Having a transperineal prostate biopsy

Read our guide below about to help you understand what to expect when you have a transperineal prostate biopsy.

You can also download a PDF version of this patient information by following the link on the right.

What is a prostate gland?

Prostate glands are only found in men and are about the size of a walnut but can be larger. Your prostate gland is just below your bladder and in front of your rectum. It produces white fluid that becomes part of your semen.

What is a prostate biopsy?

It’s where small samples of tissue are taken from your prostate gland. A specialist (histopathologist) will then examine the samples under a microscope.

Due to the way the specimens must be prepared for the histopathologist, the results may take up to 3 weeks to come back.

Why do I need a prostate biopsy?

This could be because your doctor/nurse specialist may have found a lump or abnormality during a digital rectal examination (DRE).

A DRE is where a doctor feels your prostate gland through your rectum (back passage) with his/her index finger.

You may have had a blood test showing a high level of prostate-specific antigen (PSA). PSA is a protein released into your blood from your prostate gland. High levels of PSA may indicate cancer, though can be raised for many other, non-cancer reasons.

You may also need a prostate biopsy beacuse you have:

• had an MRI or other scan suggestive of prostate cancer
• had a previous biopsy results that came back with no evidence of cancer but your PSA blood test is doubtful
• a known diagnosis of prostate cancer that has not required treatment. Your doctor/nurse specialist might want to plan for possible treatments or monitoring.

What does the biopsy show?

It can determine whether any of your prostate cells have become cancerous. Or if you have pre-existing cancer, whether the cancer has changed.

The biopsy can also diagnose other conditions such as:

• benign prostatic hyperplasia (enlargement of the prostate)
• prostatitis (inflammation of the prostate, usually caused by a bacterial infection)
• prostatic intraepithelial neoplasia (PIN) – a change in the cell type but not cancer.

How is the biopsy done?

We use an ultrasound probe in your back passage and take samples through the perineum (the skin between the rectum and scrotum), either under local or general anaesthetic.

What is an ultrasound?

It’s a way of seeing different body parts using high frequency sound waves to create images of your internal structures. The sound waves bounce off tissues and organs, picked up and then displayed on a screen.

Because your prostate gland is in front of your rectum, we can insert a small ultrasound probe into the rectum to create an image of
your prostate gland. This is called a trans-rectal ultrasound or TRUS. This will help to guide your doctor or specialist nurse when they do the biopsy.

Giving your consent

We want to involve you in decisions about your care and treatment. If you decide to go ahead, we’ll ask you to sign a consent form. This states that you agree to have the treatment and understand what it involves.

If you’d like more information about our consent process, speak to a member of staff caring for you.

What are the risks?

Although serious complications are rare, every procedure has risks. Your doctor or specialist
nurse will discuss these with you in more detail.

Infection

This can happen to 1 in 1,000 patients. We may give you antibiotics before your biopsy to reduce this risk if required.

If you develop a fever, or have pain or a burning sensation when you pass urine, you may have an infection. Get medical attention from your GP, nearest minor injuries unit or A&E.

Blood when you pass urine

This is not uncommon and can range from peachy coloured to rose or even claret coloured. It’s rarely a sign of a serious problem.

Increasing your fluid intake will usually help ‘flush the system’ and clear any bleeding. If you have persistent or heavy bleeding every time you pass urine you should go to your nearest A&E.

Difficulty passing urine

The biopsy may cause swelling that causes difficulty passing urine. This can happen in up to 10 in every 100 cases and is more likely to
happen in men who had difficulty passing urine before having the biopsy.

You may need a catheter and to go to your nearest A&E for assessment. A catheter is a hollow, flexible tube that drains urine from your bladder. It’s likely that this would be a temporary problem and will return to normal after the catheter is removed.

Allergic reaction

This may happen from the medication we give you. Although the risk of this is low (less than one in 1,000 cases), you can reduce it
by telling us if you have had any previous allergic reactions to medications or food.

Before the biopsy

You must tell the doctor or specialist nurse if you’re taking any medications, particularly antibiotics or anticoagulants including:

• aspirin
• warfarin
• clopidogrel
• rivaraxoban
• apixaban
• edoxaban
• dipyridamole

You must also tell us if you have:

• allergies to any medications, including anaesthetic
• or have ever had bleeding problems
• an artificial heart valve.

