About this page. This is a plain English summary of the transperineal prostate biopsy. It does not replace medical advice from your own doctor or specialist.
For full information and references, please read the detailed page.
What is a transperineal biopsy?
A transperineal biopsy is a way of taking small samples of the prostate to check for cancer.
The word transperineal means "through the perineum" - the area of skin between the scrotum and the back passage. The needles pass through this skin, rather than through the wall of the bowel.
How does it differ from a TRUS biopsy?
The older approach, called a transrectal ultrasound biopsy (TRUS), passes the needles through the wall of the back passage. The transperineal approach avoids the bowel altogether. This makes a real difference for two reasons:
- Lower infection risk. The bowel naturally contains bacteria. Avoiding the bowel substantially lowers the risk of a serious infection.
- Better access. Some parts of the prostate, especially the front of the gland, are easier to reach from the perineum.
MRI fusion: matching the picture to the prostate
Dr Kooner often combines a transperineal biopsy with MRI fusion. This means the MRI scan that was done before the biopsy is loaded onto the screen in theatre and overlaid onto the live ultrasound. This helps the needles go directly into the area that looked suspicious on the MRI, rather than relying on a general sampling pattern.
What is the procedure like?
- It is done as a day case, usually under a light general anaesthetic.
- An ultrasound probe is placed in the back passage to image the prostate.
- Fine needles pass through the skin between the scrotum and back passage, sometimes with a small grid template.
- Several samples are taken in a planned pattern, with extra samples from any MRI-flagged areas.
- Most patients go home the same day.
Who tends to have a transperineal biopsy?
- Men with a raised PSA or an abnormal rectal examination, especially when the front of the prostate needs to be checked.
- Men whose previous TRUS biopsy was negative but whose PSA keeps rising.
- Men who need very accurate mapping of the cancer before a treatment such as surgery, radiotherapy, or focal therapy.
Important things to know
- As with any procedure, there are still risks. The most common are temporary discomfort and a small amount of bruising in the perineum, and some blood in the urine or semen for a short time. These usually settle on their own.
- The risk of serious infection is much lower than with a transrectal biopsy, but it is not zero.
- A general anaesthetic carries its own small risks, which the anaesthetist will discuss with you.
- A biopsy reports on the samples that were taken. As with any biopsy, there is a small chance of missing a cancer in an unsampled area.
- Some specialists prefer to use a transperineal biopsy as a first-line test, while others (including Dr Kooner) prefer it as a second-line option after a TRUS biopsy. The detailed page sets out why.
What you can do next
- Read the full detailed page with references and the patient information brochures.
- Short version: prostate biopsy in general.
- Short version: the MRI scan, which often comes first.
- Short version overview of prostate cancer.
- Request a second opinion on a biopsy plan.
- Call 02 8382 6980 to make an appointment.