Prostate biopsy

Prostate biopsy
Medical diagnostics
Diagram showing a transperineal prostate biopsy
ICD-9-CM	60.11-60.12
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MRI-US fusion biopsy
Medical diagnostics
3d-reconstructed prostate gland indicating suspicious lesions for targeted biopsy. An informative video detailing the process of MRI-US fusion targeted biopsy can be found at the following website: http://urology.ucla.edu/body.cfm?id=455
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Prostate biopsy is a procedure in which small hollow needle-core samples are removed from a man's prostate gland to be examined microscopically for the presence of cancer. It is typically performed when the result from a PSA blood test rises to a level that is associated with the possible presence of prostate cancer. It may also be considered advisable after a digital rectal exam (DRE) finds possible abnormality. PSA screening is controversial as PSA may become elevated due to non-cancerous conditions such as a benign enlargement of the prostate (BPH, benign prostatic hyperplasia), by infection, or by manipulation of the prostate during surgery or catheterization; and many prostate cancers detected by screening develop so slowly that they would not cause problems during a man's lifetime, making the complications due to treatment unnecessary.

The procedure, usually done as an outpatient, requires a local anesthetic; some men do report discomfort during the biopsy. The most frequent side effect of the procedure is blood in the urine or stool for several days or blood in the ejaculate possibly for several weeks afterwards. These side effects are usually self-limited and do not require additional treatment.

The procedure may be performed transrectally, through the urethra or through the perineum. The most common approach is transrectally, and historically this was done with tactile finger guidance. The most common method of prostate biopsy as of 2014^[update] was transrectal ultrasound-guided prostate (TRUS) biopsy.

Extended biopsy schemes take 12-14 cores from the prostate gland through a thin needle in a systematic fashion from different regions of the prostate.

A biopsy procedure with a higher rate of cancer detection is template prostate mapping (TPM) or transperineal template-guided mapping biopsy (TTMB), whereby typically 50 to 60 samples are taken of the prostate through the outer skin between the rectum and scrotum, to thoroughly sample and map the entire prostate, through a template with holes every 5mm, usually under a general or spinal anaesthetic.