The usual indications for a biopsy of the prostate gland are a suspicious finding during clinical examination of the prostate (positive digital rectal examination), biochemical evidence of prostatic pathology (Increased Prostate Specific Antigen PSA) or a suspicious finding during transrectal ultrasound.

Definite diagnosis of malignancy of the prostate gland is achieved by acquisition of tissue samples by TRUS-guided biopsy. The biopsy needle is advanced through a sterile needle guide attached to or integrated in the transducer.

Transrectal Ultrasound-Guided biopsy of the prostate gland – A special transducer is used that incorporates a biopsy channel. The needle is attached to a biopsy gun.

A special cutting-type large-core needle is used, attached to a biopsy gun.

The tip of a core needle during the various phases of tissue acquisition. The needle is advanced until it is a small distance from the lesion we intend to biopsy. Then the biopsy gun is fired. First, the inner stylet is thrown forward piercing the lesion, Tissue protrudes in the tissue notch of the inner stylet. Next the outer sleeve of the needle is forwarded, cutting a core of tissue and securing it in the tissue notch. The needle is removed, the tissue collected, and the procedure is repeated over and over, until enough tissue is obtained.

Ultrasound allows us to selectively target suspicious areas.

	A minute tumour of the peripheral zone extending parallel to the prostatic capsule. Note electronic marker o in this transverse section marking the path of our needle.
	TRUS-Guided biopsy of the lesion proved an adenocarcinoma of the prostate.
	Histology slide from the same patient - A Gleason 4 tumor.

Acquisition of targeted biopsies is usually complemented by sextant biopsies from the peripheral zone, and additional biopsies from the transitional zone. PIC6 It is advisable to guide our biopsies so as to sample the periprostatic fat, the seminal vesicles, the trapezoid space and any suspicious enlarged periprostatic lymph nodes, if we wish to locally stage the disease.

	A biopsy scheme demonstrating the approximate spacing of our biopsies, in the peripheral and the central zones.
	Biopsy intended to include periprostatic fat and prostatic capsule for staging purposes.

Biopsy of the prostate gland is a safe and efficient procedure, provided certain precautions are heeded: Preparation of the rectum with enemas on the day of the procedure is essential, as well as prophylactic antibiotic administration with a suitable regimen, meant to minimize the risk of septic complications. There is a learning curve of the procedure; with increasing number of biopsies, the number of complications declines and the Positive predictive value increases.

Early diagnosis of prostate cancer may allow for less invasive treatment like brachytherapy of the prostate, a treatment for prostate carcinoma by implantation of radioactive seeds in the gland. It is an outpatient procedure performed under TRUS guidance in specialized centers.

Control X-Ray after seed implantation In a patient with a small neoplasm of Gleason score 3+3 confined to the prostate. Uniform distribution of the radioactive seeds ensures an adequate uniform radiation dose to the prostate parenchyma sparing surrounding tissues.

In skilled hands and for a strictly selected group of patients the method has shown excellent results.

For more information on Transrectal Ultrasonography and prostate biopsy the reader is also referred to our review of Transrectal Ultrasonography and TRUS-guided biopsy of the prostate gland, available as an Acrobat PDF file that can be downloaded for free. (Requires Acrobat Reader for viewing).

Another valuable source of information on this subject is the interactive CD ROM Transrectal Ultrasound and TRUS-guided biopsy of the prostate gland available through the secure page of our site.