Transperineal biopsy for prostate cancer

A transperineal biopsy is a needle biopsy to look for cancer cells in the prostate. This helps to diagnose prostate cancer.

Your doctor puts a needle into the prostate through the skin behind the testicles (perineum). They take a number of samples, which are sent to the laboratory. In the laboratory, a specialist doctor looks at the samples under the microscope.

Preparing for your transperineal biopsy

You usually have this test in the outpatient department under local anaesthetic. Sometimes, you may have it in the operating theatre under a general anaesthetic. This is when you are asleep and don’t feel anything.

Your doctor will ask you to sign a consent form once you have all the information about the test.

You take antibiotics to stop an infection from developing after the biopsy. You take them before the biopsy and for a few days afterwards. Your doctor will explain when you need to take the antibiotics and for how long. This is usually for a couple of days afterwards.

You usually have a tube (catheter) into your bladder to drain urine if you have a general anaesthetic. Your nurse removes the catheter on the day of surgery or the morning after.

Eating and drinking and taking medicines

Having the biopsy under local anaesthetic means you can eat and drink normally before the test.

Having the biopsy under general anaesthetic means that you won’t be able to eat or drink for a number of hours beforehand. You usually stop eating at least 6 hours before the biopsy and stop drinking at least 4 hours beforehand. Your team will give you instructions.

Take your usual medicines as normal, unless you have been told otherwise. If you take warfarin to thin your blood, you should stop this before your biopsy. Your doctor will tell you when to stop taking it. This is usually for 5 days before

Tell your doctor if you also take drugs that stop cells in the blood called platelets from sticking together and forming a clot. These are antiplatelets. You need to stop taking these drugs for a few days before your biopsy.

What happens

Before

When you arrive at the department, a staff member asks you to take your lower clothes off and change into a hospital gown.

Your doctor will explain what happens before they start, and you can ask them any questions.

During the biopsy

If you have it under local anaesthetic, your doctor puts an anaesthetic into the perineum. This can sting for a few seconds before the area becomes numb. They then put an ultrasound probe into your back passage to show the prostate gland.

They use the ultrasound to guide a biopsy needle through the perineum and into the prostate. Doctors may also use the results of your MRI scan to help them work out where to take the biopsies from. They then take a number of samples.

Your doctor uses the information from your MRI scan to guide where to take the biopsies from. Doctors call these targeted biopsies. They usually also take samples from other areas of the prostate. These are systematic biopsies. If your MRI did not show any specific area that looks suspicious, then you only have systematic biopsies taken.

You usually have between 12 and 15 biopsies taken. The whole procedure takes about 20 to 30 minutes.

You may have more biopsies if you have a transperineal biopsy under general anaesthetic.

Sometimes doctors use a template (or grid) with lots of holes over your perineum and guide the needle through the template. They then take between 20 to 30 samples. This is called a transperineal template biopsy. 

Having a transperineal template biopsy usually takes about 30 to 45 minutes.

After the biopsy

You can usually go home the same day or the day after.

You need to be in hospital for at least a few hours after a general anaesthetic until you have fully recovered. This normally means until you have had something to eat and drink and passed urine normally. The team looking after you make sure any pain is under control before you go.

You stay in hospital for longer if you have a general anaesthetic.

You can’t drive home if you have had a general anaesthetic because it takes some time to fully recover from the anaesthetic.

It’s important to drink a lot of fluids for the next 24 hours.

Possible risks

Transperineal biopsies are safe tests but there are some possible risks. These might include:

• bleeding
• infection
• pain
• difficulty passing urine

Drinking plenty of fluids flushes out the blood and helps to stop you from getting any infection. Contact your doctor straight away or go to the accident and emergency department (A&E) if you have signs of infection, such as:

• a high temperature
• difficulty passing urine
• a need to pass urine very often
• a lot of blood in your urine or poo
• shivering or shaking

You need to have antibiotics straight away if you have an infection.

Getting your results

You won’t get any results at the time of the biopsy. The prostate tissue samples are sent to the laboratory to be looked at under the microscope. You should get your results within 2 to 3 weeks.

Waiting for test results can make you feel anxious. Ask your doctor how long it will take to get them. Contact them if you haven’t heard anything after a couple of weeks.  

You might have contact details for a specialist nurse. You can contact them for information and support if you need to. It might help to talk to a close friend or relative about how you feel.