Is the biopsy necessary/effective for detecting PC?

thig350, better answers will follow mine. But
you need the biopsy. It will determine the stage of your cancer and ascertain location and type of prostate cancer. You have to have the biopsy before they will schedule the PSMA PT/CT which you need for treatment. You should ask for decipher or an alternate somatic test where they test the genetic mutations in the tumor itself. It can direct you on the need for (more fun) ADT or testosterone deprivation therapy. The biopsy as well as the somatic testing will give you a better idea of the aggressiveness of your cancer.
There is an ongoing study at UCLA to determine if biopsy is necessary and if microscopic ultrasound could eliminate the need. If you look up Wayne Brisbane at UCLA, you will find videos on this venture.
Positioning for the biopsy is well-described as barbaric and unexpected. Brace yourself. But it's more startling than painful. Best wishes on this journey.

Remember that PSA is not a cancer test. (In fact, prostate-specific antigen is not even prostate specific.) The PSA number is similar to a “check engine” light in a car; it indicates that something may be wrong, and further checks should be made “under the hood.” Might be as simple as a UTI; might be BPH; might be more serious, such as prostate cancer. Just need to have further checks.

Also, an MRI doesn’t diagnose prostate cancer. With an MRI, they can provide a probability that “clinically significant cancer is likely/unlikely” and assign those suspicious areas a PIRADS score.

So, that leaves the biopsy —> Taking a sample of those suspicious areas is the only way to definitively diagnose prostate cancer. The TRUS biopsy is the old-fashioned way of doing a prostate biopsy.

> Why aren’t they doing a transperineal prostate biopsy?

Yes, some call prostate biopsies barbaric - but isn’t that the case for every invasive procedure or surgery? I’ve had 2 knee surgeries - are those considered barbaric? I’ve had 1 back surgery - is that considered barbaric? I had my gallbladder removed in 2023 - is that considered barbaric? Basically, there is no logical reason to call a prostate biopsy barbaric and not every other invasive procedure or surgery. Common sense should play a role in all this.

(Note that there are two types of biopsies - tissue biopsies (like you’re talking about) and liquid biopsies. That’s a separate lengthy discussion.)

Diagnosed with prostate cancer in 2012, I had four TRUS biopsies between 2012-2021. For my first TRUS biopsy, I drove myself there and back home. Yes, for my first experience it was quite unnerving, but not terrible or traumatic (with enough Lidocaine!). For my fourth (& final) TRUS biopsy before receiving active treatment, I invited my wife to be in the room where the MRI-guided procedure was being done. I wanted her to see that it wasn’t as painful as she was imagining. She said ok; the urologist said ok. So she sat in the corner of the room (towards my head) during the entire procedure. She’ll probably never get that image out of her head!!!

The only way to find out how aggressive your cancer is, is to do a biopsy and see what the Gleason score is. It also frequently finds other aggressive issues with prostate cancer like cribriform, intraductal and more.

A TRUS biopsy is not the best. You want Transperineal not trans rectal with ultrasound. Less chance of infection.

I am in the middle of this journey. Not an expert.

My biopsy in Sept 2025 was very easy and was not “barbaric” at all. It may be for some, or it may have been worse in the past, but It was not an issue for myself.

I was put to sleep and woke up in recovery and was back home in a few hours.

There will be some blood when you wipe and pee. It was not bad and lasted for 1-2 days. I went back to work the next day, with no concerns.

You need a biopsy. Too many decisions need to be made that rely on the biopsy pathology.

I would have another biopsy tomorrow, if it was needed to provide better treatment information.

Best Wishes.

@charlesprestridge thank you and everyone for prompt and wise responses. I'm moving forward with the biopsy (taking cipro 2 hours prior to the procedure) and hoping that if I have "it" we caught it early enough to treat and move on with a normal life. I'm finding that things are on hold (road trips etc.) for now but there is never a convenient time for health issues.

Thanks again everyone.

It is necessary , it is effective , it is not very brutal (ask any woman who had uterine biopsy with no anesthetic about true "brutality"). Also, ask your doctor to send biopsy sample for Decipher test. That test analyses number of mutations in your cells and determines how aggressive the cancer is (if they find cancer to begin with, of course) , which will help you with treatment choices in the future. My husband had twilight anesthesia and felt nothing. He had no bleeding and no pain beyond the first day after biopsy.

Wishing you the best of luck with biopsy and clean results with no cancer found .