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Ultrasound-guided histological biopsy from the prostate


Medical editor Bjørn Brennhovd
Urologist
Oslo University Hospital
Norway

General

Biopsy of the prostate is performed to diagnose prostate cancer and to assess the extent and localization of the tumor.

To determine the T-stage, a histological biopsy is included in addition to digital rectal exploration (DRE), transrectal ultrasound (TRUS). The tumor type (Gleason score) is assessed by the pathologist based on the biopsy material.

The biopsy is usually taken transrectally with local anesthesia. In special cases, perineal biopsies are done under short general anesthesia.

Indications

  • Palpable finding by DRE  
  • Normal DRE and TRUS, but raised serum-PSA (<3-4 ng/ml)

Goal

Diagnostic:

  • to confirm prostate cancer.
  • to determine T-stage.

Equipment

  • Leg holders

Preparation

Transrectal biopsy

  • Antibiotic prophylaxis 

Transperineal biopsy

  • Tape scrotum
  • Wash the perineum with colored chlorhexidine

Implementation

Transrectal biopsy

  • Place local anesthesia with a thin needle in the area around the prostate capsule.
  • Fill the condom with gel and cover the ultrasound probe. 
  • Insert ultrasound probe into the rectum.
  • Inspect the prostate and target volume.
  • Localize the suspect area in the prostate using ultrasound.
  • Insert the biopsy needle with the help of ultrasound into the desired area of the prostate.
  • Retract the biopsy pistol to take the biopsy.
  • Take 4-6 biopsies from each prostate lobe in a systematic pattern.
  • Place the biopsies into separate specimen containers with formalin.

Transperineal biopsy

  • Short general anesthesia is given. 
  • Fill the condom with gel and cover the ultrasound probe.  
  • Insert the ultrasound probe into the rectum.
  • Inspect the prostate and target volume.
  • Localize suspect area in the prostate with the help of ultrasound.  
  • Insert the biopsy needle in the perineum.
  • Insert the needle into the prostate with the help of ultrasound.
  • Retract the biopsy pistol to take the biopsy.
  • Take 5-10 biopsies from each lobe of the prostate in a systematic pattern.
  • Place the biopsies into separate specimen containers with formalin.

Follow-up

The result of the test is usually available after 14 days. When prostate cancer is confirmed, the patient is referred for further investigation and treatment.

Observations

  • Fever and/or chills (bacteremia)
  • Blood in the urine, stool, or sperm is normal

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