Transperineal Biopsy
A transperineal biopsy is a procedure that involves passing the biopsy needle through the perineal skin and into the prostate.
Compared to a transrectal approach, which involves passing the biopsy needle through a potentially contaminated rectum, a transperineal biopsy offers greater accuracy.
- The procedure allows direct access to the prostate through the perineum.
- This approach may improve biopsy accuracy and reduce contamination risk.
Who is a Candidate?
Patients may need a transperineal biopsy if they have had a transrectal prostate biopsy that did not show signs of prostate cancer but have a high PSA level or an MRI scan showing suspicious areas. Patients with an unusually large prostate may also require this procedure. A transperineal biopsy may also be recommended if suspicious areas are seen on MRI scans or if prostate cancer was previously diagnosed but may have changed and require treatment.
Prior biopsy did not detect cancer
Suspicious areas found on MRI scan
Prostate cancer previously diagnosed
How to Prepare for the Procedure
Preparation steps help ensure the biopsy is performed safely.
1
Patients may continue taking most of their medications as usual but should consult with their doctor to find out which ones should be paused.
2
Patients should stop taking clopidogrel and other antiplatelet medicines seven days before the biopsy.
3
Five days before the biopsy, patients should stop taking anticoagulants. Low doses of aspirin are allowed.
4
Patients will need to have an INR check one day before the procedure.
5
On the day of the procedure, patients will be asked to give a urine sample to screen for infection.
6
A nurse will review medications and administer antibiotics to help prevent infection.
Anesthesia and Preparation on Procedure Day
Local anesthesia allows normal eating and drinking beforehand.
General anesthesia requires fasting before the procedure.
Patients must begin fasting six hours beforehand.
Drinking must stop at least four hours beforehand.
Patients may choose to be under local or general anesthesia during a transperineal prostate biopsy.
What to Expect During the Procedure
During a transperineal biopsy performed under local anesthetic, the doctor will inject the anesthetic into the perineum to numb the area. He or she will then insert an ultrasound probe into the back passage to show the prostate gland and guide the insertion of the biopsy needle through the perineum and into the prostate. The MRI scan will help the doctor identify the best location to insert a biopsy needle. During the procedure, the doctor may need to take 30 to 50 samples.
Local anesthetic numbs the perineum.
An ultrasound probe is inserted into the rectum.
Imaging guides biopsy needle placement.
Multiple tissue samples may be collected.
After the Procedure and Possible Risks
1
Recovery After the Biopsy
Patients who have been under general anesthesia will need to stay for a few hours in the hospital. They will be able to go home after they’ve had something to eat and drink and have been able to urinate as usual. Patients will be advised to drink lots of fluids for the next 24 hours to flush out blood and help prevent infection.
2
Transportation and Post-Procedure Care
Patients are required to have a designated driver to take them home if the biopsy was performed under general anesthesia.
3
Possible Side Effects and Warning Signs
Though the procedure is relatively safe, some patients may experience temporary side effects such as bleeding, infection, and pain. Patients should visit an emergency room if they experience signs of infection including high temperature or fever, shivering or chills, difficulty passing urine, blood in the urine or stool, or frequent urination.