Transperineal Prostate Biopsy

WHAT IS A TRANSPERIENAL PROSTATE BIOPSY?

A prostate biopsy is when small samples of the prostate are taken to confirm if prostate cancer is present or not. The predominate and most widely method of doing a prostate biopsy is via the perineum. The perineum refers to the patch of skin located between the anus and the scrotum.

WHAT ARE THE INDICATIONS FOR A TRANSPERINEAL PROSTATE BIOPSY?

The reasons for performing a prostate biopsy include:

  • Further assessing an unexplained raised PSA, when the MRI scan of the prostate preformed as the earlier investigation is normal
  • The MRI scan done prior has shown an abnormal area concerning for prostate cancer.

HOW IS A TRANSPERIENAL PROSTATE BIOPSY DONE?

Dr vasudevan performs transperineal prostate biopsies under a general anesthetic as a day procedure in a hospital.

You will be asked to fast 6 hours prior to the procedure. Once you arrive at the hospital, the nursing staff will admit you and get you prepared for the procedure.

You will then be taken to the operating rooms when your turn has arrived.

The anesthetist will administer you with the medications to get you to sleep completely. Once you are asleep Dr Vasudevan will clean the perineal area with antiseptic solution such as betadine. Once this is done an ultrasound probe will be inserted into your rectum to get an ultrasound image of your prostate. Once the prostate is under view, a small needle will be inserted into your perineum. Using this needle multiple small samples of the prostate are taken.

If an abnormal area was identified in the prostate on the MRI scan done as prior investigation, special targeting of this lesion will be done as part of the biopsy. Besides the abnormal area, biopsies will also be taken of other normal appearing areas of the prostate to achieve complete and through sampling of the entire prostate. Approximately 20 to 30 prostate samples are taken. All the samples are sent to the laboratory for further processing and analysis.

Once the procedure is completed you will be woken up and sent to the recovery ward where you will be kept under observation till you are completely awake.

Once you are awake, you will be discharged home. However, because the procedure was done under a general anesthetic you will not be able to drive home yourself. Hence a friend or family member will need to take you home.

WHAT CAN I EXPECT AFTER A TRANSPERIENAL PROSTATE BIOPSY?

It is common to experience the following after a transperineal prostate biopsy:

  • Tenderness and possible bruising to the perineal area – this will resolve in 24 hours or so. If required you can have simple pain killers such as paracetamol to reduce any discomfort.
  • Blood in the urine – will be present for 24 to 48 hours and will resolve by itself
  • Blood in the semen – will be present for 4 to 6 weeks. This will also resolve by itself.

WHAT ARE THE POSSIBLE COMPLICATIONS FROM A TRANSPERIENAL PROSTATE BIOPSY?

While complications from a transperineal prostate biopsy are very rare, they can include:

  • Infection – Infection after transperineal prostate biopsy is extremely rare and is less than 0.1%. If you feel feverish or generally unwell after a transperineal prostate biopsy please return back to hospital where further assessment will be done to rule out infection.
  • Urinary retention – This is where you may not be able to pass urine after the biopsy and hence will have abdominal discomfort. This happens in about 2 to 4% of men. If you do experience this please return back to hospital where a catheter will need to be inserted to empty the bladder.

FOLLOW-UP WITH DR VASUDEVAN

At the time of booking the transperineal prostate biopsy Dr Vasudevan will have already arranged a follow-up appointment for you in his office approximately 2 to 3 weeks after the date of the biopsy. During the follow-up appointment Dr Vasudevan will discuss the results of the biopsy and any further management that may arise depending on the results.