A prostate biopsy is a procedure commonly performed in urology. It is used to confirm a diagnosis of prostate cancer. The procedure is usually performed through the rectum under ultrasound guidance using an endorectal probe. A prostate biopsy is generally performed on an outpatient basis. Here you will find further information as well as a selection of prostate biopsy specialists and centers.
A prostate biopsy can confirm a diagnosis of prostate cancer. It is one of the most commonly performed procedures in urology.
The generally accepted standard for performing this procedure is via the rectum. The biopsy is monitored and guided by ultrasound using an endorectal probe.
Furthermore, it is now standard practice in medical procedures to avoid pain during an intervention. The American and European urological societies recommend reliable pain relief, such as through conduction anesthesia.
Bilateral local nerve block anesthesia is a simple procedure for effective pain reduction up to complete pain relief.
Illustration and location of the prostate © Henrie | AdobeStock
Despite all advances in medical science, prostate cancer is curable only if the tumor is diagnosed at an early stage. At this stage, the tumor is confined to the prostate and has not yet spread to other organs.
Prostate screening makes it possible to diagnose early stages of prostate cancer with increasing frequency. These early stages are generally not detectable during a digital rectal examination.
As prostate cancer is increasingly diagnosed at smaller, earlier stages, a sufficient prostate biopsy technique with high diagnostic accuracy is of fundamental importance for an adequate diagnosis.
In this context, accurate pre-treatment staging of the primary tumor is essential. Only then can physicians determine the most appropriate treatment options for the patient and tailor them to the specific characteristics of the tumor.
In the past, the sextant biopsy under transrectal ultrasound (TRUS) guidance was considered the accepted gold standard for histological confirmation of prostate cancer. Today, guidelines recommend the removal of 10–12 punch cores during the initial prostate biopsy.
At least 70 percent of carcinomas originate in the peripheral zone of the prostate. Therefore, during the initial biopsy, the examiner should obtain at least 10 cylinders from the peripheral zone of the prostate alone.
Real-time ultrasound image of a transrectal biopsy from the peripheral zone of the prostate
A prostate biopsy should be performed if
Before and after the prostate biopsy, the patient must take a high-dosecourse of prophylactic antibiotics for 5 days. Gyrase inhibitors (quinolone antibiotics) are used for this purpose.
As with all invasive procedures, blood clotting must be monitored and within normal limits. This means that the patient must discontinue any anticoagulant medications.
The standard biopsy protocol for a transrectal, ultrasound-guided prostate biopsy involving at least 10 samples consists of the following steps:
Diagram of a transrectal prostate biopsy involving the removal of 10 punch cylinders from the peripheral zone and 2 punch cylinders from the transitional zone of the prostate
The biopsy is usually performed on an outpatient basis.
Despite antibiotic prophylaxis, severe prostatitis (inflammation of the prostate) occurs in approximately 2 percent of prostate biopsies involving the removal of 10 to 12 punch cylinders. These cases require hospitalization for high-dose intravenous antibiotic therapy.
A feared but now very rare complication of transrectal prostate biopsy is rectal bleeding from the hemorrhoidal veins. This is dangerous because the bleeding initially occurs hidden within the ampulla of the rectum, making it difficult for both the patient and the urologist to detect.
The bleeding only becomes apparent when large amounts of blood are passed in the stool and, possibly, through circulatory symptoms. However, with an incidence of less than 1 percent, this is a very rare complication. It can usually be managed with conservative measures.
Every physician listed in the Leading Medicine Guide has attained the highest level of training and certification within their respective medical specialty society. Furthermore, we contacted this physician based, among other factors, on their case volume (surgeries, treatments, and therapies), which we determined by cross-referencing various publicly available sources. Following discussions with the selected physicians and the directors of the medical facilities, as well as a subsequent internal review, they were admitted to the Leading Medicine Guide.
The quality assurance of the Leading Medicine Guide is further ensured by 8 admission criteria. Each member must meet at least 6 of them:
