Prostate biopsies are performed to make the diagnosis of prostate cancer, or to follow patients with prostate cancer who are undergoing surveillance (active observation). Prior to biopsy, it is obviously important to determine the necessity of the procedure. If a patient has a normal prostate exam and an elevated PSA (prostate-specific antigen) and no family history of prostate cancer, I typically treat these patients with antibiotics to see if the PSA normalizes. If it does not, then I perform a biopsy.

If the prostate exam is abnormal, meaning an abnormal firmness, then I perform a guided biopsy to rule out a cancer. The prostate biopsies are done using transrectal ultrasound (TRUS). The prostate is imaged in order to visualize any hypoechoic area. These are areas that show up darker on ultrasound and are suspicious for cancer. One-third of these areas turn out to be cancer. During the ultrasound, measurements determine the prostate volume. The prostate is then anesthetized with local anesthesia, and six biopsies on each side are performed, for total of 12 biopsies. The biopsies are typically sent to UCLA for pathological evaluation.

The risks of the procedure include infection, pain, and blood in the urine, stool, or semen. A preparation with enemas and antibiotics lessens the risks of the procedure.