From the Guidelines
The recommended procedure for a prostate biopsy is a transrectal ultrasound-guided (TRUS) biopsy, where an ultrasound probe is inserted into the rectum to visualize the prostate while a spring-loaded needle device collects 12 core samples, as stated in the most recent guidelines 1.
Procedure Details
The procedure should be performed under local anesthesia, with the sample sites being bilateral from the apex to base, as far posterior and lateral as possible in the peripheral gland.
- Before the procedure, patients typically receive antibiotics to prevent infection, starting 1-2 days before and continuing for 1-3 days after.
- Patients should stop blood thinners like aspirin or warfarin 5-7 days before the procedure with physician approval.
- A cleansing enema is often administered the morning of the procedure.
- During the biopsy, local anesthesia (lidocaine) is injected around the prostate to minimize discomfort.
- The procedure takes about 15-30 minutes and is usually performed as an outpatient.
Post-Procedure Care
After the biopsy, patients may experience blood in urine, stool, or semen for several days to weeks.
- Patients should report fever, excessive bleeding, difficulty urinating, or worsening pain to their doctor immediately as these could indicate complications like infection.
- The tissue samples are sent to a pathologist who examines them for cancer cells, with results typically available within a few days to a week.
Alternative Approaches
The transperineal approach may be considered, as it has been shown to have higher sensitivity for the detection of clinically significant prostate cancer (csPCa) compared to the transrectal approach, especially for anterior tumors 1.
Reporting and Interpretation
Each biopsy site should be reported individually, including its location, Gleason score, ISUP grade group, and extent.
- If identified, lymphovascular invasion and extraprostatic extension (EPE) must each be reported, as well as intraductal carcinoma and invasive cribriform pattern, as these represent independent factors for metastasis and cancer-specific survival (CSS) 1.
From the Research
Procedure for Prostate Biopsy
The procedure for prostate biopsy can be performed through different approaches, including transrectal ultrasound (TRUS) guided biopsy and transperineal (TP) prostate biopsy.
- TRUS biopsy is a commonly used method, where an ultrasound probe is inserted into the rectum to guide the biopsy needle into the prostate gland 2.
- TP biopsy, on the other hand, involves inserting the biopsy needle through the perineum, which has been shown to have superior sensitivity and lower rates of sepsis compared to TRUS biopsy 3.
Techniques Used
Different techniques can be used to perform a prostate biopsy, including:
- Systematic biopsy, where tissue samples are taken from different areas of the prostate gland 4.
- Targeted biopsy, where specific lesions identified on MRI are targeted for biopsy 3.
- Saturation biopsy, where a large number of tissue samples are taken from the prostate gland 5.
Anaesthesia and Patient Positioning
Prostate biopsy can be performed under different types of anaesthesia, including:
- General anaesthesia, where the patient is fully sedated 3.
- Local anaesthesia, where the patient is awake but the area is numbed 5. The patient is typically positioned in the lithotomy position, with their legs raised and supported 3.
Guidance and Sampling
The biopsy procedure can be guided by different imaging modalities, including:
- Ultrasound, which provides real-time images of the prostate gland 2.
- MRI, which can be used to identify specific lesions and guide the biopsy needle 3. The sampling can be done either by free hand or using a brachytherapy grid, and robotic assisted prostate biopsy is also available as an alternative 3.