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.
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 and/or an MRI scan that showed suspicious areas
- Have an unusually large prostate
- Have a suspicious area observed on an MRI scan requiring further evaluation
- Have been previously diagnosed with prostate cancer that has not been treated but may have changed to require treatment
How to Prepare for the Procedure
Patients may continue taking most of their medications as usual but should consult with their doctor to find out which ones should be paused.
Five days before the biopsy, patients should stop taking anticoagulants. Low doses of aspirin are allowed, but patients should stop taking clopidogrel and other antiplatelet medicines seven days before the biopsy. In addition, patients will need to have an INR check one day before the procedure.
On the day of the procedure, patients will be asked to give a urine sample to screen for a urine infection. A nurse will then review the patient’s medications and administer antibiotics to help prevent infection.
Patients may choose to be under local or general anesthesia during a transperineal prostate biopsy. If the biopsy is performed under local anesthesia, patients may eat and drink as usual before the exam. If the biopsy is performed under general anesthesia, the patient will need to start fasting six hours before the biopsy and stop drinking at least four hours beforehand.
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.
After the Procedure
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 the blood and help prevent infection. Patients are required to have a designated driver to take them home if the biopsy was performed under general anesthesia.
Potential Side Effects and Risks
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 one or more of the following signs of infection:
- High temperature or fever
- Shivering or chills
- Difficulty passing urine
- Blood in the urine or stool
- Need to urinate frequently