A biopsy of the prostate gland is usually required when there is a suspicion of prostate cancer. It involves taking multiple small samples of prostate tissue using a biopsy needle, which are then assessed microscopically by a pathologist.
Trans rectal prostate biopsy - The prostate biopsy has traditionally been performed via the rectum (transrectal ultrasound-guided -TRUS biopsy), because the prostate sits directly in front of the rectal wall and therefore easily accessed via this route. TRUS biopsy has been the standard approach for prostate biopsy but has potential drawbacks such as the small but significant risk of serious infection, where bacteria may enter the bloodstream (septicaemia). This is due to the biopsy needle passing through the rectal wall into the prostate, which has a rich blood supply. Routine prophylactic oral antibiotics are giving pre-operatively as well as intravenously at time of procedure but infection is still a complication. Septicaemia is a serious illness that requires urgent hospital admission for further intravenous antibiotics and supportive care. The benefit of this biopsy is that it can be done under local or general anaesthetic.
Transrectal Biopsy Transperineal Biopsy
Transperineal biopsy of the prostate - Biopsy needles are passed through the perineum (between the scrotum and anus) allowing access to all aspects of the gland. Excellent imaging is obtained by an ultrasound probe passed into the rectum. This approach allows increased number of biopsy samples by use of "a grid template" being beneficial in men who have had a previous negative TRUS biopsy but whose PSA continues to rise or for men who are on active surveillance for previously-diagnosed low risk prostate cancer.The transperineal biopsy has the advantage of a much lower risk of infection. A general anaesthetic is required.