Module 5

Transrectal (TRUS) biopsy

The historic standard: technique, anatomy, anaesthesia and its infection problem.

TRUS was the standard for decades, and you will still meet it. Understanding it, and its one big weakness, explains why practice has shifted.

MRI slices live

The raw multi-parametric scan.

3D reconstruction live

Segmented gland, zones and lesion as a rotatable model.

Beside-patient spatial teaching future spatial workflow

Future spatial-computing workflows for placing the anatomy model in clinical space.

01 How TRUS works 4 min

TRUS means transrectal ultrasound-guided. The patient lies on their side, an ultrasound probe goes into the rectum, and the needle is fired through the rectal wall into the prostate. A standard systematic biopsy takes around 12 cores.

Key point In TRUS the needle crosses the rectal wall to reach the gland. Hold on to that detail, it explains everything later.

You can describe the TRUS setup and core number.

In a TRUS biopsy, the needle passes through what?

02 The periprostatic block 3 min

Local anaesthetic is placed around the prostate, at the periprostatic region near the base and the angle by the seminal vesicles. A good block makes the procedure far more comfortable.

You know how TRUS is anaesthetised.

What is the periprostatic block for?

03 The infection problem 4 min

Here is the weakness. The needle carries rectal and faecal bacteria directly into the prostate and bloodstream, so the sepsis risk is real, and rising antibiotic resistance has made it worse.

This single fact is the main reason units have moved towards the transperineal route.

The core problem Needle through faeces equals infection risk. No antibiotic strategy removes it entirely.

You can explain precisely why TRUS carries a higher infection risk.

Why does TRUS carry a higher infection risk than TP?

04 Where TRUS still fits 3 min

TRUS has not vanished. It is still used where transperineal facilities are not available, and the skills overlap. But UK practice is clearly moving towards TP, which the next module covers.

You can place TRUS correctly in current practice. End of Module 5.

What is the clear direction of travel in biopsy practice?

That is Module 5. You understand how TRUS works and why its infection risk drove change.

Next: Transperineal (TP) biopsy →