Transrectal Biopsy for Prostate Cancer

Transrectal Biopsy – Procedures
  • “Blind” Ultrasound-Guided
    2D Transrectal Biopsy
  • Transrectal 3D Fusion Biopsy

The transrectal prostate biopsy (known as TRUS bx) is currently the most widespread technique throughout the world – accounting for over 95% of biopsies.

It is conducted by means of an ultrasound scanner, ultrasound probe, sampling needle and biopsy gun, usually under local anaesthetic.

It is important to distinguish between the two types of transrectal biopsy:

Transrectal Biopsy – Procedures

“Blind” Ultrasound-Guided 2D Transrectal Biopsy

This is the most commonly applied technique. It is performed in a consultation or outpatient setting, under local anaesthetic. The patient is positioned on his side in the “supine” position, or on his back in the “lithotomy” position.

The ultrasound image enables the urologist to find their bearings within the prostate and spread out the biopsies (generally 12 biopsies, 6 per prostatic lobe) according to a sextant pattern, in order to maximise their effectiveness.

Such an approach helps sampling of the posterior surface of the prostate, however, it is limited in the anterior zone and apex.

In addition, the random nature of this method is such that we cannot rule out the presence of significant cancers, which may progress if they are not detected early.

In Summary:

  • The effectiveness of this type of biopsy is uncertain
  • The sensitivity is poor for cancers located in the anterior zone
  • If the biopsy is negative: A hypothesis of cannot be eliminated -> Iterative biopsies
  • If the biopsy produces a low-positive: The doctor may be concerned that the disease is more significant than is actually the case

Conventional Biopsy: Possible results

bio1
25% of cases Biopsy misses the tumor
bio2
Fortuitous reaching of non significant cancer
bio3
Underestimation of tumor’s size

It appears inevitable that this practice will disappear in favour of transrectal or transperineal 3D fusion biopsies.

Transrectal 3D Fusion Biopsy

MRI has considerably improved the sensitivity of diagnoses for high-risk prostate tumours.

Thanks to the fusion of MRI and ultrasound images of the prostate, suspect areas can be targeted without having to change the sampling method (Ideal for active surveillance). Performed in an outpatient setting and under local anaesthetic, a transrectal fusion biopsy does not entail additional costs, aside from the hospital acquiring the technology.

KOELIS Trinity®, developed by KOELIS, is to this day the most advanced medical MRI-Ultrasound fusion system for transrectal targeted biopsies thanks to Organ-Based Tracking Fusion® (OBT Fusion®), a patented KOELIS innovation that works in tandem with elastic fusion technology. Unlike other technologies that track the movement of the probe (robotic technology or electromagnetic sensors), OBT Fusion® tracks the shifting prostate and automatically compensates for these movements therefore maximising the accuracy of the procedure.

Find out more about Fusion Biopsy (Bx) The effectiveness of this technique has been proven by an international study PRECISION of 500 patients in more than 23 centers. The figures speak for themselves:

PRECISION TRIAL: MRI helps diagnose Prostate Cancer1

High precision

46% more detection of significant cancer

56% less detection of insignificant cancer

3 times less biopsy cores (less complications
& side effects)

  • Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study- Rouviere et al. Lancet Oncol – November 20182
  • Comparative Effectiveness of Targeted Prostate Biopsy Using Magnetic Resonance Imaging Ultrasound Fusion Software and Visual Targeting: a Prospective Study – Lee DJ et al. J Urol – September 20163
  • Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques. – Klein et al. Urol Int. June 20164
  • Magnetic resonance/transrectal ultrasound fusion biopsy of the prostate compared to systematic 12-core biopsy for the diagnosis and characterization of prostate cancer: multi-institutional retrospective analysis of 389 patients. – Mariotti GC et al. –Urol Int. – May 2016 5
  • A randomized controlled trial to assess the outcomes of 2-core MRI/TRUS-image-fusion guided prostate biopsy and traditional 12-core systematic biopsy. – Baco et al. –Eur Urol. – January 2016 6

Transrectal vs Transperineal Biopsy

Transrectal Transperineal
Anaesthetic Local Local Anesthesia General Anesthesia
Hospital stay Outpatient Outpatient Day Case
Discomfort during procedure Moderate Very moderate None
Infection risk Low Very Low Very low

Last years have seen a growth of transperineal approach as systems now allow a protocol similar to transrectal approach.

Both approaches allow:

– Practice under Local anesthesia (with or without antibioprophylaxy) sedation and General Anesthesia

-On decubitus dorsal and lithotomy positions

-In consultation, outpatient and overnight surgery stay

-Low patient discomfort. This includes LATP settings

– Very low infection for transperineal approach while low infection risk for transrectal access

KOELIS Technology for transrectal biopsy

Since 2006, KOELIS has been constantly innovating to provide clinicians with the latest technology to bring personalized answers to every patient while preserving patient’s quality of life.

At KOELIS, we focus on developing advanced, targeted and less invasive solutions as KOELIS Trinity®, the first 3D image-based cartographer allowing physicians to easily perform targeted transrectal and transperineal MRI/Ultrasound fusion guided biopsies. In a simple process and device, KOELIS Trinity® is a powerful diagnostic tool to plan, implement, review and control a patient-focused and tailored solution which avoid any under or overtreatment. Thanks to our patented Organ-Based Tracking Fusion® technology which increases the accuracy of the biopsy, our cartographer creates a detailed and personalized map of the patient’s prostate showing accurate core distribution (+/- 3 mm of accuracy). Freehand, user-friendly and with minimal instrumentation, KOELIS Trinity® fusion biopsy system effectively incorporates into any clinical practice to develop innovative activity and/or research in image-based prostate cancer management.

To locate a clinic equipped with our solutions: Discover our interactive map.

MRI – TRUS fusion guided biospy Step by step

Source: Nima Nassiri et al. Institute of Urology, Keck School of Medicine, University of Southern California. Video originally uploaded on Intbrazjurol

Last updated on April 26th 2019

  • MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. Kasivisvanathan et al. –NEJM – March 2018
  • Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study- Rouviere et al. Lancet Oncol – November 2018
  • Comparative Effectiveness of Targeted Prostate Biopsy Using Magnetic Resonance Imaging Ultrasound Fusion Software and Visual Targeting: a Prospective Study – Lee DJ et al.J Urol – September 2016
  • Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques.-Klein et al. Urol Int. October 2016
  • Magnetic resonance/transrectal ultrasound fusion biopsy of the prostate compared to systematic 12-core biopsy for the diagnosis and characterization of prostate cancer: multi-institutional retrospective analysis of 389 patients. Mariotti GC et al. Urol Int. – May 2016
  • A randomized controlled trial to assess the outcomes of 2-core MRI/TRUS-image-fusion guided prostate biopsy and traditional 12-core systematic biopsy. Baco et al. Eur Urol. – January 2016