Transrectal ultrasound-guided prostate biopsy (multifocal)

Transrectal ultrasound-guided prostate biopsy (TRUS) is a minimally invasive urological procedure used to collect small tissue samples from the prostate using a special needle under ultrasound guidance.
The purpose is to confirm or exclude the presence of prostate cancer or other structural changes of the gland.

The multifocal approach involves collecting samples from multiple areas of the prostate (usually 10–12 points) to ensure maximum diagnostic accuracy.

Components involved

• Automatic biopsy needle (tru-cut): a single-use device that extracts fine cylindrical cores of prostatic tissue.
• Transrectal ultrasound probe: allows precise visualization of the gland and accurate guidance of the biopsy needle.
• Prostatic tissue: biological material collected during the procedure, later examined histopathologically to determine malignancy and assign a Gleason score.

Role of the procedure

• Histopathological diagnosis of suspected prostate cancer.
• Confirmation of suspicious imaging findings (ultrasound, multiparametric MRI).
• Monitoring of patients with elevated PSA (prostate-specific antigen) levels.
• Evaluation of treatment response in prostate cancer.
• Clarification of the etiology of nodular lesions detected during digital rectal examination.

Indications

• Persistent elevation of serum PSA levels.
• Suspicious findings on transrectal ultrasound or MRI.
• Palpable nodules on digital rectal examination.
• Clinical suspicion of prostate cancer.
• Monitoring of patients with precancerous lesions (high-grade PIN, ASAP).

Contraindications

• Severe coagulation disorders (INR > 1.5, platelets < 50,000/mm³).
• Acute anorectal infections or acute prostatitis.
• Rectal abscesses, thrombosed hemorrhoids.
• Allergy to local anesthetics or prophylactic antibiotics.

Procedure

• The procedure is performed under ultrasound guidance, with the patient positioned in the left lateral decubitus position and knees slightly flexed.
• Using the transrectal probe, the physician visualizes the prostate and, with the help of an automatic needle, collects tissue samples from the peripheral and transitional zones.
• Typically, 10–12 fragments are obtained (two for each sextant), which are sent to the pathology laboratory for histological examination.
• The intervention lasts approximately 15–20 minutes.
• Hospitalization is not required; the patient can resume normal daily activities and diet the same day.
• Minor discomfort, slight rectal bleeding, hematuria, or hemospermia may occur for a few days.
• The necessity of continuing antibiotic treatment will be reconfirmed according to institutional protocols.

Transrectal multifocal prostate biopsy under ultrasound guidance (TRUS) is the gold standard for the diagnosis of prostate cancer. The method is safe, precise, and allows early detection of malignant lesions, optimizing subsequent treatment.

Sources:

https://www.cancerresearchuk.org/about-cancer/tests-and-scans/transrectal-ultrasound-guided-trus-biopsy
https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/TRUSP%20biopsies.pdf
https://radiopaedia.org/articles/transrectal-ultrasoundguided-prostate-biopsy-1
https://pmc.ncbi.nlm.nih.gov/articles/PMC7807378/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7082664/
https://www.baus.org.uk/_userfiles/pages/files/Publications/Transrectal%20Ultrasound%20%20Prostatic%20Biopsy%20FINAL.pd