Prostate Biopsy- How is it done? Procedure...

Standard sextant biopsy scheme of the peripheral zone of the prostate in the coronal plane on right and left sides at the base (top), midgland, and apex (bottom).

Ten-biopsy scheme of the peripheral zone (PZ) of the prostate in the coronal plane. Standard sextant scheme (closed circles) and additional biopsies from the lateral peripheral zone at the base and midgland (open circles). .

Nowadays, six prostate biopsies are usually performed in the parasagittal line halfway between the lateral border and midline of the prostate on both right and left sides from the base, midgland, and apex (right figure). But it appears that six biopsies may not be adequate for all prostate sizes and configurations, and moreover, it has been shown that prostate cancer detection rates are inversely proportional to prostate size if only six biopsies are performed.

One study demonstrated a 23% cancer detection rate in men with prostates greater than or equal to 50 cc in size, compared to 38% in men with prostates smaller than 50 cc. So the smaller the prostate, the better chance there it to detect the cancer. This is quite logical.

Currently there is an ongoing refinment of the prostate biopsy process, adapting it to prostates of different sizes and shapes. Sextant biopsies are found more and more to be inadequate in most cases, and more extended PZ (peripheral zone) biopsy schemes definitely increase cancer detection rates. A reason behind this is that the majority of prostate cancers originates in the peripheral zone of the prostate. More recently, systematic biopsy is used to provide additional information with respect to tumor volume, grade, stage, and risk assessment.

In general, studies on new biopsy schemes have used one of two approaches:

1. prospective evaluations of different prostatic biopsy schemes on referral-based populations
2. computer modeling of prostate biopsy schemes. Each of these approaches is now reviewed.

There are three ways in which this procedure is usually performed:

Transrectal prostate biopsy- Through the rectum

The doctor may use a transrectal ultrasound (TRUS) probe to guide the needles to the suspected area. The probe and needle are inserted through the rectum, and directed towards the prostate with the help of ultrasound. Then, using a spring-loaded needle, it "shoots" the prostate and collects a sample. This procedure could be repeated more times, depending on tumor size and prostate characteristics.

An alternative is to attach the needle to your doctor's finger, but this is not used so often.

Duration: some 30 minutes, and can be longer depending on the number of probes.

Transurethral biopsy- Through the urethra

Instead of the rectum, a lighted scope is inserted in the urethra, and is guided by your doctor to the prostate. When reaching it, samples will be collected.

Another transurethral intervention is transurethral resection of the prostate (TURP) , a surgical procedure used most often to treat men with BPH. Part of the prostate gland surrounding and constricting the urethra is removed. A tool with a wire loop on the end is passed into the penis and through the urethra to the prostate gland. Electricity is then passed through the wire to heat it and cut the tissue. A sample of the prostate tissue removed during TURP is sent for examination by a pathologist to determine whether any cancer is present.

Duration: 30-45 minutes, a little more because of the time imvolved in guiding the lighted scope (cystoscope)

Transperineal biopsy- Through the perineum

Is not performed as often as the previous two, since it involves local anesthetics and an incision in the perineum, through which the needle will be inserted.

The doctor inserts his hand inside the rectum as to hold te prostate. After the prostatic samples are prelevated, the incision is isolated with a small bandage. You just had a prostate biopsy done.

Duration: 20-30 minutes

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