Transperineal Prostate Biopsy
What does the procedure involve?
This procedure is performed under general anaesthetic and involves using an ultrasound probe inserted via the rectum to guide the biopsy needle. Biopsies are taken through the perineal skin using a special grid. The number of samples taken depends on the size of the prostate, usually ranging from 12 to 24 samples.
The procedure is done to assess for the presence of prostate cancer. The indications for the procedure are an abnormal PSA (prostate specific antigen) or alternatively an abnormal DRE (digital rectal examination).
This procedure is an alternative way to biopsy the prostate. The traditional way is with a Transrectal Ultrasound Prostate Biopsy.
There are two main reasons this procedure is used rather than a TRUS-biopsy:
- You may have already undergone a previous Transrectal Ultrasound Guided Prostate biopsy (TRUS-biopsy) via the rectum which has not identified the cause of your elevated PSA. Biopsy of the prostate through the perineum is a more complex procedure but can allow access to areas of the prostate that are difficult to biopsy through the rectum.
- The risk of serious infection is less with a Transperineal biopsy because the needle doesn’t have to pass through the rectum to access the prostate. Recent travel to certain areas of the world can increase the chance of you carrying resistant bacteria and this type of biopsy may be recommended if you have a higher chance of carrying those bacteria (e.g. ESBL). Likewise, if you have been treated with the antibiotics ciprofloxacin or norfloxacin in the prior 6 months, you may be at risk of carrying resistant bacteria and a transperineal biopsy may be safer for you.
After the biopsy
If you are passing urine satisfactorily and feel well, you will normally be able to go home the same day.
Blood in the urine is common for a few days, with the occasional blood clot, but this should clear quickly. You may expect to see blood in the semen for up to 12 weeks. This is harmless.
Do rest at home for the first 48 hours after the biopsy and drink plenty of fluids.
Avoid constipation and physically demanding activities for a week.
Simple painkillers should be taken for any discomfort.
Potential side effects and complications
All procedures have the potential for side effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure.
There are specific risks with this surgical procedure and these will be discussed with you before your procedure. As a guide, these include:
Common side effects include:
- Blood in the urine; should be mild and resolve within a few days
- Blood in the semen, which can continue for up to 12 weeks
- It is quite common to have bruising of the scrotum and the perineum after the biopsy. This will resolve over a few days to week.
- A drip or two of blood from the back passage soon after the biopsy
Rare side effects (please contact your GP or urologist) include
- Infection in the urine
- Difficulty or inability to pass urine
- Sepsis (infection spreading from the urine/prostate). Symptoms can include feeling very unwell, a high or swinging temperature, chills, shaking, and fast heartbeat) This is very rare but needs immediate medical attention. Please contact your GP or urologist immediately or go straight to your nearest emergency department.
