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Transperineal Prostate Biopsy

What Is A Transperineal Prostate Biopsy?

Your prostate gland is an organ that lies under your bladder and surrounds your urethra (tube that carries urine and semen to the tip of your penis (see figure 1).

A prostate biopsy involves removing small pieces of tissue from your prostate gland using a needle. The procedure is performed by an urologist.

Dr Vasudevan has recommended a prostate biopsy. However, it is your decision to go ahead with the procedure or not.

This document will give you information about the benefits and risk to help you to make an informed decision. If you have any questions that this document does not answer, ask Dr Vasudevan.

Fig 1:

Why should I have a prostate biopsy?

It is normal for your prostate gland to get larger with age but sometimes the growth can be caused by prostate cancer.

Dr Vasudevan is concerned that there may be a problem with your prostate gland. You may already have had a rectal examination, MRI scan or blood test (PSA test) that has shown a problem.

The tissue that Dr Vasudevan removes will be examined under a microscope to help make the diagnosis to help Dr Vasudevan to decide the best treatment for you. If a problem is found, Dr Vasudevan will discuss the appropriate treatment for you.

If the biopsy is normal, Dr Vasudevan can reassure you accordingly.

What Does The Procedure Involve?

Before the procedure

The healthcare team will carry out a number of checks to make sure you have the procedure you came in for. You can help by confirming to Dr Vasudevan and the healthcare team your name and the procedure you are having.

In the operating theatre

In men, the perineum is the part of the body between the scrotum and anus. The procedure is done under a full general anaesthetic. Once you are asleep your legs will be placed in stirrups to expose the perineum. The skin of the perineum will be disinfected with betadine. An ultrasound probe in placed in the rectum to obtain excellent imaging of the prostate. Biopsy needles are then passed parallel to the long axis of the prostate taking sample tissue from all aspects of the prostate gland. (See fig 2) About 20 to 30 samples of the prostate is taken from all areas of the prostate. A local anaesthetic will be injected around the prostate on completion of the procedure to keep you comfortable on completion of the procedure.
Fig 2: 

In the recovery bay

Once the procedure is completed you will wake up in the recovery bay. You will be kept under observation for half an hour to an hour and then taken back to your room. From there you will be discharged home the same day.

What are the possible complications associated with transperineal prostate biopsy?

While complications are rare they may include the following:

  • Infection such as sepsis (1 in 500 men), much less then transrectal biopsy which is 1 in 100 men
  • Blood in the urine (most men, mild )
  • Blood in the semen (most men, lasting up to three months)
  • Temporary erectile dysfunction (less than 5% of men)
  • Bruising of the skin (most men, mild)
  • Urinary retention requiring catheter placement (1% of men)

Post procedure instructions.

A responsible adult should take you home in a car or taxi and stay with you for at least 24 hours.
Be near a telephone in case of an emergency.

Do not drive, operate machinery (this includes cooking) or do any potentially dangerous activities for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination.

You should also not sign legal documents or drink alcohol for at least 24 hours.

If you take blood-thinning medication, Dr Vasudevan will tell you when you can start taking it again.

You should be able to return to work the next day unless you are told otherwise.

Do not do strenuous exercise for one to two days.

Follow-up with Dr Vasudevan in his office.

The biopsy results usually take a week or two to come back. Dr Vasudevan will have arranged with you at the initial consultation the date of your post biopsy follow-up appointment, which is normally 2 weeks after the biopsy is done. If you are unsure of the follow-up date please ring his office to confirm your follow-up appointment.