Prostate Biopsy

Figure 1: Transperineal prostate biopsy.

What are the indications for a transperineal prostate biopsy?

A transperineal prostate biopsy is done to obtain sample of prostatic tissue to assess it for prostate cancer

• Elevated PSA

• Abnormal rectal exam

• Abnormal prostate MRI suspicious for prostate cancer

What pre-operative work up is needed?

Your urologist will organise any necessary urine and blood tests and imaging scans at your consultation prior to your procedure.

If you take any blood thinning medication, you should discuss with your urologist if these need to be stopped before your procedure. 

Please ensure you return any admission forms given to you to be filled out back to the hospital.

What happens on the day of the procedure?

If your procedure is under sedation, you will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). If your procedure is under local anaesthetic, you do not need to fast. You should bring a list of your medications, any recent scans or reports with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. If your procedure is under sedation, an anaesthetist will see you to discuss the anaesthetic before you are taken to the operation theatre.

What does this procedure involve?

The biopsy can be done under general anaesthetic or sedation

After an antibiotic tablet or an injection, we position you in special supports, which allows the surgeon to access the skin behind your scrotum. We may use tape to move your scrotum out of the way. The surgeon will examine your prostate and insert some gel into your back passage before inserting the ultrasound probe.

After cleaning your perineum with an antiseptic solution, the prostate is biopsied using a needle, which is guided into position using the ultrasound scanner. The number of biopsies taken depends on your PSA level, the MRI report and other risk factors

The procedure takes 30 to 45 minutes to complete and you should expect to go home after couple of hours if the procedure is done under local anaesthetic, or within 4-6 hours if it is done under sedation.

Are there any risks or side-effects of a transperineal prostate biopsy?

• Blood in your urine for a few days 50-80%

• Blood in your semen, which can last up to six weeks 50-80%

• Bruising / discomfort in your perineal area 20-30%

• Temporary problems with erections 20-30%

• Inability to pass urine (acute retention) 2-5%

• Minor infection of skin or urine 5-10%

• Significant bleeding with clots or infection (sepsis) in the urine or blood requiring admission 1%

• Missing a significant cancer in your prostate 10%

• Need for a repeat procedure if biopsies are inconclusive 5%

What can I expect on discharge when I get home?

You will get some blood in your urine, which may last several days, often with the occasional blood clot. You should drink plenty of fluid to keep your urine clear.  It is usual to see blood in your semen for up to six weeks, which is not of any concern to you or your partner. You can resume your normal activities and driving after a few days once you are pain free and your GP is happy with your progress.  

If you are unable to pass urine or get heavy bleeding in your urine with clots, you should go to the emergency department

What follow-up will I need?

Your urologist will see you in 2 weeks when the pathology results are back to discuss further treatment.