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Prostate biopsy
Last reviewed: 06.07.2025
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The similarity of the echographic picture of prostate cancer and inflammatory changes in the gland requires the use of a set of differential diagnostic measures, the most accurate of which is a polyfocal biopsy of the prostate gland under ultrasound control with subsequent morphological study of the obtained tissues.
In addition, despite the abundance of methods for diagnosing prostate cancer, mandatory morphological confirmation of the disease is necessary. There are two methods for performing prostate biopsy - transrectal or transperineal. Transperineal biopsy has a number of disadvantages that significantly limit its use: traumatic manipulation, the need for local or general anesthesia, a relatively high incidence of complications, the lack of dynamic ultrasound control during the biopsy needle. In this regard, transrectal multifocal biopsy can currently be considered the method of choice for morphological diagnostics of prostate cancer.
[ Indications for prostate biopsy
The following indications for primary biopsy are identified:
- total serum PSA level >2.5 ng/ml (or higher than the corresponding age norms);
- suspected prostate cancer based on digital rectal examination;
- suspected prostate cancer by transrectal ultrasound.
Indications for repeat biopsy (in the absence of prostate cancer in the initial biopsy):
- PSA increase after initial biopsy;
- Free PSA/Total PSA <15%;
- PSA density >20% (the ratio of the total PSA level to the volume of the prostate gland according to TRUS data);
- high-grade prostatic intraepithelial neoplasia (PIN) (three months after initial biopsy);
- Suspected local tumor recurrence after radical prostatectomy based on DRE and TRUS data.
How is a prostate biopsy performed?
Prostate biopsy is performed on an outpatient basis. Preparation for the biopsy involves bowel cleansing the day before the procedure and prophylactic oral administration (24 hours prior) of antibiotics (usually fluoroquinolones) and metronidazole. After the biopsy, prophylactic antibiotic administration may be continued for 5 days. The procedure is performed with the patient lying on his side or in the perineal surgery position. Prostate biopsy requires anesthesia. The best results are achieved by administering local anesthetics around the prostate gland: this is a fairly reliable, safe and convenient method. 20 out of 23 studies have shown its advantage over placebo or rectal administration of a gel with a local anesthetic. Anesthesia is administered by administering 1% lidocaine solution at a dose of 20 ml into the paraprostatic tissue on both sides. The number of injections is determined by the urologist. It is generally accepted to supplement the biopsy with targeted tissue sampling from suspicious hypoechoic foci.
Special modern devices are used for biopsy, allowing to obtain a sufficient amount of tissue for histological examination. When biopsy samples are obtained correctly, the length of each should be at least 15 mm, and the diameter should be 1 mm.
Among the complications of biopsy, the most common are: pain in the rectum (up to 35% of cases), hematuria (15-35%), acute prostatitis (5-10%), acute urinary retention (2%), and rectal bleeding (296). Complications usually do not require inpatient care, but in case of hospitalization, symptomatic therapy is recommended.
Contraindications to prostate biopsy
The following contraindications for prostate biopsy are identified:
- acute prostatitis;
- complicated hemorrhoids;
- acute inflammatory diseases of the rectum and anal canal;
- severe stricture of the anal canal;
- condition after abdominoperineal extirpation of the rectum;
- diseases leading to severe disorders of the blood coagulation system (hypocoagulation).
In addition, puncture biopsy of the prostate gland is a method of differential diagnostics of chronic prostatitis, prostate cancer, its benign hyperplasia and tuberculosis. Sometimes prostate cancer occurs under the guise of chronic inflammation. It is for this reason that determining the level of prostate-specific antigen (PSA) and prostate biopsy (in case of an increase in PSA above 2.5 ng/ml) are advisable.