TRUS Biopsies

A prostate biopsy is the removal of tissue samples from areas of the prostate using a special biopsy needle. These tissue samples will be further studied for the presence of cancer.  A Transrectal Ultrasound (TRUS) biopsy procedure uses sound waves to make an image of the prostate on a video screen in order to guide the biopsy needles into the appropriate area of the prostate. Using the ultrasound image, the physician quickly inserts a thin, hollow needle through the wall of the rectum into the prostate gland. When the needle is pulled out, it removes a small cylinder (core) of prostate tissue. This may be repeated up to 18 times, but most urologists will take about 12 samples. Though the procedure sounds painful, it may only cause a brief uncomfortable sensation because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needle in a fraction of a second. Some physicians who perform the biopsy may offer mild sedation. The biopsy procedure takes about 10 minutes and is usually done in the doctor's office. You will likely be given antibiotics to take before the biopsy and possibly for a day or two after to reduce the risk of infection.

A TRUS biopsy may be performed when a man has symptoms of prostate cancer or to follow-up a high PSA level or an abnormal digital rectal exam (DRE). However, locating a tumor in the prostate, a gland about the size of a walnut, isn’t always easy.  TRUS biopsies are not always able to locate tumors. Initial TRUS biopsies are negative in an estimated 66 percent of the time, and detection of tumors only increases 15 to 20 percent with repeat biopsies.

Reasons for a repeat TRUS biopsy

There are two primary reasons to have repeat TRUS biopsies:

• Even with many samples, biopsies can still miss a cancer if none of the biopsy needles pass through it. This is known as a false negative result. If your doctor still suspects prostate cancer, a repeat biopsy may be needed to help be sure.
• Prostate biopsy results are sometimes called suspicious. Suspicious results mean that the cells do not look quite normal, but they don't look like cancer, either. If your biopsy results come back suspicious, your doctor may want to repeat the biopsy.

After a TRUS biopsy

For a few days after the procedure, you may feel some soreness in the area and will probably notice blood in your urine. You may also have some light bleeding from your rectum, especially if you have hemorrhoids. Many men also see some blood in their semen or have rust colored semen, which can last for several weeks after the biopsy depending on how frequently you ejaculate.

When repeat TRUS biopsies have been unsuccessful in locating the tumor, noninvasive Advanced Magnetic Resonance Imaging (MRI) with an MRI-guided prostate biopsy is a preferred alternative. Advanced Prostate Imaging and biopsy techniques can successfully detect and locate clinically significant prostate cancer in more than 90 percent of patients.

Testimonial

"After three unsuccessful TRUS biopsies, my doctor sent me to VCU Medical Center and Dr. Yu was able to find my cancer by Prostate MRI. It was very smooth. I liked that it was non-invasive. It was convenient and quick to schedule a Prostate MRI at the Stony Point Center. He also performed a MRI-guided prostate biopsy on me. I don't know what I would have done if Dr. Yu had not found the cancer. It helped me make a decision on what to do next. Prostate imaging isn't for everyone, but it is a good "tool in the toolbox" that should be used more often than it is today."

Patient A.H. - Central Virginia