Insights

What Is a Prostate Biopsy?

When test results raise concern — whether it’s an elevated PSA blood test or findings on imaging — the next step is often a prostate biopsy. A biopsy provides the only definitive way to confirm or rule out prostate cancer by examining small samples of prostate tissue under a microscope.

There are two main approaches used today: TRUS biopsy and MRI Fusion biopsy.

TRUS Biopsy: The Traditional Approach

TRUS stands for transrectal ultrasound-guided biopsy. The “TRUS” part refers to how the prostate is visualized (with an ultrasound probe in the rectum), not necessarily how the biopsy needles are inserted.

• In the traditional method, the needles are passed through the rectal wall into the prostate to collect samples.
• Typically, 10 to 12 tissue cores are taken in a systematic pattern.
• These samples are taken mainly from the peripheral zone — the outer edge of the prostate where about 92% of cancers begin. This systematic approach may still miss cancers in the central zone or near the top of the prostate.

Limitations of the traditional TRUS biopsy:

• Passing needles through the rectum introduces rectal bacteria, leading to a 2-3% risk of serious infection.
• Systematic sampling can miss clinically significant cancers or over-detect very low-risk ones.

How UIC Does It Differently

At UIC, we still use ultrasound guidance (TRUS) to see the prostate — but we never insert needles through the rectum. Instead, all biopsies are performed transperineally, with needles passed through the patch of skin above the anus and below the base of the scrotum (perineum).

• Infection risk with transperineal needle insertion is around 0.1%, compared with 2-3% for the traditional transrectal approach.
• It also allows better access to certain areas of the prostate that are harder to reach transrectally.

MRI Fusion Biopsy: A More Targeted Option

MRI Fusion biopsy combines the detail of advanced imaging with the real-time accuracy of ultrasound.

• First, a multiparametric MRI highlights suspicious areas of the prostate. This scan may already have been completed before you come to us, or if needed, our team will arrange a referral so you can obtain one.
• During the biopsy, software fuses the MRI images with live ultrasound guidance.
• This lets the urologist precisely target abnormal regions while still sampling the rest of the gland.

Benefits

• Higher accuracy in detecting clinically significant cancers.
• Lower chance of over-diagnosing harmless cancers.
• Especially helpful for men with persistently high PSA after a negative biopsy.

TRUS vs MRI Fusion: Which Is Right for You?

Both methods are important in modern prostate care:

• TRUS biopsy (when performed transperineally as we do at UIC) remains a reliable option for men undergoing their first biopsy.
• MRI Fusion biopsy is particularly valuable when an MRI shows suspicious areas or when more precision is needed after prior inconclusive results.

TRUS vs MRI Fusion Comparison at a Glance

Why Choose Urology Innovations Canada (UIC)?

At UIC in Toronto, accuracy and patient safety guide everything we do. That’s why we perform only transperineal biopsies – never transrectal.

Lower Risk

Studies show infection rates after transperineal biopsy are less than 0.1%, compared with 2-3% for the traditional transrectal route. While no medical procedure is ever risk-free, the transperineal method is widely recognized as the safer choice.

Higher Accuracy

When combined with MRI Fusion, the transperineal approach offers greater precision in detecting clinically significant prostate cancers.

Our Philosophy

At UIC, we always aim to do less harm. Choosing the transperineal technique reflects that commitment.

Focused Expertise

Our practice is dedicated solely to prostate health, giving you access to specialists with deep experience in prostate diagnostics and treatment.

When it comes to prostate cancer detection, how the biopsy is done matters. At UIC, our commitment is clear: advanced diagnostics, safer techniques, and care designed with your long-term health in mind.

At Urology Innovations Canada (UIC) in Toronto, we specialize in accurate, minimally invasive diagnostics with very short wait times. Our patients often come to us looking for more clarity, more options, and faster answers than they’ve received through the public system.

We’ll walk you through how prostate cancer is typically detected — and how we approach testing at UIC to give you the information you need without delay.

Step 1: PSA Blood Test – the Starting Point

A simple blood test measuring Prostate-Specific Antigen (PSA) is usually the first step.

The most common first sign of a potential issue is an elevated PSA (prostate-specific antigen) level in your blood. PSA is a protein produced by the prostate, and higher levels can be linked to:

• Prostate cancer
• Benign prostatic hyperplasia (BPH)
• Inflammation

An abnormal PSA doesn’t mean you have cancer — but it’s a reason to investigate further.

At UIC:

• We review PSA trends over time, not just one number
• We help you understand your result — and what it means
• We don’t leave you waiting weeks for answers

If your PSA is elevated or rising, we’ll help you decide whether to monitor, repeat the test, proceed with imaging, or a prostate biopsy.

Step 2: Digital Rectal Exam (DRE)

Your urologist may perform a DRE — a brief in-office exam that can detect abnormalities in the prostate.

While not all cancers can be felt through a DRE, this exam provides important information when interpreted alongside your PSA result.

