Senior Director & Unit Head, Urology, Kidney Transplant, Uro-Oncology, Robotic Surgery, Max Hospital, Gurugram
Part 5 of 11 in Prostate Cancer: Diagnosis and Management
Prostate Biopsy: TRUS-Guided and MRI Fusion Techniques
September 6, 2026
Once a high PSA or a hard nodule on digital rectal exam raises suspicion, biopsy is the standard of care Dr. Amit Goel uses to confirm prostate cancer. The conventional approach is a transrectal ultrasound-guided biopsy, where a probe placed in the rectum lets the urologist see the prostate and guide the biopsy needle in real time.
MRI Fusion Biopsy
A newer option is MRI fusion biopsy, where a multiparametric MRI is taken first, and any suspicious regions it identifies are fused with the real-time ultrasound image so the biopsy needle can be directed precisely at that zone rather than sampling more broadly. Dr. Goel performs the biopsies himself for every patient, specifically so that targeting stays accurate to wherever the lesion actually shows up on ultrasound.
How Many Samples Are Taken
A standard biopsy takes 12 cores: three to four each from the base, the mid-gland and the apex of the prostate, with additional cores taken from any specifically suspicious region. A separate, less commonly used option is perineal biopsy, done through the perineum rather than the rectum, which requires general anesthesia.
This article is based on a Jivo Masterclass session conducted by Dr. Amit Goel, Director and Head of Unit, Renal Transplant, Uro-oncology, Urology and Robotic Surgery, Max Hospital, Gurugram, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Amit Goel taught doctors across Africa on April 20, 2025.
FROM THE LIVE Q&A
Moderator
What is the management of metastatic prostate cancer?
Dr. Amit Goel
It depends on where the metastasis is. Bilateral orchidectomy is still a valid option for patients who don't want to spend money on ongoing hormone injections, and it works about as well as hormone therapy. For bone metastasis with pain or fracture risk, bone-strengthening injections and radiotherapy to the affected bone are added. Once the disease becomes castration-resistant, treatment moves to stronger anti-androgens such as abiraterone or enzalutamide, chemotherapy for visceral metastasis, and increasingly immunotherapy.
Frequently Asked Questions
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?▼
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
What is the average cost of robotic surgery for prostate cancer?▼
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
What is the management of metastatic prostate cancer?▼
It depends on where the metastasis is. Bilateral orchidectomy is still a valid option for patients who don't want to spend money on ongoing hormone injections, and it works about as well as hormone therapy. For bone metastasis with pain or fracture risk, bone-strengthening injections and radiotherapy to the affected bone are added. Once the disease becomes castration-resistant, treatment moves to stronger anti-androgens such as abiraterone or enzalutamide, chemotherapy for visceral metastasis, and increasingly immunotherapy.
What is the difference between a TRUS biopsy and an MRI fusion biopsy?▼
A TRUS biopsy uses real-time ultrasound alone to guide the needle, while an MRI fusion biopsy overlays a prior MRI's suspicious findings onto the ultrasound image so the needle can target that specific zone.
How many samples are taken in a standard prostate biopsy?▼
A standard biopsy takes 12 cores, split across the base, mid-gland and apex of the prostate, with extra cores from any suspicious area.
In This Series: Prostate Cancer: Diagnosis and Management
- 1.Diagnosis and Management of Prostate Cancer
- 2.Prostate Cancer Risk Factors and Why Men of African Descent Face the Highest Risk
- 3.Recognizing Prostate Cancer: From Early Symptoms to Advanced and Metastatic Disease
- 4.How Prostate Cancer Is Diagnosed: PSA Testing and Digital Rectal Examination
- 5.Prostate Biopsy: TRUS-Guided and MRI Fusion Techniques
- 6.The Gleason Score: Grading Prostate Cancer and What It Means for Treatment
- 7.Staging Prostate Cancer: TNM Classification and PSMA PET Scans
- 8.Choosing a Treatment: Risk-Based Options From Active Surveillance to Surgery
- 9.Robotic, Laparoscopic and Open Radical Prostatectomy: Comparing the Evidence
- 10.The Retzius-Sparing Technique: Protecting Continence and Erectile Function After Surgery
- 11.Managing Metastatic and Castration-Resistant Prostate Cancer