What is prostate biopsy?

Prostate cancer is one of the most common cancer in men. The prostate biopsy procedure is where tissue samples are collected from the prostate gland to determine whether the tissue is cancerous.

The prostate gland is below the bladder and in front of the rectum. It is about the size of a walnut and generally larger in older men. The doctor may refer you for prostate biopsy if you are having symptoms of prostate cancer or high level of prostate-specific antigen (PSA) in the blood test. PSA is a substance released by the prostate gland and high level of PSA may indicate prostate cancer. The doctor may also perform digital rectal exam (DRE), where the doctor’s finger is inserted into the rectum to feel for any bumps on the prostate.

Prostate biopsy is performed by a urologist. The procedure can be done in the clinic or the hospital operating theatre. The procedure is normally carried out under either general anesthesia (you will be asleep and will not feel any discomfort) or local anesthesia (the biopsy area will be numbed). It is usually done as a day case, means you are allowed to go home on the same day after you have recovered from the effects of anesthesia.

Introduction Image
Methods Image


What is the most common method of prostate biopsy?

Most commonly, biopsies are performed under ultrasound guidance. During the procedure, you will be lying on your side and an ultrasound probe will be placed in your rectum. Guided by ultrasound imaging, the biopsy needle is inserted into your prostate gland via the rectum wall to collect the samples. Generally, about 10-12 samples are taken. This method is known as transrectal ultrasound (TRUS) guided biopsy.

The prostate can also be accessed via the perineum (area of skin between the scrotum and the rectum). The transperineal prostate biopsy has the potential advantage of a lower risk of infection, as the perineum skin area can be easily disinfected.
Prostate biopsies can also be guided by MRI, which provides more detailed images of the prostate than ultrasound.

Why Robotic Targeted?

The robotic prostate biopsy is the least invasive method of sampling prostate tissue and has higher accuracy in prostate cancer detection through targeted tissue sampling.

The robotic technology allows your specialist to obtain targeted tissue samples from any part of the prostate gland with high precision. If MRI scan is done and it indicates a suspicious region in the prostate, your specialist can target and collect samples at this region.

The robotic targeted approach provides more details on the locations of the cancer, if found positive, thus provides greater certainty whether you have prostate cancer or not. With the comprehensive report provided, this will help your physician decide whether to continue monitoring or to go for treatment.

Furthermore, this method of biopsy utilizes an innovative technology whereby only two skin puncture points are used regardless the number of tissue samples taken. The risk of infection is close to zero1.

1. Grummet J, Pepdjonovic L, Huang S, et al. Transperineal vs. transrectal biopsy in MRI targeting. Transl Androl Urol. 2017 Jun; 6(3): 368–375.

Why Robotic Image

Image shows Robotic targeted prostate biopsy with MRI-Ultrasound fusion using iSR’obot™ Mona Lisa

When To Consider

Who should consider robotic targeted prostate biopsy?

You may consider robotic targeted prostate biopsy if you have the following:

  • High level of PSA and abnormal DRE
  • Prior negative biopsy and yet has persistent elevated PSA
  • Known prostate cancer patients under active surveillance
  • To improve the sensitivity of prostate cancer diagnosis.

The Procedure

What happens during robotic targeted prostate biopsy?

1 Preparation

The procedure is carried out under in one of three ways:

  • general anesthesia

(you will be asleep and will not feel any discomfort), or

  • spinal anesthesia

(you will not feel any pain below the waist), or

  • local anesthesia

(only the biopsy area is numbed).

This biopsy is performed via the transperineal route, that is, the biopsy needle passes through the skin area between the scrotum and anus. You will be positioned in special supports to allow your specialist to access the area behind the scrotum.

2 Real-time ultrasound

An ultrasound probe, about the width of a thumb, is inserted into the rectum and automatically scans the prostate.

3 MRI-ultrasound fusion

The MRI images prepared beforehand are then fused with ultrasound images. This step enables your specialist to see the suspicious region location on a 3D model.

4 3D biopsy plan

The specialist then indicates on the computer software the specific regions where the tissue samples will be taken.

5 Robotic targeted biopsy

The robotic needle guide automatically and precisely aims at the desired targeted region. A spring-loaded biopsy needle is inserted through the robotic needle guide into the prostate gland to remove a small tissue sample. The innovative technology uses only 2 skin puncture points regardless of the number of samples taken.

Procedure Image

Side Effects

Are there any side effects?

You may feel mild pain in the biopsy area and notice blood in your urine afterwards. Blood in the semen may last for a few weeks, but is not harmful. If you suffer from symptoms of prostate enlargement, there is a small risk of urinary retention (inability to urinate) after the procedure. There is also a small risk of mild transient erectile dysfunction. Because the biopsy needle is passed through disinfected skin, the risk of infection is close to zero1.

1. Grummet J, Pepdjonovic L, Huang S, et al. Transperineal vs. transrectal biopsy in MRI targeting. Transl Androl Urol. 2017 Jun; 6(3): 368–375.

Patients FAQ

  • Is the procedure painful?
    The procedure is performed under local, spinal or general anesthesia. If under local anesthesia, as the ultrasound probe is inserted into the rectum, you may feel some discomfort. You may feel a brief sting when the needle is inserted into the prostate gland. If under spinal or general anesthesia, you will not feel any discomfort. You will rest for a few hours after the biopsy and will need someone to send you home. Your specialist will discuss with you the type of anesthesia to be used before your biopsy.
  • Is MRI required?
    MRI allows visualization of potential cancer site, enabling your specialist to target precisely the site and increase the detection rate. However, if MRI is not obtained, your specialist can do a saturation biopsy, meaning that tissue samples are collected at random sites over the entire prostate.
  • How many biopsy samples are taken?
    The number of samples taken depends on the size of your prostate. Generally, between 20 - 35 biopsy samples are collected.
  • How long does the procedure take?
    The procedure itself usually takes about 30-40mins as time is required for MRI-ultrasound fusion and biopsy planning.