During a DRE, your doctor feels the prostate through the rectum to check for:

• Lumps or hard areas
• Asymmetry or enlargement
• Surface texture changes

It’s a quick test — and while it can be uncomfortable, it’s an important part of prostate evaluation.

Our Toronto-based team handles this step with professionalism and care. You’ll know exactly what to expect, and why it matters.

Step 3: Imaging — MRI or Ultrasound

If PSA and/or DRE results are concerning, imaging is often the next step. This helps your urologist identify suspicious areas and decide whether a biopsy is needed.

Two imaging options we use in diagnostics:

• Multiparametric MRI (used in MRI Fusion biopsy)
• Transrectal ultrasound (TRUS) (used in TRUS biopsy)

Step 4: Prostate Biopsy — TRUS or MRI Fusion

If cancer is suspected, a prostate biopsy is the only way to confirm a diagnosis. At Urology Innovations Canada, we perform both TRUS-guided and MRI Fusion-guided prostate biopsies, depending on your clinical needs.

TRUS-Guided Biopsy

This is the standard biopsy method used across most clinics. We use real-time ultrasound to obtain 10-12 samples from systematic zones of the prostate. It’s fast, performed under local anaesthetic, and efficient in many cases.

However, because traditional ultrasound doesn’t clearly show lesions, some cancers — especially smaller or more aggressive ones — may be missed with this technique alone.

At UIC, we do not perform the older transrectal approach, since the transperineal method offers better safety and accuracy.

MRI Fusion Biopsy

We are the first clinic in downtown Toronto to offer MRI fusion-guided prostate biopsy. This advanced method combines high-resolution MRI images with real-time ultrasound to precisely target suspicious areas seen on the MRI.

We recommend MRI fusion biopsy when:

• A previous TRUS biopsy was negative but your PSA remains high
• There are areas on MRI that require direct targeting
• More accurate detection of clinically significant prostate cancer is needed
• A prostate is larger than average in size and a standard prostate biopsy would not reach all areas

This technology is not widely available in Canada, and we’re proud to provide access to it in our clinic — helping you get answers sooner and with greater precision.

Not sure which biopsy is right for you? We’ll guide you through your options and recommend the approach that fits your health history, symptoms, and diagnostic findings.

Transperineal Biopsy

At UIC, we perform prostate biopsies exclusively using the transperineal approach. Unlike the traditional transrectal route, the transperineal method involves passing the biopsy needle through the skin between the scrotum and rectum, guided by ultrasound — never through the rectum itself.

Why this matters:

• Lower infection risk: Because the needle doesn’t pass through the bowel, the risk of introducing bacteria is significantly reduced.
• Better access: This approach allows your urologist to sample regions of the prostate that can be harder to reach with the transrectal technique, including the anterior prostate.
• Precision when paired with MRI: When combined with MRI fusion, transperineal biopsy provides the most accurate, targeted sampling available.

This technique is becoming the gold standard in prostate cancer diagnosis worldwide, and we’re proud to make it standard practice at our Toronto clinic.

Step 5: What Happens After the Biopsy – Pathology Results

Your biopsy results will be ready in approximately 3 weeks, and will include:

• Gleason score: indicates how aggressive the cancer is
• Stage and grade: helps determine if treatment is needed

The results of your biopsy are sent to your treating urologist for further discussion. If you’re not under anyone’s care, we will discuss your results with you.

If no cancer is found, we’ll recommend a personalized follow-up plan. If cancer is confirmed, we’ll walk you through every option, from active surveillance to treatment.

We believe in informed decisions — not pressure.

Who Should Be Screened for Prostate Cancer?

At UIC, we help men across Ontario decide if — and when — screening makes sense. You should consider evaluation if:

• You’re over 50, or over 40 with risk factors
• You have a family history of prostate cancer
• You’ve been told your PSA is rising
• You’re experiencing urinary symptoms and want to rule out cancer

We also see men who haven’t had a PSA yet but want to be proactive.

Why Patients Choose UIC in Toronto for Fast-Tracked Prostate Diagnostics in Toronto

At Urology Innovations Canada, we are specialists in prostate health — delivering fast access to advanced diagnostics and minimally invasive treatments. Unlike traditional hospital-based care, our independent clinic often sees patients within days. It’s important to note that care at our clinic is best suited for the right patients — those whose condition and circumstances are a good fit for our treatments and the way we operate. That’s why we ask all prospective patients to complete our secure pre-screening form first.

While referrals are usually helpful and preferred, they’re not required. Simply complete our online pre-screening form to see if we’re the right fit for you.

We’re here to help you move forward with clarity and confidence, whether you’re dealing with:

• Elevated PSA
• A previous biopsy
• Rising PSA numbers with no clear diagnosis

📍 Based in Toronto, with patients visiting from across Ontario and beyond.
🗓️ Short wait times for the right patients

Complete the Pre-Screening Form Now