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The role of transrectal ultrasound and biopsy in the diagnosis and management of prostate cancer

Department of Radiology, St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK

• The majority of prostate cancers diagnosed in contemporary practice are isoechoic on ultrasound.
  
• An elevated prostate-specific antigen (PSA) test has the highest positive predictive value for high-risk cases.
  
• NHS guidelines recommend 10–12 biopsy cores targeted on the peripheral zone.
  
• Minor bleeding is very common, but major risks are low with careful technique and prophylactic antibiotics.
  

Although the incidence of prostate cancer is still rising in the UK, it is now being detected earlier and therefore at a more manageable stage. One of the key reasons for this is the introduction of prostate-specific antigen (PSA) testing, combined with biopsy of the prostate guided by transrectal ultrasound (TRUS). Unlike other biopsy procedures, TRUS biopsy is not lesion directed, aiming instead to sample systematically the peripheral zone of the prostate in order to identify clinically significant tumours. The procedure is relatively straightforward to perform, but is not without potential complications, although most of these can be anticipated. The biopsy result, combined with other clinical parameters, is used to determine optimum management for the patient, which may include further cross-sectional imaging. This article covers the current indications, technique and potential complications of a TRUS-guided biopsy of the prostate and outlines the subsequent management options as dictated by its result.