Transperineal Ultrasound Guided Prostate Biopsy

The purpose of a prostate biopsy is to sample the prostate gland to determine if prostate cancer is present. Prostate biopsies are most commonly performed in men with an elevated PSA level or an abnormal prostate examination (a prostate nodule). Most biopsies are performed via a transrectal route – i.e. the biopsy needle traverses the wall of the rectum before reaching the prostate gland.

Trans-perineal (TP) biopsy differs in that the biopsy needle passes through the skin of the perineum, avoiding the rectum. There are several advantages to this technique. A more extensive sampling of the prostate gland can be achieved. For this reason a TP biopsy may be recommended if there is concern that a TRUS biopsy may have missed a cancer or in men on a active surveillance program for monitoring of low risk prostate cancer or in men who have an abnormality detected on prostate MRI scan. Transperineal biopsies also have a very low risk of infection as a result of the biopsy.


Procedure

A general anaesthetic is given. The patients legs are placed in stirrups. An ultrasound probe is inserted into the rectum so as to view the prostate gland. A needle guide with attached grid is fixed in place near the perineum. The biopsy needle is inserted through the needle guide into the prostate gland at multiple locations ensuring extensive sampling is achieved. Any areas of suspicion will be specifically targeted. The procedure takes 45 minutes to complete. Often you are able to go home the same day of surgery. If the surgery has been performed in the afternoon then staying overnight is usual. Before leaving you need to pass urine. There will be temporary sweliing and bruising of the perineum and scrotum which takes several weeks to completely resolve. It is normal for blood to drip from the urethra and be seen in the urine for several days afterwards, this may even last for two weeks or more, especially in men who take blood thinners such as aspirin. There will be blood in your semen for up to six weeks following the biopsy.

Pre-procedure

Aspirin, clopidogrel, dabigatran, warfarin and any other blood thinning medications will need to be stopped prior to surgery. We will advise you on the timing of when to stop and re-start these medications A urine sample needs to be provided to the laboratory 1 week prior to surgery.

Risks

There is a very small risk of urinary blockage (urinary retention) following biopsy. If you feel that voiding has become difficult then contact us or attend the Emergency Department, as a catheter may need to be temporarily inserted. Some men experience temporary impairment in erections following biopsy. This is due to bruising of the nerves which cause erection & usually resolves within three months.

Return to Work

Following your biopsy we recommend that you take three days off work.

Results

The biopsies are sent to the pathology laboratory. We usually have the results within ten days. An appointment will made to discuss the results with you.