Prostate Biopsy

Overview
Prostate biopsy is the means by which the diagnosis of prostate cancer is made. It involves taking a number of tissue samples of the prostate using a biopsy needle. It can be performed by a number of approaches:

  1. Transrectal ultrasound guided prostate biopsy – the biopsy is performed under ultrasound visualisation using a needle inserted into the prostate through the rectum.
  2. Transperineal ultrasound guided prostate biopsy – the biopsy is performed under ultrasound visualisation using a needle inserted into the prostate through the perineal skin between the scrotum and anus.
  3. MRI-US fusion biopsy – either transrectal or transperineal biopsies can be performed using technology which allows for mapping of suspicious areas of the prostate seen on MRI over the ultrasound picture in real time. Read more about MRI-US fusion biopsy.

The decision to proceed with prostate biopsy will be made after discussion with your urologist, based on your prostate specific antigen (PSA) level, certain additional PSA parameters, the findings on rectal examination and the findings on multiparametric MRI of the prostate.

Description of the procedure
Prostate biopsy can be performed awake or under anaesthesia. It can also be performed in the rooms or in theatre. For the least unpleasant experience, we recommend having a prostate biopsy under anaesthesia in theatre. It can usually be performed as a day case procedure.

Transrectal ultrasound guided prostate biopsy
This procedure involves placing an ultrasound probe into the rectum (back passage) to visulalise the prostate. A biopsy needle is placed through the ultrasound probe and used to take at least 12 tissue samples from the prostate. This technique is best suited to sampling the peripheral area of the prostate.

Transperineal prostate biopsy
This procedure involves placing an ultrasound prove into the rectum (back passage) to visualise the prostate. Following a specific template, a biopsy needle is placed into the prostate through the perineal skin between the scrotum and anus. This is used to take biopsies throughout the entire prostate. This technique is indicated when the suspicious area is thought to be in the central or front part of the prostate.

Risks and Complications of the Procedure
All surgical procedures have inherent risks and complications. It is not possible to list every possible complication of a surgical procedure. Some of the common risks and complications of prostate biopsy are:

  1. Haematuria (blood in the urine) which can last for several days after prostate biopsy.
  2. Haematospermia (blood in the semen) which can last for several months after prostate biopsy.
  3. Blood in stools or mild rectal bleeding.
  4. Prostatic pain or discomfort for several weeks after prostate biopsy.
  5. Infection of the urinary system. Prostatitis (infection of the prostate) and epididymo-orchitis (infection of the testicles) are common and require antibiotic treatment.
  6. Urinary retention (inability to pass urine) due to bleeding and blockage of the urethra with a blood clot. This is uncommon and requires catheterisation and the bladder to be washed out.
  7. Systemic infection (infection beyond the urinary tract including in the bloodstream) requiring admission for intravenous antibiotics.
  8. Failure to detect significant cancer or need for repeat biopsy if the biopsy is inconclusive or is negative but the PSA continues to rise.
  9. Complications related to surgery in general and anaesthesia such as deep vein thrombosis (DVT), pulmonary embolism, hospital acquired infection, pneumonia and heart attack can occur.

Requirements before the Procedure

  1. You may need a pre-operative assessment by a physician or anaesthetist if you have any medical problems which place you at additional risk for anaesthesia or surgery.
  2. You will be admitted on the day of the procedure, approximately two hours before surgery.
  3. You will be seen by the surgeon and anaesthetist prior to surgery.
  4. You must inform the surgeon at least 7 days in advance if you are on blood thinning medication or have a pacemaker or other implanted device.

Expectations after the Procedure

  1. You will return to the general ward after the procedure.
  2. You may have a haemostatic sponge in the rectum. This will come out by itself when you pass stool.
  3. Once you have had a walk, passed urine and had something to eat and drink, you may go home.
  4. You will be given antibiotics and anti-inflammatories to take at home.
  5. You do not need to see the surgeon prior to going home. You will be signed out directly from theatre.
  6. If you have any concerns after the procedure, please phone the practice. If a medical emergency develops, please call an ambulance or proceed directly to the emergency department.
  7. You will need to see your urologist approximately 1 week after the biopsy to discuss the results. Biopsy results cannot be given over the phone.

Alternatives to the Procedure
There is no alternative to prostate biopsy to confirm the diagnosis of prostate cancer. Assessment of additional PSA parameters like free PSA, PSA density, PSA velocity and prostate health index and multiparametric MRI of the prostate may improve the prostate biopsy decision making process.

Disclaimer
This page is intended to provide information about the surgical procedure discussed. All diagnoses and treatment options should be discussed between the patient and his/her doctor. This page is not intended to replace that discussion in any way, or to provide advice in any specific circumstance. The information contained herein is evidence based, but the authors make no guarantees regarding the accuracy and completeness of the information. There may be errors or omissions in this information and the authors take no responsibility for decisions taken or not taken as a result of the information contained herein.