Skip to main content

Advertisement

SpringerLink
Log in

The technique of ultrasound guided prostate biopsy

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

This article discusses the preparations for ultrasound guided prostate biopsy, the conditions used and the process of performing a biopsy. The first step in preparing the patient is a cleansing enema before biopsy. Every author proposes the use of a preoperative antibiotic based prophylaxis. Differences may be found in the type, dosage and the duration of this preoperative application, which can last from 2 h to 2 days. For anaesthesia, lidocaine has been proposed, which may be used as a gel applied in the rectum or in the form of a prostate infiltrate. Quite a few colleagues administer a brief intravenous narcosis. A major debate goes on in respect of defining the number of biopsy samples needed. Hodge proposed sextant biopsy in 1989, for which we had false negative findings in 20% of all cases. Because of this, it has recently been suggested that eight or rather ten samples be taken. There are some who question even this. Twelve biopsy samples do offer an advantage compared to six, although in the case of eight this is not the case. We shall present an in depth discussion of the various opinions on the different numbers of biopsies samples required. For the sample site, the apex, the base and the middle part are proposed, and (completing the process) two additional samples can also be taken from the transition zone (TZ), since 20% of all prostate cancers originate from TZ. In case of a palpable nodule or any lesion made visible by TRUS, an additional, targeted, biopsy has to be performed. Certain new techniques like the 3-D Doppler, contrast, intermittent and others shall also be presented. The control of the full length of samples taken by a gun, as well as the proper conservation of the samples, are parts of pathological processing and of the technical tasks. A repeated biopsy is necessary in the case of PIN atypia, beyond which the author also discusses other indications for a repeated biopsy. We may expect the occurrence of direct postoperative complications and it is necessary to know how to treat these.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Matlaga BR, Lovatio JF, Hall MC (2003) Randomized prospective trial of novel local anesthetic technique for extensive prostate biopsy. Urology 61:972–976

    Article  PubMed  Google Scholar 

  2. Lee-Eliott CE, Dundas D, Patel U (2004) Randomized trial of lidocaine vs lidocaine/bupivacaine periprostatic injection on longitudinal pain scores after prostate biopsy. J Urol 171:247–250

    Article  PubMed  Google Scholar 

  3. Cormio L, Berardi B, Callea A, Fiorentino N, Sblendorio D, Zizzi V, Traficante A (2002) Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam. BJU Int 90:700–702

    Article  CAS  PubMed  Google Scholar 

  4. Galetti TP, Dal Moro F, Milani C, Pinto F, Pagano F (2002) Patient’s preparation in order to reduce pain, anxiety and complications of TRUS prostatic biopsies. Eur Urol [Suppl] 1:3–7

    Google Scholar 

  5. Adamakis I, Mitropoulos D, Haritopoulos K, Alamanis C, Stravodimos K, Giannopoulos A (2003) Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with intrarectal instillation of lidocaine-prilocain cream. World J Urol 21:386–4

    Google Scholar 

  6. Öbek C, Önal B, Özkan B, Önder AU, Yalcin V, Solok V (2002) Is periprostatic local anesthesia for transrectal ultrasound guided prostate biopsy associated with increased infectious or haemorrhagic complications? A prospective randomized trial. J Urol 168:558–561

    Google Scholar 

  7. Rifkin T, Peters TL (2001) Should ultrasound criteria of prostate be redefined to better evaluate when and where biopsy. Ultrasound Q 17:171–6

    PubMed  Google Scholar 

  8. Hodge KK, McNeal JE, Terris MK, Stamey TA (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142:71–74

    CAS  PubMed  Google Scholar 

  9. Palisaar J, Eggert T, Graefen M, Haese A, Huland H (2003) Transrectal ultrasound-guided punch biopsies of the prostate. Indication, technique, results and complications. Urologe A 42:1188–1195.

    Article  CAS  PubMed  Google Scholar 

  10. Epstein JI, Walsh PC, Sauvageot J, Carter HB (1997) Use of repeat sextant and transition zone biopsies for assessing extent of prostate cancer. J Urol 158:1886–1890

    CAS  PubMed  Google Scholar 

  11. Meng MV, Franks JH, Presti JC, Shinohara K (2003) The utility of apical anterior horn biopsies in prostate cancer detection. Urol Oncology 21:361–365

    Article  Google Scholar 

  12. Miyake H, Sakai I, Ishimura T, Hara I, Eto H (2004) Significance of cancer detection in anterior lateral horn on systematic prostate biopsy: the effect on pathological findings of radical prostatectomy specimens. BJU Int 93:57–59

