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Prostate biopsy

Prostate biopsy — taking tissue samples from the prostate when PSA is elevated or examination is suspicious.

A procedure in which tissue samples are taken from the prostate by transrectal or transperineal route under MRI fusion guidance, allowing diagnosis of prostate cancer.

Indication

  • Elevated or rising PSA (prostate-specific antigen) level
  • Hardness or nodule felt on digital rectal examination
  • Suspicious lesion classified as PI-RADS 3-5 on multiparametric prostate MRI
  • Persistent clinical suspicion despite a previous negative biopsy
  • Re-evaluation in low-risk prostate cancer under active surveillance
  • Elevated PSA together with a family history (first-degree relative with prostate cancer)

Preparation

  • Infection is excluded with urinalysis and culture before the procedure
  • Blood thinners (aspirin, warfarin, new-generation anticoagulants) are stopped with physician approval
  • Prophylactic antibiotics are started before the procedure (usually fluoroquinolone or a combination regimen)
  • An enema is recommended for bowel preparation in the transrectal approach
  • A light breakfast may be eaten on the day of the procedure; if sedation is planned, fasting for 6 hours is required

How it's performed

  1. The patient is placed in the lateral or lithotomy position; local anesthesia or light sedation is administered
  2. A transrectal ultrasound probe is placed in the rectum to assess the prostate
  3. Previously obtained MRI images are merged with ultrasound (MR-fusion biopsy)
  4. 12-14 tissue samples (cores) are taken from different areas of the prostate using a fine needle
  5. Additional targeted samples are taken from suspicious MRI lesions
  6. In the transperineal approach, the needle is inserted through the perineal skin, reducing infection risk

Post-procedure

  • 30-60 minutes of observation after the procedure; most patients are discharged the same day
  • Blood in urine, stool, or semen for 1-3 days is normal
  • Antibiotic therapy is continued for 3-5 days
  • Emergency consultation is required in case of fever, chills, or inability to urinate
  • The pathology result is available within 7-10 days and is reviewed with the urologist

Risks

  • Urinary tract infection or sepsis (1-3% with the transrectal approach, lower with the transperineal approach)
  • Temporary bleeding in urine, stool, or semen
  • Temporary difficulty urinating or urinary retention
  • Discomfort or mild pain in the perineal or rectal area
  • Rarely, hematoma in the prostate or surrounding tissue

FAQ

Is prostate biopsy painful?

Thanks to local anesthesia or sedation, pain is mostly mild. Brief pressure or discomfort may be felt at needle insertions.

When are the results ready?

The pathology report is usually completed within 7-10 days. Results are evaluated by the urologist together with PSA and MRI findings.

Is it normal to see blood after the procedure?

Mild blood may be seen in urine, semen, or stool for a few days. Bleeding in semen may last 4-6 weeks and usually resolves on its own.

Is MR-fusion biopsy better than classical biopsy?

MR-fusion biopsy increases the detection rate of clinically significant cancer by targeting suspicious areas and reduces the number of unnecessary samples.

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Specialty

Urology

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