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Diagnosing prostate cancer

Last Modified: 9/17/2020

Prostate Cancer

This post was written by Adam Thomas, MD, PPG – Urology.

In our series on prostate cancer awareness, we’ve discussed the prevalence of this form of cancer, as well as screening options. This post will focus on how physicians diagnose prostate cancer.

Prostate cancer is diagnosed via a transrectal ultrasound and a prostate biopsy, which combined are referred to as TRUS Prostate Biopsy. These office-based procedures typically take five minutes. They are most commonly performed while the patient is awake with a local anesthetic, although a general anesthetic or nitrous oxide can be used for patients who cannot tolerate procedures while awake.

What patients can expect

First, the physician will do the ultrasound. A wand is placed into the rectum to allow the urologist to visualize the prostate, accurately size the prostate and make sure the prostate is adequately biopsied. Different areas of the prostate have names and carry different risks for harboring cancer. Although ultrasound has limitations on resolution, and cannot reliably visualize actual cancer, newer techniques overlay an MRI image on top of the ultrasound to allow for localization of suspicious areas of prostate cancer. One specific device with this capability is called a UroNav fusion biopsy.

Second, the urologist will perform the biopsy. The physician will numb the prostate with lidocaine before typically obtaining twelve biopsies. If the MRI fusion biopsy technique is used in the first procedure, obtaining several biopsies may target a specific area in addition to further random biopsies for thorough evaluation of the entire prostate. 

Potential risks

Risks related to the biopsy are low. Infection is a concern, but is lowered by antibiotics. It’s normal and expected for patients to have some blood in their urine, rectum and semen for two weeks.


Results often return within three to seven days. The three potential results are benign, prostate cancer or atypical small acinar proliferation (ASAP), which essentially means there are unusual cells that are not cancerous but worrisome. 

Being evaluated for prostate cancer is, without question, a stressful period, but TRUS prostate biopsy is the gold standard for diagnosis. The procedure can be done safely and in a comfortable office setting, and allows for an MRI to enhance the ability to find suspicious areas. Remember, diagnosis is on the path to recovery, and can ultimately save your life.


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