A prostate biopsy is a medical procedure that involves collecting small tissue samples from the prostate gland. The purpose of this procedure is to examine these samples under a microscope for the presence of cancer cells. If cancer is detected, the biopsy results help determine its aggressiveness, which informs treatment decisions. This diagnostic step is the only definitive method to confirm prostate cancer.
Indications for Prostate Biopsy
A doctor may recommend a prostate biopsy when initial tests suggest a potential issue with the prostate gland. One common indicator is an elevated level of prostate-specific antigen (PSA) in a blood test. While high PSA levels can be due to various reasons, they can also signal the presence of prostate cancer.
Another reason for a biopsy is an abnormal finding during a digital rectal exam (DRE). A doctor manually checks for any unusual lumps, hardness, or enlargement of the prostate during a DRE. Suspicious areas identified on a magnetic resonance imaging (MRI) scan of the prostate can also lead to a biopsy recommendation.
Transrectal Ultrasound (TRUS) Biopsy
The transrectal ultrasound (TRUS) biopsy is a widely used method for obtaining prostate tissue samples. During this procedure, the patient lies on their side with knees pulled towards the chest or on their stomach. A doctor inserts a thin ultrasound probe into the rectum, which provides real-time images of the prostate on a screen. This imaging guides the placement of a biopsy needle.
Local anesthesia is administered to numb the area around the prostate, reducing discomfort. A spring-loaded device rapidly inserts a needle through the rectal wall into the prostate gland to collect small tissue cylinders, known as cores. Multiple samples, between 10 to 18, are taken from different areas of the prostate within about 10 minutes. A risk with this approach is infection due to the needle passing through the non-sterile rectal wall.
Transperineal Biopsy
The transperineal biopsy offers an alternative approach to prostate tissue sampling. In this method, the biopsy needle is inserted through the skin of the perineum, the area between the scrotum and the anus. This technique uses general or spinal anesthesia, or sometimes local anesthesia.
Ultrasound imaging is used to guide the needle and ensure accurate sample collection. A key difference from the transrectal approach is the lower risk of infection. By avoiding passage through the rectal wall, the transperineal method reduces the chance of introducing bacteria into the prostate or bloodstream.
MRI-Guided Fusion Biopsy
MRI-guided fusion biopsy is an advanced technique that combines the detailed imaging capabilities of MRI with the real-time guidance of ultrasound. Before the procedure, a patient undergoes a prostate MRI, where a radiologist identifies suspicious areas. These MRI images are then digitally “fused” with live ultrasound images during the biopsy.
This fusion technology creates a more precise, three-dimensional view of the prostate, enabling the doctor to target specific suspicious lesions with greater accuracy. The biopsy can be performed via either a transrectal or transperineal route, with the fusion guidance enhancing targeting regardless of the access point. The advantage of this method is its increased ability to detect clinically significant prostate cancers, reducing the need for random, untargeted samples.
Preparing For and Recovering From a Biopsy
Preparing for a prostate biopsy involves several steps to ensure a smooth procedure. Patients are prescribed antibiotics to take before and after the biopsy to prevent infection. Bowel preparation, such as an enema, is performed to cleanse the rectum. Adjustments to certain medications, particularly blood thinners like aspirin, are necessary several days prior to the biopsy to reduce bleeding risk.
After the biopsy, recovery takes a few days. Common side effects include mild discomfort and the presence of blood in urine, stool, or semen, which can last for days to several weeks. Light activities are recommended for 24 to 48 hours following the procedure. Patients should contact their doctor if they experience severe pain, heavy bleeding, difficulty urinating, or signs of infection such as fever or chills.