What is a prostate biopsy? A biopsy of the prostate gland may be ordered when the prostate-specific antigen (PSA) test gives elevated values ​​or the digital rectal examination (DRI) shows suspicion of prostate cancer. While screening tests may show that there is a problem, a biopsy of the prostate gland is needed to make the diagnosis of prostate cancer and to determine the aggressiveness of the disease. A biopsy of the prostate gland can also help determine the course of treatment. In the procedure, a needle is inserted into the prostate gland (most often through the rectum) to obtain tissue samples, which are then examined under a microscope. Tissue sampling may be performed under imaging guidance. Reasons for doing this test may include: Elevated PSA test values; Suspected cancer, such as a lump on digital rectal examination; Suspected cancer on transrectal ultrasound (TRUS); When a previous biopsy of the prostate gland was negative, but the PSA test continues to give elevated results A biopsy of the prostate gland may also be done in men with known prostate cancer to check the progression of the disease. What types of prostate biopsy are there? Biopsies of the prostate gland can vary in both the method used and the location where the biopsy is taken. Previously, a random 12-point biopsy was more commonly used. In this procedure, samples are taken from 12 random areas of the prostate gland. Image-guided biopsies are becoming more widely used and have greater sensitivity as well as fewer complications (although they are more expensive). In these procedures, abnormal areas are first detected using rectal ultrasound (TRUS), multiparametric MRI, or MRI-TRUS fusion biopsy (a combination of rectal ultrasound and multiparametric MRI), and these abnormal areas are then selectively biopsied. The most common biopsy of the prostate gland is transrectal, in which biopsy needles are inserted into the prostate gland through the rectum. Another option is a transperineal prostate biopsy, where an incision is made between the scrotum and rectum and biopsy needles are inserted into the prostate gland from this area. A transperineal approach may be necessary if the specialist suspects cancer in the front of the prostate gland or if the man has had previous rectal surgery. Much less commonly, a transurethral approach may be used, where biopsy needles are inserted into the prostate gland from the urethra during cystoscopy. What are the limitations of a biopsy of the prostate gland? Like many medical tests, a prostate biopsy can give both false negative results (which are normal even though cancer is present) and false positive results (which showthat there is cancer when none is present). In terms of false-negative results, prostate biopsies miss about 20% of prostate cancer cases. Most prostate cancers are slow-growing, and if the prostate-specific antigen (PSA) remains elevated, a repeat biopsy is often recommended. It is believed that MRI/targeted biopsies can improve the accuracy of the results and miss fewer cancers, but as this is a relatively new technique, it also depends on the specialist’s experience and training. False-positive results (overdiagnosis) in prostate biopsy can lead to overtreatment, exposing men to adverse effects for no benefit. Random biopsies (which are performed without imaging), in particular, are thought to often overdiagnose benign tumors (6 on the Gleason scale). What are the alternatives to prostate biopsy? Many men wonder if it is possible to replace the biopsy of the prostate gland with an imaging study. Currently, multiparametric MRI (as well as some enzyme tests) can help reduce the number of unnecessary biopsies performed, but a biopsy is still needed to diagnose the disease and to determine its aggressiveness. References: 1. Tikkinen KAO, Dahm P, Lytvyn L, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline 2. Naji L, Randhawa H, Sohani Z, et al. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis 3. Guo G, Xu Y, Zhang X. TRUS-guided transperineal prostate 12+X core biopsy with template for the diagnosis of prostate cancer 4. Applewhite JC, Matlaga BR, McCullough DL, Hall MC. Transrectal ultrasound and biopsy in the early diagnosis of prostate cancerCurrently, multiparametric MRI (as well as some enzyme tests) can help reduce the number of unnecessary biopsies performed, but a biopsy is still needed to diagnose the disease and to determine its aggressiveness. References: 1. Tikkinen KAO, Dahm P, Lytvyn L, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline 2. Naji L, Randhawa H, Sohani Z, et al. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis 3. Guo G, Xu Y, Zhang X. TRUS-guided transperineal prostate 12+X core biopsy with template for the diagnosis of prostate cancer 4. Applewhite JC, Matlaga BR, McCullough DL, Hall MC. Transrectal ultrasound and biopsy in the early diagnosis of prostate cancerCurrently, multiparametric MRI (as well as some enzyme tests) can help reduce the number of unnecessary biopsies performed, but a biopsy is still needed to diagnose the disease and to determine its aggressiveness. References: 1. Tikkinen KAO, Dahm P, Lytvyn L, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline 2. Naji L, Randhawa H, Sohani Z, et al. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis 3. Guo G, Xu Y, Zhang X. TRUS-guided transperineal prostate 12+X core biopsy with template for the diagnosis of prostate cancer 4. Applewhite JC, Matlaga BR, McCullough DL, Hall MC. Transrectal ultrasound and biopsy in the early diagnosis of prostate cancer