Ultrasound guided biopsy, a gold standard diagnostical test of the prostate cancer.
The author discusses preparations for ultrasound guided prostate biopsy, its technique conditions and the process of performing a biopsy. Every author proposes the use of preoperative antibiotics based prophylaxis. Differences may be found in the type, dosage and the time span of preoperative application. For anaesthesia mostly lidocaine was proposed, which may be a gel applied in the rectum or used in the form a prostate infiltrate. The widest debate goes on in respect of defining the number of biopsies needed. Recently 8 or rather 10 samples are proposed to be taken. Twelve biopsies do offer an advantage compared to 6 although in case of 8 this isn't so. According to the site of sample taking the apex, the base and the middle part are proposed. In case of a palpable nodule or any lesion, made visible by TRUS an additional, targeted, biopsy has to be performed. Certain new techniques like the 3D Doppler, contrast, intermittent and others shall also be presented. A repeated biopsy shall be necessary in case of PIN atypia, beyond that the author also discusses other indications for a repeated biopsy. We may expect the occurrence of direct postoperative complications and it is necessary to know how to treat these.
Romics
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Department of Urology, Semmelweis University, Budapest.