When a PSA blood test, MRI scan or examination raises the possibility of prostate cancer, a biopsy can provide the definitive answer. In a transperineal biopsy, fine needle samples are taken through the skin between the scrotum and rectum (the perineum) under image guidance, avoiding the rectal wall entirely and almost eliminated the risk of serious infection.
TREATMENTS
Transperineal Prostate Biopsy
When may a Prostate Biopsy be recommended?
• An elevated or rising PSA or abnormal prostate examination
• A suspicious lesion on prostate MRI (PI-RADS 4–5). PIRAD 3 may have a biopsy depending on imaging review and other factors (ie. PSA-density, PHI, family history, PSMA, etc)
• As part of an active surveillance programme, to confirm the cancer has not changed
Biopsy Techniques
• MRI-targeted (fusion) biopsy: Your MRI images are combined with live ultrasound, either with the help of software or mental (cognitive) fusion, to ensure biopsy needles are directed precisely into the suspicious areas.
• Systematic biopsy: Samples taken from a template of locations across the prostate, so significant cancer outside the MRI target is not missed and if considering focal therapy or nerve-sparing procedures
Risks and Considerations
All procedures carry risks, which your surgeon will discuss with you in detail. These may include:
• Blood in the urine (~ 1 week) or semen (~1 month)
• Bruising and tenderness of the perineum
• Temporary difficulty passing urine (around 1–2%)
• Serious infection is now rare (< 1%) as no needles go through the rectum
Recovery at a glance: Day procedure; most men return to normal activities after 2 days
1
Planning and Imaging Review
Your PSA history, examination findings and MRI are reviewed to decide whether a biopsy is needed and to map the areas to be sampled.
2
Image-Guided Sampling
With you comfortable under general and/or local anaesthesia, an ultrasound probe in the rectum guides fine needles through the numbed perineal skin, targeting the MRI lesion and performing a systematic template.
3
Comfort and Safety
Because the needles do not pass through the rectal wall, pre-operative or post-operative are often unnecessary and the risk of sepsis is close to zero.
4
Results and Next Steps
Pathology results are available a few weeks and discussed with you in detail. All options from surveillance through to curative treatment are discussed and further tests are organised if needed.
Our Approach
