discussed with your urologist.
You may also feel less comfortable having sex while you are recovering or while blood remains in your semen. These changes usually improve with time, but if erection problems continue after you have recovered, you should speak with your urologist.
Do Blood-Thinning Medicines Increase the Risk of Bleeding?
Yes, blood-thinning medicines can increase your risk of bleeding during or after a prostate biopsy. These include anticoagulants and antiplatelet medicines, so you should give your specialist a complete list of the medicines you take.
You should not stop any prescribed blood thinner yourself before a biopsy. Your healthcare team can advise you whether the medicine needs to be paused or adjusted and will make a plan that balances your bleeding and clotting risks.
How Long Do Side Effects Usually Last?
How long side effects last after a prostate biopsy depends on the biopsy technique, the number of samples taken and how your body responds. Most mild symptoms should gradually improve, although some effects, particularly blood in the semen, can last longer than others.
- Soreness and Discomfort: Mild tenderness or urinary discomfort often improves within the first few days after your biopsy.
- Blood in the Urine: Small amounts of blood may remain visible for several days but should gradually become lighter.
- Bruising: Perineal bruising can take longer to settle as the needle-entry sites and surrounding tissues heal.
- Blood in the Semen: Haematospermia can remain noticeable for several weeks and may gradually change colour as the blood clears.
Your recovery should generally show a gradual trend towards improvement rather than worsening symptoms. Contact your clinical team if bleeding becomes heavier, pain increases or your symptoms last longer than you were advised to expect.
How Can You Reduce the Risk of Complications?
You can help support a safer recovery by following the preparation and aftercare instructions given by your biopsy team. Tell your team about all medicines you take, including anticoagulants or antiplatelet medicines, as well as any bleeding problems, allergies or existing urinary symptoms. If antibiotics are prescribed, take them exactly as directed, and make sure you understand any instructions about medicines that need to be paused or restarted around the procedure.
After your biopsy, give your body time to recover and avoid activities your clinical team has advised you to postpone. Keep the discharge instructions and contact details from your biopsy centre available so you know who to contact if a problem develops. Monitor how you feel as you recover, especially for worsening pain, fever or shivering, heavy bleeding, large clots or increasing difficulty passing urine. If your recovery feels different from what you were told to expect, contact your biopsy team rather than waiting for symptoms to become severe.
Myth vs Fact
| Myth | Fact |
| Any blood after a biopsy means something has gone wrong. | Small amounts of blood in the urine and semen are common expected effects. |
| Blood in semen should disappear after a few days. | It can remain visible for several weeks and occasionally for a couple of months. |
| Transperineal biopsy cannot cause infection. | Infection risk is lower, but infection and sepsis can still occur. |
| Being unable to pass urine is something you can wait to see improve. | Complete urinary retention needs urgent assessment and may require a temporary catheter. |
| A prostate biopsy commonly causes permanent erectile dysfunction. | Temporary erection problems can occur, but BAUS estimates them at around 5% and describes them as temporary. |
| Blood-thinning medicine should always be stopped before biopsy. | Medication changes depend on the individual medicine and clotting risk and should only be made on medical advice. |
| More severe pain means the biopsy is healing. | Severe or worsening pain is a reason to contact the clinical team. |
| Taking antibiotics means infection is impossible. | Infection can still occur, and antibiotic practice differs between biopsy approaches and centres. |
When Should You Seek Medical Help After a Biopsy?
You should seek medical advice if you cannot pass urine, have heavy bleeding or large blood clots, or develop a high temperature with shivering. Severe pain, faintness, confusion, breathing difficulties or rapidly worsening symptoms also need urgent assessment.
You do not need to wait until your symptoms become severe before asking for help. If your recovery feels different from what you were told to expect, contact your biopsy team or follow the emergency instructions provided at discharge.
Key Takeaways
- Small amounts of blood in the urine and semen are common after prostate biopsy.
- Blood in the semen often lasts longer than urinary bleeding and can occasionally remain visible for several months.
- Perineal bruising and soreness are common after transperineal biopsy.
- Transperineal biopsy generally has a lower infectious risk than transrectal biopsy, but infection is still possible.
- Published complication frequencies vary between hospitals and biopsy protocols, so one percentage should not be treated as a universal personal risk.
- Men with a large prostate or poor urinary flow may have a greater risk of post-biopsy urinary retention.
- Complete inability to pass urine requires urgent assessment.
- Heavy bleeding, large clots, severe or worsening pain and significant systemic illness should not be treated as routine recovery symptoms.
