When it may be recommended
A biopsy may clarify a concern after PSA, examination, MRI and medical history have been assessed. It can also be part of surveillance for known cancer or a further assessment when concern remains after a negative biopsy. Its potential value is weighed against the risks and, when appropriate, the option of monitoring. [1]; [2].
Access route and imaging guidance
Transperineal means the needle passes through the skin between the scrotum and anus. With a transrectal approach, it passes through the wall of the rectum. [1].
EAU guidelines favour the transperineal route for its lower infection risk; the choice requires individual assessment. [3].
Image fusion combines information from a previous MRI with ultrasound used during the biopsy to guide sampling of a suspicious area. It is not another access route and cannot guarantee that every cancer will be found. Depending on the case, targeted samples and samples from other areas are taken. An ultrasound probe in the rectum may still be used when the needle enters through the perineum. [1].
What to confirm beforehand
Tell the team about medicines — including anticoagulants and antiplatelet medicines — allergies, recent infections and previous problems with anaesthesia. Do not stop or change medicines yourself. Confirm instructions about eating, antibiotics if needed, transport and having someone accompany you; these depend on the procedure and anaesthesia. [4].
Ask which anaesthetic is planned, how discomfort will be managed and whom to contact afterwards. There is no single preparation plan for every biopsy.
During and after the procedure
The team uses imaging to guide the needle and sends the samples to pathology. Local or another type of anaesthesia may be used, depending on the plan. Afterwards, you will receive instructions about recovery, activity and follow-up. Confirm when and how you will receive the result; no fixed turnaround is promised. [5]; [6].
Discomfort, bruising or a small amount of blood in urine or semen may occur. Risks also include infection, significant bleeding and difficulty emptying the bladder. Seek urgent medical care if you develop fever or chills, feel very unwell, cannot urinate, or have heavy bleeding in your urine, especially with clots. Do not wait for a WhatsApp reply in an emergency. [7].
Understanding the result
A biopsy may show benign tissue, cancer or changes that need clarification. A negative result does not completely rule out cancer: it must be considered alongside PSA, MRI and the rest of the assessment. If cancer is found, the report helps guide the next decisions. [8].
Questions for your consultation
- What question is the biopsy intended to answer in my case?
- Which access route and guidance method do you recommend, and why?
- Will I need targeted samples and samples from other areas?
- What should I confirm about my medicines and anaesthesia?
- How will I receive the result, and what happens if it is negative?