Procedure · Diagnostics

Transperineal prostate biopsy

A transperineal biopsy is the most accurate and lowest-infection way to sample the prostate. Guided by your MRI scan, targeted samples are taken through the skin to confirm or rule out prostate cancer.

What are the indications for a transperineal biopsy?

A biopsy may be recommended to find out whether cancer is present in the prostate. It is usually advised when:

  • The prostate feels abnormal on digital rectal examination.
  • An area looks suspicious on your prostate MRI scan.
  • Your MRI scan was normal but your PSA blood test remains high for your prostate size (raised PSA density).
  • You have recently been diagnosed with low-risk prostate cancer and require a more thorough 'confirmatory' biopsy.
  • You are on active surveillance and your PSA or MRI scan suggests possible progression.

At present there is no more reliable way than a biopsy to check the prostate for cancer.

What are the alternatives?

  • Monitoring with repeat PSA/MRI — Rechecking your blood tests +/- MRI scan and only investigating further if there are ongoing concerns.
  • Transrectal (TRUS) biopsy — Sampling through the rectum, which carries a higher risk of infection than the transperineal route.

What happens before surgery?

You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain drugs should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.

On the day of surgery you should avoid eating for six hours before, and drink only clear fluids within two hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss your anaesthetic and pain relief.

What does the procedure involve?

  • Carried out under local anaesthetic as an outpatient, or under general anaesthetic as a day-case procedure.
  • An ultrasound probe is placed in the rectum to scan the prostate.
  • Your MRI images can be overlaid on the ultrasound to target suspicious areas.
  • The perineum (skin between scrotum and rectum) is cleaned and numbed.
  • Fine biopsy needles are passed through the skin, guided by ultrasound.
  • The procedure usually takes 30-45 mins after which, once you have recovered and passed urine, you will be allowed home.

What are the side-effects?

  • Blood in the urine for up to 10 days (almost all patients).
  • Blood in the semen for up to 6 weeks (almost all patients).
  • Bruising and discomfort in the perineal area (5-10%).
  • Temporary difficulty with erections from bruising (about 5%).
  • Inability to pass urine (retention) needing a catheter (about 5%).
  • A urine infection needing antibiotics (about 1%).
  • A serious blood infection (sepsis) needing admission (less than 1%).

What happens after surgery?

Drink plenty of fluid to help settle any bleeding. It is normal to see blood in the urine for a few days and in the semen for up to six weeks. Seek advice if the bleeding does not settle, and contact the hospital or attend A&E promptly if you cannot pass urine at all.

Your samples will be processed by the pathology department and reviewed by a multidisciplinary team within 10-14 days. An appointment will be made for approximately 2 weeks after the biopsies to talk through the results. Very occasionally further testing is needed, meaning that the results are not ready by then - we will contact you if this is the case.

British Association of Urological Surgeons

Patient information leaflet

Read the British Association of Urological Surgeons (BAUS) leaflet: Transperineal biopsy of the prostate.

View the BAUS leaflet