Trans-rectal Ultrasound-guided biopsy with or without Fusion Biopsy

Ultrasound scans use sound waves that build a picture of the structures inside the body. To scan the prostate gland, a small probe is passed through the anal opening, which takes images of the prostate. This type of scan is used to measure the size and density of the gland. A sample of cells (biopsy) can be taken at the same time for examination under the microscope by a pathologist. The scan may be uncomfortable but it only takes a few minutes.

Transrectal ultrasound is indicated when blood levels of prostate-specific antigen (PSA) are abnormally high or the findings on examining the prostate through the anus are abnormal.

Before transrectal ultrasound, your doctor prescribes antibiotics and encourages you to clear your bowels.

An ultrasound probe is gently inserted into your anus. This probe allows visualisation of the prostate. Images of the prostate can be viewed on a monitor. It also allows your surgeon to insert a special needle to collect samples of your prostate (biopsy). The procedure takes about 20 minutes.

Following a prostate biopsy, you can expect to see some blood in the urine, bowel and semen. This usually settles down in a few weeks. You may develop an infection or fever after the procedure (rare).

Traditionally, prostate biopsies are performed under ultrasound guidance by randomly sampling all regions of the prostate gland. While some prostate cancers can be seen on ultrasound, the ultrasound images are not distinct enough to distinguish cancerous from normal prostate tissue.

Recently, with the advent of MRI scans of the prostate, we are able to obtain high-quality images of the inside of the prostate gland. An MRI scan may indicate suspicious areas for prostate cancer, but prostate cancer cannot be diagnosed with an MRI scan and a needle biopsy is required to confirm prostate cancer. Unfortunately, it is difficult to perform prostate biopsies in the confined space of an MRI machine.

MRI/US fusion technology allows the abnormalities on MRI images to be overlaid on live transrectal ultrasound images during prostate biopsy. This allows accurate targeting of MRI detected suspicious lesions rather than random biopsies of the entire prostate.

Some recent studies have shown that MRI/US fusion targeted prostate biopsies are better than traditional biopsies at finding prostate cancers that are serious and need treatment and will overlook clinically insignificant prostate cancers that we don’t need to worry about.