• The patient is placed in the left lateral decubitus position with hips and knees flexed.
• The transducer is inserted and the prostate volume is measured. The exam is started at
the base of the prostate and extends to the apex, with imaging in both tranverse and
• Lidocaine anesthesia is performed with a long spinal needle (22 gauge) and TRUS
guidance at the seminal vesicle – prostate junction bilaterally.
• Currently, the originally sextant biopsy scheme is replaced by extended schemes, using
more cores directed at the peripheral zone. The biopsy gun is guided to take five peripheral
zone biopsies and one central biopsy on either side, starting at the base and ending
at the apex (Figs. 1 and 2).
Fig. 1 Transrectal ultrasoundguided prostate biopsy of the right and left prostatic peripheral zone
Fig. 2 Transrectal ultrasoundguided prostate biopsy of the right and left prostatic peripheral zone
• Any hypoechoic suspicious nodules should also be separately biopsied.
• Applying constant gentle forward pressure with the transducer during the biopsy flattens
the rectal wall, reducing discomfort and bleeding.
• The specimen is placed in 10% formalin with correct labeling of side and region of biopsy.
Immediate Post-Procedure Care
• A rectal examination may be performed after the biopsy with pressure applied to the
• The patient is advised to remain lying for 15 min post procedure and may be discharged
if stable. In patients lacking a rectum, a CT-guided transgluteal prostate biopsy may be performed
Fig. 3 CT-guided transgluteal prostate biopsy in a patient lacking a rectum post lower anterior resection. Bilateral guiding needles are poised to allow passage of biopsy needles into peripheral gland