These are the most common types of biopsies and the least accurate. Also referred to as blind or random biopsies, ultrasound does not discriminate cancerous tissue from noncancerous tissue within the gland. They are random due to a generic segmenting of the gland into which needles are directed in a hit-or-miss attempt to capture cancerous tissue. In a nutshell, cancer can be missed.
The transrectal biopsy uses a spring-loaded needle to collect the samples as quickly, efficiently, and painlessly as possible. The biopsy gun can collect between 6 and 13 samples, depending on how many a doctor believes is necessary to diagnose you correctly. In the transrectal biopsy, the ultrasound guides the doctor and the biopsy gun to the proper place. Patients who opt for this prostate biopsy may experience a small amount of bleeding from the rectum as well as blood and urine in the semen afterwards.
The transurethral biopsy is performed with a lighted cystoscope up through the urethra so the doctor can look directly at the prostate gland. The transperineal biopsy collects the tissue through a small incision in the perineum. The transurethral biopsy inserts the cystoscope into the urethra and local anesthesia is given to numb the area. The doctor looks directly at the prostate through the cytoscope and then inserts a cutting loop to extract tissue. The cutting loop works by turning and extracting a small amount of tissue with each turn.
The transperineal prostate biopsy uses a spring-loaded needle to collect samples as quickly, efficiently, and painlessly as possible. The biopsy gun can collect between 6 and 13 samples, depending on how many a doctor believed is necessary to diagnose you correctly. Patients opting to undergo the transperineal biopsy may also be put under general anesthesia if they wish to be unconscious during the biopsy. Men who opt to have the transperineal biopsy performed may experience some tenderness as well as blood in the semen for one to two months afterwards.
Template biopsies are performed under general anesthetic. An ultrasound probe is inserted into the back passage, and biopsies are then taken through the perineum (the area between scrotum and anus) using a grid to accurately map out where the biopsies are being taken from. The doctor puts a template (or grid) with lots of holes over your perineum. They put an ultrasound probe to guide a biopsy needle through the template and into the prostate. Usually about 30 to 50 biopsies are taken.
Similar to the template biopsy, a saturation biopsy typically entails 40–80 core samples taken from the prostate under general anesthesia. This technique is used on certain high risk patients, typically with elevated prostate specific antigen levels, abnormal findings on previous biopsies, or abnormal rectal examinations.
NOTE: No studies have proved that saturation biopsies offer important advantages and they do pose a higher risk of bleeding, infection, and urinary retention.
Technology has allowed for improved accuracy with biopsies. Research facilities and learn the types of biopsies performed so that informed decisions can be made for the most accurate diagnosis.
A fusion biopsy is where the doctor does the biopsy procedure using images from a previously performed MRI that are uploaded to a computer and fused to transrectal ultrasound (TRUS) images which are obtained in real time to guide a prostate biopsy.
This is a traditional biopsy; however, a 3T MRI is done prior to the procedure so that the doctor is able to target any abnormalities that are shown on the image.
This is an MRI targeted biopsy done in real time while the patient is lying in the MRI machine.
These types of biopsies use specialized technology and equipment and are less common.
The PrecisionPoint process uses equipment, along the transperineal path, that can thoroughly sample all regions of the prostate, including those difficult to access with the transrectal approach. It is said to minimize the potential for infection, since passage of the biopsy needle avoids the rectal wall contaminants entirely. This allows the patient to avoid pre-medicating with antibiotics or doing bowel prep.
Micro-ultrasound platform is a tool for urologists to perform targeted biopsies in real time.