MRI-Ultrasound Fusion Prostate Biopsy at Bournemouth Hospital

What is an MRI-ultrasound fusion prostate biopsy?

An MRI-ultrasound fusion prostate biopsy is a procedure that combines an earlier MRI scan of your prostate with a live ultrasound image, so your doctor can see exactly where to take tissue samples from. This helps target any areas that looked suspicious on the MRI, rather than sampling the prostate more generally.

Why might I need one?

Your doctor may suggest this biopsy if you have:

• a raised PSA (prostate-specific antigen) level on a blood test
• a lump or hard area felt on your prostate during an examination
• a suspicious result on an MRI scan
• a raised PSA that keeps rising even though an earlier ultrasound-only biopsy didn't find cancer
• a diagnosis of prostate cancer that your doctor is monitoring (active surveillance), or is considering treating with a targeted, localised approach

The biopsy can also help diagnose non-cancerous conditions that cause similar symptoms to prostate cancer, such as an enlarged prostate or an infection or inflammation of the prostate (prostatitis).

What are the benefits of having it?

Combining MRI and ultrasound gives a clearer, more detailed picture of your prostate than ultrasound alone, helping your doctor target the exact areas that need sampling. This more precise approach can mean fewer samples are needed overall, may reduce the number of biopsies you need in future, and can reduce the chances of missing a significant cancer.

If the biopsy is done through the perineum (the skin between your anus and scrotum) rather than through the rectum, there's no risk of rectal bleeding, and a significantly lower risk of infection.

Are there different types of the test?

There are two routes the biopsy needle can take:

• transrectal, where the sample is taken through the rectum
• transperineal, where the sample is taken through the perineum (the skin between the anus and scrotum), which carries a lower risk of infection

There are also different ways of combining the MRI and ultrasound images:

• MRI-ultrasound fusion, where specialist software overlays the two images in real time
• in-bore MRI biopsy, where the whole procedure is done inside the MRI scanner itself
• cognitive fusion, where the doctor reviews the MRI beforehand and manually matches it to the live ultrasound view, without fusion software

Sources also describe different approaches to anaesthetic: some use a local anaesthetic, sometimes with a mild sedative, while others use a general anaesthetic or deeper sedation. Some services offer you a choice.

How do I prepare for the test?

You'll need to have already had an MRI scan of your prostate before this procedure can be arranged.

Before your biopsy, you may be asked to:

• tell your care team about any implanted metal devices, such as a pacemaker or joint replacement, before your MRI
• empty your bowels beforehand; some services suggest an enema, though this isn't always necessary
• stop taking anti-inflammatory painkillers or blood-thinning medication for a period beforehand, as these can increase your risk of bleeding and bruising
• take a course of antibiotics before and after the procedure to lower your infection risk, though this often isn't necessary for a transperineal biopsy, since the infection risk is already low

What happens during the test?

1. You'll have an MRI scan of your prostate beforehand, sometimes using a contrast dye given through a vein, to identify any areas that need closer sampling.
2. On the day, you'll be given either a local anaesthetic (sometimes with a mild sedative) or a general anaesthetic or deeper sedation, depending on the approach being used.
3. Your doctor inserts an ultrasound probe into your rectum so they can see your prostate.
4. Using specialist software, the earlier MRI images are combined, or 'fused', with the live ultrasound picture, so any suspicious areas show up clearly.
5. For a transrectal biopsy, the needle passes through the rectum wall to reach the marked areas; for a transperineal biopsy, it passes through the perineum instead, often guided through a small grid placed against the skin.
6. Your doctor takes tissue samples, usually 10–16 in total, from the identified areas, sometimes with a few extra from elsewhere in the prostate to double-check nothing's been missed.

Sources give slightly different timings, but the procedure itself usually takes around 20–60 minutes.

What happens after the test?

Sources vary on this: some describe going home the same day, while others describe staying in hospital overnight, depending on the approach used and your individual recovery.

It's common to have some mild bleeding at the biopsy site, which can usually be managed with gentle pressure, along with some discomfort or bruising in the area for a day or two. You may notice a small amount of blood in your urine for several days, and in your semen for a few weeks; this isn't dangerous, though it can be alarming to see.

Sources describe slightly different timescales for returning to normal activities, but as general guidance:

• avoid driving for 24 hours
• avoid heavy lifting for at least 48 hours
• you can usually resume normal activities, including exercise, after 48 hours
• avoid sex for 48 hours

You can take paracetamol or ibuprofen for any discomfort. Your results usually take around a week, sometimes longer, and you'll normally have a follow-up appointment 1–2 weeks after your biopsy to discuss them. If cancer is found, it will be given a grade to show how aggressive it looks, which helps your doctor plan the right treatment for you.

Go to your nearest emergency department if you're unable to pass urine, or if you develop a fever, chills or shakes, as these can be signs of infection.

What are the risks or side effects?

Common, usually mild effects include:

• blood in your urine or semen for some days afterwards
• discomfort, bruising or swelling around the biopsy site
• a temporary burning feeling when passing urine

Less common but more serious risks include:

• infection, which is significantly less likely with a transperineal approach than a transrectal one; one study of transrectal biopsies found that 63% of patients had at least one minor complication, with blood in the urine sometimes persisting for 3–7 days
• a rare allergic reaction to the MRI contrast dye, which can cause hives, swelling or nausea, usually soon after the injection
• temporary difficulty passing urine (urine retention), which can be resolved with a short-term catheter
• erectile dysfunction or bowel changes, though these are uncommon