Ultrasound Guided Prostate Biopsy

Authors: Dr Alain Lavoipierre*
                            Prof Rob Gibson *

What are the generally accepted indications for an ultrasound guided prostate biopsy?

The generally accepted indications for an ultrasound guided prostate biopsy are:

  • Raised or rising PSA (especially if the PSA velocity is high. The PSA velocity is the rate at which the PSA is rising). Whilst a cut-off PSA level of 4 is generally accepted as abnormal, a PSA of 2 in a
  • 50-year-old patient, particularly if it is rising, warrants further investigation.
  • Digital rectal examination suggesting prostatic neoplasia.

NOTE: The ultrasound guided prostate biopsy can sometimes be carried out through the perineum, called a trans-perineal approach.

What are the prerequisites for having an ultrasound guided prostate biopsy done?

Cessation of warfarin with INR measured on the day before the procedure. The exact value for INR required to render the procedure ‘safe’ is determined by the individual radiologist carrying out the procedure.

Antibiotic cover. This is optimally provided with oral norfloxacin 400 mg bid, commencing the day before the procedure, and often continued for a total of 7 days. Norfloxacin is the antibiotic that best penetrates the prostate gland. Trimethoprim is an acceptable substitute.

What are the absolute contraindications for an ultrasound guided prostate biopsy?

Absence of an anus or rectum, for example after rectal resection, precludes a trans-rectal approach, but a perineal approach can be used in this circumstance.

What are the relative contraindications for an ultrasound guided prostate biopsy?

Intercurrent infection. This includes prostatitis. It is appropriate to wait until the infection is cured before proceeding with a biopsy.

Similarly, anticoagulation must be ceased and an INR less than 2 is required.

What are the adverse effects of an ultrasound guided prostate biopsy?

Rectal bleeding:
mild – very common;
severe, requiring admission to hospital and surgery or transfusion – very uncommon.
Haematuria (>60%, and usually mild. Clots may be passed).
Haematospermia (>90%. Small clots may be seen and the ejaculate may be brownish). May persist for over 2 weeks.

Septicaemia (<1%): occurs usually 12–72 hours after the procedure. Must be rapidly treated with antibiotics and may require hospital admission for IV antibiotics.

Is there any specific post procedural care required following an ultrasound guided prostate biopsy?

There is no specific special care that need apply after an ultrasound-guided prostate biopsy.

Are there alternative imaging tests, interventions or surgical procedures to an ultrasound guided prostate biopsy?

Magnetic resonance imaging guided prostate biopsy is not currently carried out in Australia.
Finger-guided prostate biopsy is carried out by some urologists, usually only if there is a very obvious palpable abnormality.

Useful websites about ultrasound guided prostate biopsy:

Trans-rectal Ultrasound Guided Prostate Biopsy:
Prostate Biopsy Procedure, Effects, Uses, Complications, and More:
Prostate Biopsy Procedure:

*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.

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