    Article  CAS  Google Scholar 

  13. Djavan B, Remzi M, Ghawidel K, Marberger M (2003) Diagnosis of prostate cancer—the clinical use of transrectal ultrasound and biopsy. EAU Update Ser 3:1–6

    Google Scholar 

  14. Stricker HJ, Ruddock LJ, Wan J, Belville WD (1993) Detection of nonpalpable prostate cancer. A mathematical and laboratory model. Br J Urol 71:43–46

    CAS  PubMed  Google Scholar 

  15. Levine MA, Ittmann M, Melamed J, Lepor H (1998) Two consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate for the detection of prostate cancer. J Urol 159:471–476

    CAS  PubMed  Google Scholar 

  16. Eskew LA, Bare RL, Mc Cullough DL (1997) Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol 157:199–202

    Article  CAS  PubMed  Google Scholar 

  17. Beurton D, Barthelemy Y, Fontaine E, Chartier E, Lamotte F, Franc B (1997) Twelve systematic prostate biopsies are superior to sextant biopsies for diagnosing carcinoma: a prospective randomized study. Br J Urol 80:239

    Google Scholar 

  18. Singh H, Canto EI, Shariat SF, Kadmon D, Miles BJ, Wheeler TM, Slawin KM (2004) Six additional systematic lateral cores enhance sextant biopsy preditction of pathological features at radical prostatectomy. J Urol 171:204–209

    Article  PubMed  Google Scholar 

  19. Presti JC, O’Dowd GJ, Miller MC, Mattu R, Veltri RW (2003) Extended peripherial zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol 169:125–129

    Article  PubMed  Google Scholar 

  20. Horninger W, Reissigl A, Fink K, Pointer J, Strasser H, Bartsch G (1998) Results of a prospective randomised study comparing the prostate cancer detection rates in PSA screening volunteers undergoing 10 vs 14 transrectal ultrasound guided biopsies. J Urol 159:180

    Google Scholar 

  21. Nava L, Montorsi F, Consonni P, Scattoni V, Ghazzoni G, Rigatti P (1997) Results of prospective randomised study comparing 6, 12, 18 transrectal, ultrasound guided, sextant biopsies in patients with elevated PSA, normal DRE and normal prostatic ultrasound. J Urol [Suppl] 157:59

    Google Scholar 

  22. Djavan B, Zlotta AR, Remzi NI, Bursa B, Hruby S, Wolfram R, Schulman CC, Marberger M (1999) Total and transition zone prostate volume and age: how do they affect the utility of PSA based diagnostic parameters for early prostate cancer detection? Urology 54:846–852

    Article  CAS  PubMed  Google Scholar 

  23. Kravchick S, Cytron S, Peled R, Ben-Dor D, Kravchenko Y (2003) Colour Doppler ultrasonography for detecting perineural invasion (PNI) and the value of PNI in predicting final pathological stage: a prospective study of men with clinically localized prostate cancer. BJU Int 92:28–31

    CAS  PubMed  Google Scholar 

  24. Rabbani F, Stroumbakis N, Kava BR, Cookson MS, Fair WR (1998) Incidence et clinical significance of false-negative sextant prostate biopsies. J Urol 159:1247–1250

    Article  CAS  PubMed  Google Scholar 

  25. Djavan B, Zlotta A, Remzi M, Ghawidel K, Basharkhah A, Schulman CC, Marberger M (2000) Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men. J Urol 163:1144–1149

    Article  CAS  PubMed  Google Scholar 

  26. Sakr WA, Billis A, Ekman P, Wilt T, Bostwick DG (2000) Epidemiology of high-grade prostatic intraepithelial neoplasia. Scand J Urol Nephrol [Suppl] 205:11–18

    Google Scholar 

  27. Shinohara K, Gulati M, Koppie TM, Terris MK (2003) Transperineal prostate biopsy after abdominoperineal resection. J Urol 169:141–144

    Article  PubMed  Google Scholar 

  28. Veltman J, Goosen T, Laguna P, Wijkstra H, De la Rosette J (2002) New technical improvements for TRUS in the diagnosis of prostate cancer. Eur Urol [Suppl 1]:8–14

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Semmelweis University, Budapest, Üllői út 78/B, 1082 Budapest, Hungary

    Imre Romics

Authors
  1. Imre Romics
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Imre Romics.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Romics, I. The technique of ultrasound guided prostate biopsy. World J Urol 22, 353–356 (2004). https://doi.org/10.1007/s00345-004-0420-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-004-0420-1

Keywords

Search

Navigation