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The standard of care in the UK is that men with an elevated PSA should have an mpMRI scan of their prostate gland. If their scan shows an area of suspicion with a PIRADS Score of 3, 4 or 5 they will go on to have a biopsy of their prostate gland in order to determine whether or not significant cancer is present.
A prostate biopsy involves taking tiny samples of tissue from the prostate gland which are examined under a microscope to check for cancerous cells. If these cancerous cells are found, the biopsy will also show how aggressive the cancer is, whether it has already spread, and how likely it is to spread outside the prostate.
If your biopsy results show the presence of cancerous cells, the histo-pathologist (the specialist responsible for interpreting your biopsy results) will assign your cancer with a Gleason Grade and a TNM Stage.
Half of men who undergo biopsy will have a negative result, ie no clinically significant prostate cancer will be detected.
If your biopsy results come back negative, your doctor will discuss the non-cancerous conditions that might be causing your symptoms and will put together a treatment plan to address these.
In the case that clinically significant prostate cancer is detected, your
urologist will discuss the meaning of the Gleason Grade and TNM Stage with you in detail.
A transrectal ultrasound guided biopsy of the prostate (TRUS) is a type of needle biopsy done through the wall of the rectum using a transrectal ultrasound scanner probe.
The patient lies on their side with their knees up while the doctor pushes a fine needle through the probe and into the prostate gland in order to get samples of prostate tissue.
Different areas of the prostate are sampled with approximately 8–14 biopsy cores. This is typically done under local anaesthetic.
TRUS biopsies are being increasingly replaced in the UK with Transperineal biopsies as they offer an improved level of accuracy and significantly reduced risks of infection (read more below).
A transperineal biopsy of the prostate is also a type of needle biopsy in which a very fine needle is inserted into the prostate through the skin between the testicles and the rectum (back passage) – an area known as the ‘perineum’.
Here, the man is typically lying on his back with his legs in the air, and the samples are taken through the skin of the perineum. This procedure can be done under local or general anaesthetic.
The principal advantages of the transperineal biopsy technique are a greatly improved diagnostic accuracy and a substantially reduced risk of infection.
Dr Clare Allen, Uro-Radiology Lead Consultant, University College Hospital, London
MRI-Ultrasound fusion transperineal biopsy is the state-of-the-art technique for prostate biopsy and allows surgeons to get a precise understanding of the extent of prostate cancer within each section of the prostate gland.
This technique is typically carried out under general anaesthetic and takes between 30 and 50 minutes. The number of cores taken can range between 5 – 30.
The difference with this type of prostate biopsy is that it involves using a grid (or template) with tissue samples extracted through holes in the grid by several needles. Each hole correlates to numbers and letters, in the same way as grid references are located on maps.
Computer registration (or ‘fusion’) of the mpMRI image onto an ultrasound image, which currently guides biopsy, allows accurate targeting through direct visualisation of the lesion.
This means that tissue samples can be taken from the prostate in a very precise and specific way, leading to more accurate results.
Transperineal prostate biopsies are generally considered to be very safe and straightforward, but there are some possible side effects and potential risks that you should be aware of before undertaking the procedure.
These can include:
As a group of consultants we are passionate about prostate cancer sufferers knowing about all of their treatment options.
We know that settling on the right treatment is a big decision for you. If you would like to speak to one of our friendly and knowledgeable patient advocates about your diagnosis and the HIFU Focal Therapy treatment option then please do not hesitate to get in touch today.
All enquiries to The Focal Therapy Clinic are confidential, and we are delighted to offer our advice and support with no obligation.