Transperineal Prostate Biopsy

What is a prostate biopsy?

Prostate glands are only found in men and are about the size of a chestnut. The prostate gland is located just below the bladder in front of the rectum (back passage). Its function is to produce white fluid that becomes part of your semen. Small needle samples of tissue are taken from your prostate gland and then sent to be examined under a microscope for cancer.

Why do I need a prostate biopsy?

It is usually performed because the prostate-specific antigen (PSA) blood test is elevated, indicating a higher risk of prostate cancer. PSA is a protein produced by the prostate and detected in the blood.

A lump or abnormality during a digital rectal examination (DRE) of the prostate may be detected. A DRE is an examination where the doctor feels the prostate gland through rectum.

In the case of a known diagnosis of prostate cancer where further treatment is not as yet required, your urologist may require further information to ensure the cancer has not changed or plan for further treatments.

How is the biopsy performed?

Under a general anaesthetic, an ultrasound probe is initially inserted into the rectum to image the prostate.  This helps guide needles that are introduced through the perineum, or skin between the scrotum and anus, to obtain the samples.

An MRI prior to the biopsy may help in localising areas of the prostate suspicious for cancer.  The MRI images can be combined with the transrectal ultrasound to ensure that these areas of the prostate are accurately sampled.

Before the biopsy

Please inform your doctor or specialist nurse if you are

  • taking any blood thinning medications such as aspirin, warfarin, clopidogrel, rivaroxaban or dipyridamole
  • have bleeding problems
  • have allergies to any medications, including anaesthetic
  • have an artificial heart valve

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

The biopsy is usually carried out as a day case, which means you will be able to come in to hospital, have the biopsy and leave on the same day. The hospital will usually call the day before to tell you when to fast and come into the hospital

If you are having a general anaesthetic, medication will be administered through a small needle inserted into the back of your hand. This will make you sleep for the whole procedure, so you will not feel any pain or discomfort. You will wake up in the recovery room and your surgeon will see you prior to discharge.

After the biopsy

Nursing staff will ensure that you can pass urine and feel comfortable before leaving the hospital.  You will need someone to help you at home, as your muscles may ache and you may feel woozy because of the anaesthetic. The anaesthetic takes 24-48 hours to wear off, so please rest for this period. You will be given antibiotics to take at home to prevent infection.

There may be mild discomfort in the biopsy area for a few days after the biopsy. There will be blood in your urine for a 1-2 weeks and discoloured semen (pink or brown) for up to 3 months. This is nothing to worry about. You should drink plenty of non-alcoholic fluids while you have blood in your urine.

What are the risks?

Although serious complications are rare, every procedure has risks.

  • Blood in the urine (haematuria) can range from peachy coloured urine to even claret coloured. It is rarely a sign of a serious problem. Increasing your fluid intake will usually help clear any bleeding. However, if there is persistent or heavy bleeding every time you pass urine you should go to your nearest Emergency department.
  • There can be difficulty passing urine as the prostate swells after the biopsy. It is common if your prostate is already enlarged and you have pre-existing lower urinary symptoms (LUTS). If you cannot pass urine at all, please attend your nearest emergency department in case a catheter is required to drain the bladder.
  • Infection is rare after this procedure. Nevertheless, antibiotics are given at the time of the procedure as well as on discharge. If you develop a fever, chills, uncontrollable shaking (rigors) or burning when passing urine, you may have an infection and should seek medical attention. Please attend Lake Macquarie Private Hospital Emergency if insured or your nearest emergency department if this occurs.  Our specialist urology nurses are usually available for phone advice during working hours.