Prostate biopsy is required to diagnose prostate cancer and also provide a histological grade which helps guide treatment decisions. Prostate biopsy is invasive. It is important to determine the need for biopsy and if it is required to perform it safely. Biopsy is typically indicated for an elevated PSA test and abnormal MRI prostate. It may also be indicated to investigate an abnormal digital rectal examination (DRE). Occasionally an elevated PSA with a normal prostate MRI will also require prostate biopsy.
Transperineal prostate biopsy
This is Dr Coughlin's preferred technique for performing prostate biopsy. The needle is passed through the skin of the perineum and this reduces the risk of infection to an extremely low level. It is performed under a general anaesthetic (you will be asleep). All areas of the prostate can be accessed via this approach. If a cancer is suspected on MRI that area can then be specifically targeted during biopsy.
MRI guided prostate biopsy
If a suspicious lesion is identified in the prostate on MRI scan it is possible to biopsy this under MRI guidance. This usually involves 2-4 needle biopsies performed in the MRI scanner. The main downside of this technique is the needles are passed into the prostate transrectally (i.e. through the bowel wall) and this increases the risk of infection which can be serious. At present there is no data to suggest this technique is more accurate than targeted transperineal prostate biopsy. The procedure is currently relatively expensive and there is no medicare or private insurance rebate available.
TRUS prostate biopsy
Transrectal ultrasound guided biopsy is the most common technique used for prostate biopsy. Dr Coughlin does not perform this due to a 1-2% risk of infection which can be life threatening. Also only the back portion of the prostate is able to be reliably biopsied in this fashion. Under sedation a needle is passed through the bowel wall of the rectum into the prostate for biopsy. 12-18 needle biopsies are typically performed. Dr Coughlin recommends against undergoing this procedure.