What Is a Prostate Biopsy? When Should It Be Performed and How Is It Done?

Who should undergo a prostate biopsy?

A prostate biopsy is recommended when a digital rectal examination and blood PSA measurement raise suspicion of prostate cancer in men with urinary complaints that may indicate prostate cancer, such as passing small quantities of urine, slow or interrupted urination, or blood in the urine, or in men attending for a checkup despite having no complaints.

The initial biopsy decision

• Suspicious findings on digital rectal examination and/or increases in blood PSA levels are sufficient for deciding on biopsy.
• Many prostate cancer diagnosis, treatment and follow-up guidelines consider serum total PSA values above 3.0 ng/ml elevated and recommend biopsy at PSA levels above this value.
• In men with increased total PSA levels, whether PSA changes with antibiotic treatment does not affect the biopsy decision.

What should the prostate biopsy technique be?

• Prostate biopsy should be performed from at least 10-12 sites under Transrectal Ultrasound (TRUS) guidance.
• It is a procedure taking samples from the prostate through the rectum under ultrasound guidance.
• It is performed under local anesthesia; general anesthesia is not used.
• Bowel cleansing with an enema is performed on the morning of biopsy, and hospitalization is not necessary for this procedure.

The initial biopsy result

• If the biopsy result examined by a pathologist is benign, follow-up should be performed.
• If it is cancer, treatment should be evaluated.
• If there is atypical small acinar proliferation (ASAP) or multifocal high-grade prostatic intraepithelial neoplasia (HGPIN), biopsy should be repeated.

Repeat biopsy

• ASAP or multifocal HGPIN on initial biopsy, continuing rises in total PSA during follow-up in men with a benign initial biopsy, or new examination findings require repeat biopsy.
• Repeat biopsy should use the saturation technique or be performed as an extended biopsy.
• It is generally recommended 3-6 months after the first biopsy.