- Blood-thinning medication should only be stopped or adjusted according to individual clinical instructions.
- Follow the aftercare and emergency instructions from the centre that performed your biopsy because recovery advice and antibiotic protocols vary.
Frequently Asked Questions
1. Is bleeding normal after a prostate biopsy?
Yes, small amounts of blood in your urine, semen or from the biopsy area can be normal after a prostate biopsy. The bleeding should gradually become lighter, while heavy bleeding or large blood clots require prompt medical advice.
2. How long does blood in semen last after a prostate biopsy?
Blood in your semen can remain noticeable for several weeks after a prostate biopsy and may gradually change from red or pink to brown as it clears. If it becomes heavier or continues beyond the timeframe your clinical team advised, you should contact them.
3. Can a prostate biopsy cause an infection?
Yes, infection is a possible complication, although the risk is generally lower with a transperineal biopsy. You should contact your clinical team promptly if you develop a fever, shivering, burning when passing urine or feel unusually unwell.
4. Can a prostate biopsy cause urinary problems?
You may temporarily experience a weaker urine flow, mild stinging or increased urgency because your prostate can become swollen after the procedure. These symptoms should generally improve, but being unable to pass urine requires urgent medical attention.
5. Is pain normal after a prostate biopsy?
Mild soreness, tenderness or bruising can occur, particularly around the perineum after a transperineal biopsy. Severe or worsening pain, especially when accompanied by fever, swelling or heavy bleeding, should be assessed promptly.
6. Can a prostate biopsy cause urinary retention?
Yes, although acute urinary retention is uncommon. Temporary swelling around the prostate can make it difficult for you to empty your bladder, and sudden inability to pass urine requires urgent medical assessment.
7. Does a prostate biopsy affect sexual activity?
You may prefer to avoid sexual activity while you are recovering, particularly if you have discomfort or blood in your semen. A biopsy does not usually cause permanent erectile problems, but you should speak with your urologist if erection difficulties continue after recovery.
8. Do blood-thinning medicines increase biopsy risks?
Blood-thinning medicines can increase your risk of bleeding during or after a prostate biopsy. You should tell your specialist about every medicine you take and never stop a prescribed anticoagulant or antiplatelet medicine without medical advice.
9. How long does it take to recover from a prostate biopsy?
Mild soreness, urinary discomfort and blood in your urine often improve within a few days, while bruising can take longer to settle. Blood in your semen may remain for several weeks, so your recovery can vary depending on the biopsy type and your individual circumstances.
10. When should you seek medical help after a prostate biopsy?
You should seek prompt medical advice if you develop heavy bleeding, large blood clots, fever, severe pain or worsening urinary problems. If you cannot pass urine, develop severe shivering, confusion, breathing difficulties or feel suddenly very unwell, seek urgent medical attention.
Final Thoughts: What to Expect After a Prostate Biopsy
A prostate biopsy can cause some temporary side effects, including soreness, bruising, changes when passing urine and blood in your urine or semen. Knowing what to expect can help you feel more prepared and recognise when your recovery is progressing normally.
If you are considering a prostate biopsy in London, you can contact our team at Prostate Clinic London to discuss your concerns and whether a biopsy may be appropriate for you.
References:
- British Association of Urological Surgeons (2024) Transperineal ultrasound-guided biopsies of the prostate gland. Leaflet No. O24/107. Available at: https://www.baus.org.uk/patients/information_leaflets/112/transperineal_prostate_biopsies
- University College London Hospitals NHS Foundation Trust (no date) Transperineal biopsy of the prostate. Available at: https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/transperineal-biopsy-prostate
- Hu, J.C., Assel, M., Allaf, M.E. et al. (2024) ‘Transperineal vs transrectal prostate biopsy The PREVENT randomized clinical trial’, JAMA Oncology, 10(11), pp. 1590–1593. Available at: https://pubmed.ncbi.nlm.nih.gov/39298143/
- North Bristol NHS Trust (2024) LATP prostate biopsy. Published March 2024. Available at: https://www.nbt.nhs.uk/bristol-urological-institute/urology-patient-services/urology-patient-information/latp-prostate-biopsy
- NHS (2026) Sepsis. Last reviewed 14 May 2026. Available at: https://www.nhs.uk/conditions/sepsis/
- Kum, F., Jones, A. and Nigam, R. (2019) ‘Factors influencing urinary retention after transperineal template biopsy of the prostate: outcomes from a regional cancer centre’, World Journal of Urology, 37(2), pp. 337–342. Available at: https://pubmed.ncbi.nlm.nih.gov/29974188/