A prostate biopsy is the taking of tissue samples from the prostate gland and examining them under a microscope for cancer cells. This can be done using either the transrectal or transperineal technique. Approximately 25 to 35% of patients having a biopsy will have cancer, depending upon their risk factors.
Transperineal biopsy
This technique is generally safer and more accurate. Dr Stricker developed this method which employs template guided, grid based sampling. This maximises accuracy of results and minimises the chance of infection. There is no cutting involved as this is all done by needle puncture in the skin behind the scrotum. It is a day only procedure and performed under a light anaesthetic.
I developed this technique way back in 1996 and since then have performed over 7,000 cases. Recent papers by my Registrars and Fellows have been accepted for publication or published in the renowned Journal of Urology. Huo et al, J.Urol 2012 showed improved accuracy, Hosack et al J Urol 2012 confirmed the better detection of cancers in certain areas of the prostate compared with the traditional technique of transrectal biopsy and Symons et al confirmed the improved safety of the technique minimising the risk of any infection.
Before and after your prostate biopsy
Before
Before undergoing the biopsy, the patient will take antibiotics the day before to reduce risk of infection after prostate biopsy. Generally a small suppository is used to empty the bowels if they have not emptied immediately before.
Side effects of prostate biopsy
Only minimal pain is associated with the procedure. Often there is some blood in the urine for between two and seven days and in the semen for a few weeks. This may occur for up to two months. There may be some soreness for a few days after the procedure. Generally it is wise to have someone take you home as there has been a recent anaesthetic.
Very small prostate tumours can sometimes be missed during the biopsy process, so the biopsy process is not foolproof. This may require further PSA testing in the future and a repeat biopsy if the PSA continues to rise.
MRI Ultrasound Fusion Biopsies
MRI-targeted biopsy employs the technique of fusing the MRI image to the ultrasound to accurately biopsy lesions found on MRI. This is a further development which makes diagnosis much more accurate and less invasive. It requires far fewer biopsies and improves the accuracy in terms of targeting lesions in the prostate.
MRI targeted biopsy allows for the safety of biopsying through the perineum. This avoids the risks of rectal biopsy yet allowing the accuracy of MRI imaging. The alternative MR-targeted technique is carried out inside an MRI machine which requires biopsy through the rectum. This has the disadvantage of severe infection in 2% to 3% of patients.