Prostate Biopsy

Hi Chris,

Thank you for getting in touch with us and welcome to our online community.  My name is Adrienne and I’m one of the Cancer Information Nurse Specialists at Macmillan.  I see you’ve joined a couple of our forums.  I hope that you are finding them helpful and supportive.

I’m sorry to hear about the change noted on your MRI scan, leading to you needing a biopsy.  MRI scans are very detailed but the biopsy is vital to see exactly what is going on with the prostate cells.

Generally, there are two types of prostate biopsy.  A trans-perineal (TP) biopsy and a trans-rectal ultrasound guided (TRUS) biopsy.  

A TP biopsy is when they take samples of the prostate gland through the area between the scrotum and the back passage (called the perineum).  You will be asked to lie on your back and the nurse will place your legs into stirrups.  The doctor then passes a small ultrasound probe into the rectum using lubricating gel. This shows an image of the prostate gland on a screen. The images from your MRI scan may also be used.  The doctor will then pass a needle through the skin of the perineum. It can take many small tissue samples from different areas of the prostate gland using a grid (template biopsy). The doctor may take samples from a specific area of the prostate gland (targeted) or from the whole prostate gland.  They will then place a dressing over your perineum.  This can be done under local or general anaesthetic (GA) but if you have a GA, you may need to stay in hospital overnight. You may also be given an antibiotic before and/or after the procedure to prevent infection.

With a TRUS biopsy you will be asked to lie on your side, with your knees pulled up to your chest.  Like the TP biopsy, an ultrasound probe will be placed into the rectum to help guide them when removing samples of prostate tissue (biopsies).  Again, your MRI scan may also be used.  They will then put a needle next to the probe in your back passage and insert it through the wall of the back passage into the prostate.  This is usually done under local anaesthetic and like the TP, you may have antibiotics to take before and/or after the procedure. 

Although there are two different types of prostate biopsy, most are still done using TRUS approach.  This is because the TP biopsy isn’t available in all areas. 

There is a lower chance of infection with TP biopsy however this is why antibiotics are usually given, as a preventative measure.  There is no good evidence yet to suggest TRUS is better at detecting cancer yet but TP does not look any worse than TRUS at detecting cancer.  I have included a retrospective study from 2023, looking at 452 patients here for you to read if you’d be interested. 

Prostate Cancer UK have stated that because a TP biopsy has a reduced risk of infection and therefore of developing sepsis, it should be available as a choice for anyone who needs a prostate biopsy.  Therefore, they are supporting nurse training on how to perform TP biopsies. 

The main thing is to discuss all of this with your urologist on Friday.  Ask if both biopsies are available and talk through your options.  Don’t be afraid to voice any concerns you may have and ask as many questions as you need to.  It might be helpful to write down some questions prior to your appointment on Friday, so you don’t forget to ask anything.

I hope this information was helpful and please don’t hesitate to get back in touch with us at any time.

Take care and best wishes,

Adrienne

Cancer Information Nurse Specialist

You can speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or send us an email.

Ref:  AMc/RH

Dear Adrienne, Thank you very much for taking the time to outline the two types of biopsy techniques. The information was clear and very helpful.

Kind regards

Chris