Modern prostate testing means many men can safely avoid a biopsy unless imaging clearly shows a reason to proceed.
Have you or a loved one been advised to have a prostate biopsy?
If so, you may be wondering why it’s needed, what it involves, and whether it’s really necessary. This newsletter explains prostate biopsies in plain language, including how modern testing has changed the decision-making process.
What Is a Prostate Biopsy?
A prostate biopsy is a medical procedure where small tissue samples are taken from the prostate and examined under a microscope.
At present, a biopsy is the only definitive way to diagnose prostate cancer.
How Biopsies Have Changed Over Time
In the past, biopsies were commonly done:
Without any imaging beforehand
Using an ultrasound probe through the bowel
With multiple random samples taken
While effective, this approach could miss cancers or detect cancers that were unlikely to cause harm.
Modern Prostate Cancer Assessment (2025)
Today, biopsy decisions are guided by advanced imaging, helping avoid unnecessary procedures.
Step 1: MRI Scan
A multiparametric MRI allows us to:
Visualise the prostate in detail
Identify suspicious areas
Avoid biopsy altogether if no concerning lesion is found
If the MRI is normal, many men can be safely monitored with PSA tests.
Step 2: PSMA PET Scan (If Needed)
If PSA levels continue to rise despite a normal MRI, a PSMA PET scan may be recommended.
Detects lesions not visible on MRI
Further reduces unnecessary biopsies
MRI misses cancer in only about 10% of cases
Step 3: Biopsy (When Indicated)
A biopsy is recommended if:
MRI shows a suspicious lesion
PSMA PET scan identifies a target
PSA continues to rise without explanation
How Is the Biopsy Performed?
In Australia (Most Common Approach)
Transperineal biopsy
✔ Performed under general anaesthetic
✔ Needle passes through the skin (not the bowel)
✔ Significantly lower infection risk
✔ Day procedure (20–30 minutes)
After the procedure:
Go home the same day
No driving until the next day
Temporary blood in urine, semen, or stool is common
In Some Other Countries
Transrectal biopsy
Done under local anaesthetic
Performed in the clinic
Slightly higher infection risk
Getting Your Results
Results are usually available within 48 hours
You will be contacted to discuss:
Whether cancer is present
The grade of cancer (how aggressive it is)
If cancer is found:
A PSMA PET scan is used for staging
Treatment options are discussed in detail
Care is tailored to your individual situation
Final Thoughts
Thanks to modern imaging such as MRI and PSMA PET scans, many men do not need an immediate prostate biopsy, even if their PSA is elevated. Today, the decision to biopsy is based on your individual risk, imaging findings, and PSA trends over time—helping avoid unnecessary procedures while still detecting significant cancers early.