Technical Advices for Prostate Needle Biopsy Under Transrectal Ultrasound Guidance

In the early 1990's when systematic biopsy of prostate using transrectal ultrasonography (TRUS) had just begun, there was enthusiasm for identifying abnormalities and obtaining appropriate samples. Since the occurrences of early small prostate cancer are increasing and identifying tumors using TRUS are somewhat subjective, the efficiency of the method in detecting and staging prostate cancer has decreased. (Ohori, et al. 2003) Instead, many physicians discuss about where and how many biopsy cores should be taken in order to improve the detection-rate of cancer. Clinicians have also focused on the pathological features of cancer in biopsy specimens that sometimes provide significant information to stage prostate cancer. (Satake, et al. 2010) Prostate biopsy itself is not technically challenging and residents as well as fellows are regularly in charge of the biopsy with or without ultrasound technicians. Those with less experience of TRUS guided biopsy are helped by studying technical advices to get appropriate specimens. At Baylor College of Medicine, Memorial Sloan-Kettering Cancer Center, and Tokyo Medical University we have performed more than 5000 cases of TRUS guided prostate biopsy. This large number of TRUS guided prostate biopsies has provided several technical tips to obtain appropriate tissue samples and to avoid complications such as rectal bleeding. In this chapter we will describe practical methods that will improve prostate biopsy.