Prostate Cancer Diagnosis
Image-Guided Prostate Biopsy: MRI Fusion and Augmented Reality
A prostate biopsy takes small samples of tissue from the prostate so that a pathologist can look for cancer. It is usually recommended after an elevated or rising PSA blood test, an abnormal digital rectal examination, or a suspicious area on prostate MRI. Most patients now have an MRI before biopsy. When the MRI shows a suspicious area, the MRI images can be overlaid on the live ultrasound during the biopsy so that samples can be taken directly from that area. This is called MRI-ultrasound fusion, or targeted, biopsy. Systematic samples from the rest of the gland are usually taken as well.
Overview
Biopsies can be performed through the rectal wall or through the skin between the scrotum and the anus, the transperineal route. The transperineal approach avoids passing the needle through the rectum and is increasingly used. Dr. Khandekar's clinical and research work includes augmented reality guidance for prostate biopsy, in which the MRI target is displayed in the operator's field of view to support needle placement. His presentations on this topic are listed on the research page.
Who May Be a Candidate
Whether this treatment is appropriate is an individual decision made with your care team. In general it may be considered for:
- An elevated or rising PSA, after other causes have been considered.
- A suspicious area on prostate MRI, graded by the PI-RADS scale.
- An abnormal finding on digital rectal examination.
- Patients on active surveillance for known low-risk prostate cancer, who have periodic biopsies to confirm that the cancer has not changed.
What Is Typically Involved
- 1A prostate MRI before the biopsy in most cases, reviewed by radiology and urology.
- 2Instructions on medicines, particularly blood thinners, and an antibiotic when the transrectal route is used.
- 3The biopsy itself, done in the office under local anesthesia or in a procedure room with sedation, taking about fifteen to thirty minutes.
- 4Targeted samples from any MRI-visible area, plus systematic samples from across the gland.
- 5Mild blood in the urine, semen or stool for days to weeks afterward, which is expected.
- 6A pathology report within one to two weeks and a visit to review the results and any next steps.
A more detailed, plain-language guide to preparing for and recovering from this surgery, in English and Spanish, is in the Prostate Biopsy patient guide.
Questions Patients Often Ask
Is a prostate biopsy painful?
Most patients describe pressure and brief discomfort rather than sharp pain. Local anesthetic is used, and sedation is available for some procedures. Discomfort afterward is usually mild and short-lived.
What is the difference between transperineal and transrectal biopsy?
In a transrectal biopsy the needle passes through the rectal wall into the prostate. In a transperineal biopsy it passes through the skin of the perineum, avoiding the rectum, which lowers the risk of infection and reaches some parts of the gland more easily. Both are guided by ultrasound. Your urologist will recommend the approach suited to your anatomy and situation.
Do I need an MRI before a biopsy?
An MRI before biopsy is now standard for most patients. It can show areas that should be specifically targeted, and in some cases a reassuring MRI may support deferring a biopsy. That decision is made with your urologist based on your PSA, examination and MRI findings together.
What happens if the biopsy finds cancer?
The pathology report describes the grade of the cancer and how many samples were involved. Combined with PSA and MRI, this places the cancer in a risk group. Options can range from active surveillance for low-risk cancer to surgery, radiation or focal therapy for others. Your care team will review all appropriate options with you.
Related Procedures
Discuss Your Options
This page is general information and is not a recommendation for any individual. To discuss whether this treatment is appropriate for you, request a consultation through UHealth or call (305) 243-6090. Please do not send personal health information through this website.
Request an AppointmentEducational content reviewed by Archan Khandekar, MD. Last updated 2026-09-19. This material is general in nature, does not constitute medical advice, and does not create a physician-patient relationship. Individual care decisions should be made with your own treating physicians.
Schedule a Consultation
Dr. Khandekar sees patients across the University of Miami Health System and Sylvester Comprehensive Cancer Center. Request an appointment for urologic oncology care.