Prostate biopsy: Precise, image-guided diagnosis

An outpatient procedure in which small samples of prostate tissue are obtained for histological analysis, essential when PSA is elevated or a digital rectal exam is abnormal.

The study is performed under ultrasound guidance via a transrectal or transperineal route, depending on each case, with local anesthesia or sedation. Between 10 and 14 representative tissue cores are obtained and the study takes approximately 20 minutes.

Every prostate biopsy is ultrasound-guided, but the route the needles take makes the difference in precision, risk and sampling coverage.

Transrectal route (conventional). The probe enters through the rectum and the needles cross the rectal wall. It is a valid, widely documented approach, but it crosses an area with bacterial flora and leaves some regions of the gland out of reach.

Transperineal route. The needles enter through the perineum, without crossing the rectum. It markedly reduces the risk of infection and bleeding, and allows sampling of the entire prostate, including the anterior and apical zones.

We perform transperineal biopsy with a stabilizer or stepper, a system that holds and moves the probe in a controlled, millimetric way.

Without a stabilizer, the biopsy is essentially freehand. With a stabilizer, each needle is directed to the exact point of suspicion flagged on MRI, and its position is recorded in a reproducible map of the gland.

The result is a targeted biopsy, not an approximate one:

• Sampling of the exact point of suspicion
• Lower likelihood of false negative results
• Reproducible map for follow-up or repeat studies
• True coverage of the entire prostate

We are one of the few centers in the country performing transperineal biopsy with a stabilizer.

The choice depends on PSA, MRI findings, prostate anatomy, previous biopsies and each patient's infection risk profile. During consultation we define the route offering the best diagnostic yield with the lowest possible risk.

Men with elevated PSA, a family history of prostate cancer, suspicious findings on multiparametric MRI, or an abnormal digital rectal exam.