Transrectal multiple core prostate biopsy – is one of the main diagnostic methods used for early diagnosis of prostate cancer. The pioneers of transrectal ultrasound (TRUS)-guided prostate biopsy were Hoodge and McNeal, who in 1989 performed the first ultrasound-guided multiple core biopsy. This method describes taking tissue samples from six regions (see Fig. 1).

Over time, this method has been improved and L.A. Eskew suggested taking tissue samples from 12 regions (Fig. 2.3).

Indications for prostate biopsy:

1) Increased PSA (prostate-specific antigen) above the age-specific reference ranges, and dynamic changes in PSA values.

2) Change in the free PSA to bound PSA ratio (less than 15% indicates prostate cancer)

3) Suspicious lesions in the prostate found during a digital rectal examination (presence of nodes, tissue stiffness, uneven contours)

4) Evidence of hypoechoic areas in the prostate gland tissues during TRUS.

The presence of a few of the clinical and objective criteria written above are a solid basis for performing a biopsy.

Prostate biopsy is performed on an outpatient basis in the absence of severe comorbidities. Before performing a prostate biopsy patients must be warned about discontinuing the use of medication that affects blood clotting, and if this is not possible, the biopsy needs to be done in an inpatient facility.

Medical equipment and personnel necessary for a transrectal prostate biopsy:

  • Ultrasound scanner with a rectal probe
  • Biopsy gun with a sterile biopsy needle.
  • A guide device that is compatible with the rectal probe
  • An ultrasound specialist who has experience with transrectal prostate imaging.
  • A urologist that has experience performing multiple core prostate biopsies.
  • A pathomorphological laboratory that can histologically examine the acquired tissue samples.

Because a fast biopsy gun is used, the patient usually doesn’t feel any pain. Prior to the biopsy, intramuscular administration of a nonsteroidal anti-inflammatory drug is recommended. A gel with local anesthetic can also be applied into the rectum. For the biopsy the patient is placed on the left side with legs bent at the knees and hip joints. A rectal probe with biopsy attachment is then inserted into the rectum.

After that, tissue samples from 12 regions (Figure 4.) are taken with a guided shot from the biopsy gun. The depth the biopsy needle penetrates (Figure 5) ranges from 20 to 22 mm and 1.2 mm in diameter.

After the biopsy patients are prescribed a prophylactic course of antibiotics to prevent bacterial complications (levofloxacin 500mg once a day, 2 days prior to biopsy and twice a day for 3 days after the biopsy, or other oral fluoroquinolone)

Complications after transrectal prostate biopsy:

  • Hematuria (blood in the urine), - 35-37%
  • Acute urinary retention - 1.5-2%
  • Hematospermia (blood in semen) 26-27%
  • Bleeding from the rectum - 1.7-2%
  • Exacerbation of chronic prostatitis or formation of prostate abscess 3,6-4%
  • Orchiepididymitis (inflammation of the testicle and its appendages) 1-1.5%


Transrectal multiple core prostate biopsy is the standard diagnostic test for prostate cancer. Advantages of this method are that it can be performed on an outpatient basis, doesn’t have a high risk of complications, if properly done and careful selection of patients make this method safe and highly-effective for diagnosing prostate cancer.

Roman Vernyk, urologist, BiMedis company