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Prostate Biopsy

Urology

A prostate biopsy is a standard medical diagnostic procedure used to collect prostate tissue samples to determine the presence of prostate cancer or other prostate conditions. Doctors typically recommend a biopsy when there are abnormalities in prostate-specific antigen (PSA) levels or digital rectal examination (DRE) findings.

This procedure is widely used in urology and can be performed using different techniques, such as transrectal ultrasound-guided biopsy (TRUS) or MRI-USG fusion-guided biopsy, to enhance diagnostic accuracy.

Aplications

A prostate biopsy may be recommended by Urologist if the following abnormalities are detected:

Elevated Prostate-Specific Antigen (PSA) Levels	PSA above 4 ng/mL (age and other factors are also considered) Abnormal Free PSA Ratio or Prostate Health Index (PHI), which may indicate a higher risk of malignancy
Abnormal Digital Rectal Exam (DRE) Findings	Presence of hard nodules, lumps, or irregular surfaces, which may indicate cancer
Suspicious Findings on Imaging Tests	MRI scans showing suspicious lesions in the prostate
Family History of Prostate Cancer	There is a higher risk if a father or brother has had prostate cancer
Suspected Prostate Infection or Other Conditions	If chronic prostatitis, granulomatous disease, or abnormal tissue growth is suspected, a biopsy may be performed.

Types of Prostate Biopsy

前列腺活檢方法主要包括以下幾種：

Type	Procedure	Advantages	Disadvantages
Transrectal Ultrasound-Guided Biopsy (TRUS Biopsy)	An ultrasound probe and biopsy needle are inserted through the rectum to sample prostate tissue	Quick, commonly used, performed in outpatient settings	Risk of infection, rectal bleeding, lower accuracy
Transperineal Biopsy	A needle is inserted through the perineum (between the scrotum and anus) to sample prostate tissue	Lower infection risk, better for detecting anterior prostate lesions	Requires local or general anesthesia, longer procedure
MRI – USG Fusion Biopsy	MRI imaging is used to precisely target suspicious areas before the biopsy	Higher diagnostic accuracy, reduces unnecessary biopsies	More expensive, requires MRI images, and equipment for MRI-USG fusion
Saturation Biopsy	20-30 tissue samples are taken to improve detection accuracy	Used for rising PSA levels after a negative biopsy	More invasive, longer recovery time

Procedure

1. Pre-Biopsy Preparation

Stop blood thinners (e.g., aspirin, warfarin) to reduce bleeding risk
Antibiotics may be prescribed to prevent infection
Patients may need to empty the bladder and undergo an enema to clean the rectum

2. The Biopsy Process

Monitoring under Anesthesiologist's Care (MAC) and/or Local Anesthesia (some cases may require general anesthesia)
A biopsy needle is inserted via the rectum or perineum, guided by ultrasound or MRI imaging
10-12 tissue samples are usually taken (MRI-USG fusion biopsy targets specific areas)

3. Post-Biopsy Care

Short-term side effects like blood in urine or rectal bleeding (usually resolve in days)
Blood in semen may persist for a longer period of time
Avoid strenuous activity or heavy lifting for a few days
Seek medical attention if fever, urinary retention, or severe bleeding occurs

Risks and Complications

Short-Term Side Effects:

Blood in urine or semen (may last a few days to weeks)
Rectal bleeding (usually mild, self-resolving)
Mild pain or discomfort

Serious Complications (Rare):

Infection (prostatitis, sepsis) – some patients may develop bacterial infections requiring antibiotics
Urinary retention – difficulty urinating may require temporary catheterization
False-negative results – if PSA remains elevated, a repeat biopsy may be needed

FAQ

With MAC or local anesthesia, patients may feel pressure or mild discomfort, but it is generally tolerable.

Most patients resume normal activities within 1-2 days, but should avoid intense exercise for a few days.

Not necessarily. PSA levels may rise due to benign prostatic hyperplasia (BPH), infection, or inflammation. A biopsy is recommended if multiple risk factors are present.

If PSA levels continue to rise or imaging shows abnormalities, an MRI scan or repeat biopsy may be required.