A transperineal biopsy is performed by passing the biopsy needle through the perineal skin and into the prostate. This type of biopsy offers greater accuracy, compared to a transrectal approach, which involves passing the biopsy needle through a potentially contaminated rectum.
Who is a Candidate?
Patients may need a transperineal biopsy if they:
- Have had a transrectal prostate biopsy that did not reveal prostate cancer, but have a high PSA level or suspicious areas seen on an MRI scan
- Have a very large prostate
- Have a suspicious area observed on an MRI scan which needs further evaluation
- Have known prostate cancer that has not been treated but may have changed to require treatment
How to Prepare for the Procedure
Patients will be able to continue taking most medications as usual, but should consult with their doctor to find out which ones should be paused.
Patients should stop taking anticoagulants five days before the biopsy and will need to have an INR check one day before the procedure. Low doses of aspirin are allowed, but clopidogrel and other antiplatelet medicines should be stopped seven days before the biopsy.
The day of the procedure, patients will need to give a urine sample to check for a urine infection. A nurse will review the patient’s medications and administer antibiotics to help prevent infection.
A transperineal prostate biopsy may be performed under local or general anesthesia. If the biopsy is performed under local anesthesia, patients will be able to eat and drink as usual before the exam. If the biopsy is performed under general anesthesia, the patient will need to stop eating at least six hours before the biopsy and stop drinking at least four hours beforehand.
What to Expect During the Procedure
During a procedure performed under local anesthetic, the doctor will inject the anesthetic into the perineum to numb the area. An ultrasound probe will be inserted into the back passage to show the prostate gland and guide the biopsy needle through the perineum and into the prostate.
The results of an MRI scan will help the doctor identify the best location to insert a biopsy needle. Some doctors may take 30 to 50 samples, called a transperineal template biopsy.
After the Procedure
Patients will need to stay for a few hours in the hospital after a general anesthetic. Patients will be able to go home after they’ve had something to eat and drink and have passed urine normally. Healthcare staff will advise patients to drink lots of fluids for the next 24 hours in order to flush out the blood and help prevent an infection. Patients should have a designated driver to take them home if the procedure was performed under general anesthesia.
Potential Side Effects and Risks
The procedure is relatively safe, but patients may experience temporary side effects such as infection, bleeding and pain. Patients should visit an emergency room if they experience the following signs of infection:
- High temperature or fever
- Difficulty passing urine
- Shivering or chills
- Blood in the urine or stool
- Need to urinate frequently