TRUSguided

TRUS-guided (transrectal ultrasound-guided) procedures use a transrectal ultrasound probe to visualize a target and guide a needle or instrument. The most common application is biopsy of the prostate to diagnose prostate cancer, though the technique can be used for other prostatic interventions. The ultrasound images provide real-time localization, enabling precise sampling of suspicious areas.

In a typical TRUS-guided prostate biopsy, the patient is positioned on their side or in a seated position and given local anesthesia or light sedation. A lubricated transrectal probe is inserted into the rectum, and ultrasound imaging is used to delineate the prostate. Multiple core samples are taken with a biopsy needle through the rectal wall, usually totaling about 10 to 12 cores from standard zones; MRI-targeted cores can be added if MRI indicates a lesion. Prophylactic antibiotics are commonly prescribed to reduce infection risk, and patients may be advised to avoid strenuous activity for a short period afterward.

Indications include elevated prostate-specific antigen (PSA) levels, an abnormal digital rectal exam, prior inconclusive biopsy results, or monitoring of known prostate cancer. The procedure helps establish the presence and grade of cancer, informing treatment decisions or active surveillance strategies.

Risks include bleeding, discomfort, urinary retention, and infection, including prostatitis or sepsis, though antibiotic prophylaxis lowers but does not eliminate infection risk. Compared with transperineal biopsy, TRUS-guided biopsy has a higher risk of infection in some settings. Advances such as MRI fusion and targeted biopsy techniques have improved cancer detection rates and may reduce unnecessary sampling.

Overall, TRUS-guided prostate biopsy remains a standard diagnostic tool in urology, continually evolving with imaging advances to improve accuracy and safety.