How many days before the biopsy should I start taking antibiotics?

It depends on the technique and the regimen chosen by the urologist. For modern transperineal biopsy, the most common regimen is a single dose of cefuroxime 500 mg, one hour before the procedure. In some selected cases or with transrectal biopsy, it may be started 1 to 2 days before and continued for 2 to 3 days afterward. Always follow your individualized prescription.

Can I keep taking aspirin (ASA) before a prostate biopsy?

Generally, no. Aspirin should be stopped 5 to 7 days beforehand to reduce the risk of bleeding. However, stopping it must be authorized by the cardiologist who prescribed it. In patients with a recent stent or high thrombotic risk, it may be necessary to continue aspirin or bridge with heparin. Never stop it on your own.

When can I return to exercise after the biopsy?

Light walking from 48 hours. Gym or moderate running in 7 to 10 days. Heavy weight training, high-impact sports and prolonged cycling in 14 days. Intense physical exertion too early may increase bleeding and discomfort.

How soon can I have sexual intercourse after a prostate biopsy?

It is recommended to wait 10 to 14 days before sexual intercourse with penetration or ejaculation. This allows the prostate to heal properly and reduces the risk of active bleeding. Semen may continue to contain blood for up to 6 weeks, which is normal and does not prevent intercourse after the initial rest period.

Do I need a companion for a prostate biopsy?

Yes, it is mandatory. Intravenous sedation, although safe, may cause mild confusion, drowsiness or impaired balance in the first few hours. The hospital team requires an adult companion before authorizing discharge. Without a companion, the procedure may be canceled on the day for safety reasons.

When should I worry about infection after the biopsy?

The main warning signs are fever above 38 °C (100.4 °F) in the first 48 to 72 hours, severe chills, marked general malaise, increasing pelvic pain that does not ease with painkillers, or increasing local redness. Any of these signs requires immediate contact with the urologist or a visit to the emergency department. The incidence is below 1% with modern transperineal biopsy, but early recognition is essential.

Prostate Biopsy Preparation: A Complete Step-by-Step Guide

A successful prostate biopsy begins before the day of the procedure. Antibiotics at the right time, proper interruption of anticoagulants, adequate fasting and care during the first 48 hours determine comfort, safety and the accuracy of the result.

Urologist and Urologic Oncologist CRM-SP 126.265 RQE 60022 AUA Member

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Dr. Bruno Benigno

Uro-oncology Specialist

Hospital Alemão Oswaldo Cruz

Hospital Vila Nova Star

Hospital Alemão Oswaldo Cruz

Hospital Vila Nova Star

Brazilian Society of Urology (SBU)

American Urological Association

How does a Prostate Biopsy work?

Understand the technical details, the difference between the approaches and how we ensure your safety and comfort during the procedure.

Cover of the explanatory video on biopsy

Pay Attention to Medications

Any medication that impairs blood clotting increases the risk of bleeding. Stopping it must always be authorized by the prescribing doctor.

5 to 7 Days Before

ASA / Aspirin

Medications such as Aspirin®, AAS Prevent® and Bufferin® should be stopped in advance to normalize blood clotting.

48h to 10 Days Before

Other Anticoagulants

Clopidogrel (Plavix®): 7 to 10 days
Warfarin / Ticagrelor: 5 days
Rivaroxaban / Apixaban: 48 hours
Dabigatran: 48h to 4 days

Mandatory

Prophylactic Antibiotic

For transperineal biopsy (the recommended approach), the most common regimen is cefuroxime 500 mg, 1 tablet, 1 hour before the procedure. It reduces the risk of infection to less than 0.5%.

Step-by-Step Preparation Timeline

Proper preparation dramatically reduces the risk of infection and urinary retention. Follow it strictly.

Day -7 to Day -5

Guidance Consultation

Review of regular medications, delivery of personalized prescriptions and alignment of the surgical protocol.

Day -1 (The Day Before)

Light Diet and Bowel Preparation

Easy-to-digest diet (broths, chicken, gelatin). Avoid raw leafy greens and beans. A rectal enema (Fleet Enema) is performed according to protocol, essential for ultrasound quality and for reducing bacteria.

Day 0 (The Procedure)

Complete Fasting and Admission

No solid food from 10 p.m. the night before. Arrive at the hospital 1 to 2 hours in advance. An adult companion must be present for discharge after sedation.

Day +1 to Day +2

Rest and Hydration

Relative rest at home. Drink 2 to 3 liters of water. It is normal to see blood in the urine and semen during these first days. Do not drive for 24 hours.

Day +7 to Day +14

Resuming Activities and Results

Gradual return to intense physical exercise and sexual intercourse (10 to 14 days). Follow-up visit with the urologist to review the pathology result (report).

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What to expect during Recovery?

Knowing how to tell normal postoperative symptoms from warning signs is essential for your peace of mind.

Completely Normal

Expected Symptoms

Blood in the urine for 3 to 5 days.
Blood in the semen for up to 6 weeks (very common and harmless).
A feeling of pelvic heaviness during the first 3 days.
A mild increase in urinary frequency.

Warning Signs

When to contact the team

Fever above 38 °C (100.4 °F) in the first 72 hours.
Severe chills or shaking.
Complete inability to urinate (retention) for more than 6 hours.
Severe pelvic pain that does not ease with painkillers.

Facilities and Care

See the facilities where we perform procedures, focused on cutting-edge technology and compassionate care.

Patient Reviews

What patients who have had procedures with us say.

“Dr. Bruno was extremely clear and attentive from the first consultation. The preparation material I received made me feel very confident about the biopsy. A painless procedure and a smooth recovery.”

Carlos M.

Verified review via Doctoralia

“The support team answered all my questions about stopping my heart medications. The test at Hospital Oswaldo Cruz was quick, and the post-procedure follow-up was excellent.”

Roberto S.

Patient, Hospital Alemão Oswaldo Cruz

“I was very apprehensive, but the technique used and the anesthesia ensured I felt nothing. Dr. Bruno conveys great competence and empathy.”

José A.

Verified review via Doctoralia

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Frequently Asked Questions

Get quick answers about preparation and recovery.

It depends on the technique and the regimen chosen by your urologist. For modern transperineal biopsy, the most common regimen is a single dose of cefuroxime 500 mg, one hour before the procedure. Always follow your individualized prescription.

Generally, no. Aspirin (ASA) should be stopped 5 to 7 days beforehand to reduce the risk of bleeding. However, stopping it must be authorized by the cardiologist who prescribed it. Never stop it on your own.

Yes, and it is very common. Hematospermia occurs in up to 60% of patients and may last 2 to 6 weeks. The color may range from bright red to dark brown. It is not a sign of complication, just the elimination of residual blood.

Light walking: from 48 hours. Gym or moderate running: 7 to 10 days. Heavy weight training, high-impact sports, prolonged cycling: 14 days.

It is recommended to wait 10 to 14 days before sexual intercourse with penetration or ejaculation. This allows proper healing and reduces the risk of active bleeding.

No. The anesthetic medication affects reflexes and attention for 8 to 12 hours. An adult companion is mandatory at discharge. You may drive again the following day.

Where we perform procedures

Hospital Alemão Oswaldo Cruz Hospital Vila Nova Star

Your next consultation with Dr. Bruno Benigno

The pre-biopsy guidance consultation includes a personalized day-by-day protocol, prescriptions for the medications and direct contact with the team for any questions up to the day before.

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In-person consultations at Clínica Uro Onco (Rua Borges Lagoa, 1070, Conjunto 131, Cobertura — Vila Clementino, São Paulo/SP) or via telemedicine.
Health insurance plans or private (self-pay) consultations.