Prostate biopsy: Information & prostate biopsy specialists

A prostate biopsy is a frequently performed examination in urology. It can be used to confirm the diagnosis of prostate cancer. Access is usually via the rectum under ultrasound guidance using an endorectal probe. A prostate biopsy is usually performed as an outpatient procedure. Here you will find further information and selected prostate biopsy specialists and centers.

Definition: Ultrasound-guided transrectal prostate biopsy

A prostate biopsy can confirm the diagnosis of prostate cancer. It is one of the most frequently performed procedures in urology.

The generally accepted standard procedure is access via the rectum. The biopsy is checked and guided by ultrasound control using an endorectal probe.

In addition, it is now standard medical practice to avoid pain during the procedure. The American and European urological societies require the safe elimination of pain, e.g. through conduction anesthesia.

Bilateral local conduction anesthesia is a simple procedure for effective pain reduction to complete pain elimination.

Representation and location of the prostate © Henrie | AdobeStock

Importance of prostate biopsy for the diagnosis of prostate cancer

Despite all the progress that has been made, prostate cancer can only be cured if the tumor is diagnosed at an early stage. The tumor is then limited to the prostate and has not yet spread to other organs.

Prostate screening makes it possible to diagnose early stages of prostate cancer more and more frequently. These early stages cannot usually be detected during a digital rectal diagnosis.

With the stage migration of prostate cancer to smaller, early stages, a sufficient prostate biopsy technique with high significance is of fundamental importance for adequate diagnosis.

In this context, accurate pre-therapeutic staging of the primary tumor is essential. Only then can doctors determine the most appropriate treatment options for the patient and tailor them to the individual tumor.

In the past, sextant biopsy under transrectal ultrasound guidance(TRUS) was considered the accepted gold standard for the histological diagnosis of prostate cancer. Today, the guidelines recommend the removal of 10-12 punch cylinders during the initial biopsy of the prostate.

At least 70 percent of carcinomas arise from the peripheral zone of the prostate. Therefore, the examiner should only take at least 10 cylinders from the peripheral zone of the prostate during the initial biopsy.

Real-time ultrasound image of a transrectal biopsy from the peripheral zone of the prostate

Indications for performing a prostate biopsy

A prostate biopsy should be performed if

• the examiner feels a hard lump in the prostate (conspicuous rectal palpation findings),
• there is an elevated PSA value confirmed by controls, which is higher than 3 to 4 ng/ml depending on age,
• an abnormal finding appears in the transrectal ultrasound of the postata (carcinomas are usually darker than the surrounding prostate tissue)

Preparation for a prostate biopsy

Before and after the prostate biopsy, the patient must take a high-dose antibiotic prophylaxis for 5 days. This involves the use of gyrase inhibitors (quinolone antibiotics).

As with all invasive procedures, blood coagulation must be controlled and normal. This means that the patient must stop taking anticoagulant medication.

Procedure for a prostate biopsy

The standard biopsy protocol for a transrectal ultrasound-guided prostate biopsy at least 10 times consists of the following steps:

• The patient is positioned in the left lateral position.
• The anal mucosa is anesthetized by applying a mucosal anesthetic.
• An endorectal probe with an attached guide is used for the transrectal ultrasound.
• The prostate volume is determined via transrectal ultrasonography using the elipsoid formula. Morphologically abnormal areas are documented as part of the ultrasound diagnosis.
• Bilateral local conduction anesthesia of the prostate is performed to effectively prevent pain. For this purpose, 5 to 10 ml of a one percent local anesthetic is injected at the base of the prostate using a fine needle under ultrasound guidance. The anesthetic will take effect after a few minutes.
• The 10-fold biopsy of the prostate is performed under TRUS guidance by taking five cylinders from the peripheral zone of each lateral lobe. An 18 gauge 24 cm biopsy needle in a standard biopsy gun is used for the prostate biopsy.

Scheme of the transrectal prostate biopsy with 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 as an outpatient procedure.

Possible complications of a prostate biopsy

Despite antibiotic prophylaxis, severe prostatitis(inflammation of the prostate) develops in around 2 percent of prostate biopsies involving the removal of 10 to 12 cylinders. This requires the patient to be hospitalized for high-dose intravenous antibiotic therapy.

A feared but nowadays very rare complication of transrectal prostate biopsy is rectal bleeding from the hemorrhoidal veins. This is dangerous because it is initially hidden from the patient and the urologist in the rectal ampulla.

The bleeding only becomes noticeable when large amounts of blood are passed in the stool and possibly also through circulatory symptoms. However, with a frequency of less than 1 percent, this is a very rare complication. It can usually be controlled by conservative measures.