Prostate Biopsy

Prostate biopsy is usually recommended when the results of initial tests, such as prostate-specific antigen (PSA) blood test or digital rectal exam (DRE), raise concerns of possible cancer.

Occasionally the biopsy does not detect prostate cancer but does detect some abnormal cells which may indicate that there may in fact be prostate cancer somewhere within the prostate. Under these circumstances, a repeat biopsy may be indicated.

What is involved in a prostate biopsy?

A prostate biopsy involves taking tiny samples of tissue from the prostate to check if there is cancer. If there is cancer, you will be able to know “Gleason Grade” which gives a score as to how aggressive the cancer may be.

The biopsy procedure is performed by a urologist. Depending on the type of biopsy, you will have either local or general anaesthetic.

A ultrasound probe is placed into rectum and the entire prostate is scanned. Then either of transrectal or a transperineal biopsy (+/- MRI fusion) is performed.

Types of prostate biopsy:

Transrectal biopsy:

This is the most commonly performed biopsy technique in Australia. The biopsy needle is passed through the rectum into the prostate.

Transperineal biopsy:

This new technique involves passing the biopsy needle through the perineum which is the area between the scrotum and the anus.

Transperineal biopsy with MRI fusion:

This is the same technique as the transperineal biopsy but is used in some patients when the MRI detects a suspicious area. This helps to target the biopsy to the area of concern.

Each of these techniques have their respective benefits and downsides and your specialist will discuss which is best suited for you.

The key differences between the 2 techniques:

• The transrectal biopsy is quicker and does not need a general anaesthetic. It is possible to be done in the clinic and so you do not need to go into the hospital. However it is associated with a higher rate in infections as the probe passes through rectum. However, this rate of infection is still low at ~3%.

  Source: http://www.auanet.org/publications/hpbrief/view.cfm?i=1088&a=2618

• The transperineal biopsy is associated with less infection and allows easier sampling in the anterior part of the gland. In addition, many more cores are usually taken compared to the transrectal biopsy which means that the results are more accurate. However, it involves a general anaesthetic, takes longer and may be associated with more short-term urinary flow problems.

  Source: http://www.auanet.org/publications/hpbrief/view.cfm?i=1088&a=2618