You should continue to take all of your medications as normal, unless the doctor who organised your biopsy tells you otherwise.

Will I have a local or general anaesthetic?

Most biopsies involve a local anaesthetic with medication used to numb a specific area of your body.

In some circumstances, you may have a general anaesthetic.

Your doctor or specialist nurse will discuss the options with you before you have your biopsy.

What will happen on the day of my biopsy?

We usually do the biopsy as a day case (outpatients) either in the urology unit or operating theatre at Wycombe Hospital.

We’ll send you a letter telling you when and where to come on the day of your admission.

Once we admit you to the ward or urology unit, you’ll see your urology doctor/nurse specialist. They’ll go through the procedure again with you and ask you to sign the consent form. You’ll have an opportunity to ask any questions.

If you’re having a general anaesthetic

We’ll tell you when to stop eating and drinking before the procedure. You’ll have the  anaesthetic through a small needle inserted into the
back of your hand. This will make you sleep for the whole procedure, so you won’t feel any pain or discomfort.

You’ll wake up in the recovery room and your surgeon will see you before discharge.

If you’re having a local anaesthetic

We’ll ask you to lie on the specially modified table and put your legs in supportive stirrups. Your doctor/nurse specialist will examine
your prostate with a finger in the back passage and use a special gel to relax your anus muscle. They’ll tape your scrotum out of the way and lift your legs so that your hips are bent as far as possible.

If you find this position difficult, let the doctor/nurse specialist know.

The doctor/nurse specialist will then use an antiseptic solution to clean the skin between your scrotum and your anus. You’ll then have an injection of the local anaesthetic to numb the treatment area so that you do not feel any pain during the procedure. The injection will sting for a few seconds at first, a bit like having an injection at the dentist.

What happens during the biopsy?

It’s a three stage process. Once the anaesthetic has had time to work, although you may find the procedure uncomfortable, you should not feel pain.

The procedure feels about the same in terms of discomfort as a trans-rectal prostate biopsy, which you may have had before.

Ultrasound

The ultrasound probe is covered in gel to make the passage into the rectum easier. The probe will be in your rectum throughout the procedure so that your doctor/nurse specialist can see your prostate.

Biopsies

Your doctor/nurse will pass very fine needles through the numb skin taking biopsies of your prostate. We may take some targeted biopsies depending on the results of your MRI scan.

We take prostate biosies with a device that contains a spring-loaded needle. The needle inserts into the prostate gland and removes a tissue sample very quickly. You’ll hear the click of the ‘gun’ as it takes the biopsies (between 24 and 32).

You may feel a brief, sharp pain as the from the biopsy needle when it goes into the prostate gland.

After the biopsy

If you have had a local anaesthetic you can leave as soon you pass urine normally.

We’ll tell you to rest for about 4 hours at home after this. You’ll need someone to take you home after the procedure.

General anaesthetic takes 24 to 48 hours to wear off so please rest for this period of time.

When you’re at home

You may:

• have mild discomfort in the biopsy area for 1 or 2 days after the biopsy
• notice some blood in your urine for a few days
• have discoloured semen (pink or brown) for up to 6 weeks, and occasionally longer, after the biopsy.

This is nothing to worry about. You should drink plenty of non-alcoholic fluids while you have blood in your urine.

Please go to your local accident and emergency department if your pain increases or you:

• have a fever higher than 38C
• do not pass urine for eight hours
• start to pass large clots of blood
• have persistent bleeding.

If you need to visit your local A&E, ask them to contact the on-call urology registrar for advice.

Your results

We’ll arrange an appointment in our dedicated cancer nurse specialist-led results clinic, usually around 2 weeks after the biopsy.

Reducing associated healthcare infections

Find out how you can help to reduce healthcare associated infections when visiting hospital

Useful sources of help

Prostate Cancer Charity provides support and information for men with prostate cancer.

Macmillan Cancer Support gives information on living with cancer

Language and accessible support services

If you need an interpreter or information about your care in a different language or format, please contact our nurses.