Prostate biopsy

Prostate biopsy is indicated when PSA testing or digital rectal examination gives suspicion of prostate cancer. MRi is usually indicated before biopsy, as it may make the biopsy more targeted toward the lesion.

The biopsy can be performed transrectally, transperineally, or (rarely) transurethrally. The standard is transrectal biopsy with ultrasound guidance (TRUS biopsy).

MRi-targeted biopsy is preferred, but if unavailable, a systemic approach should be used. 10-12 biopsies should be taken. Samples should be taken from each side of the prostate, more samples should be taken from the lateral aspects than the medial, and the apex should be biopsied. This is according to McNeals view of prostate anatomy.

Antibiotic prophylaxis is recommended for transrectal biopsy in all cases but not for transperineal biopsy unless the patient is immunocompromised.