Transperineal prostate biopsies

This is the procedure used to check whether you have prostate cancer, usually performed because a MRI scan has suggested some abnormality of the prostate, the prostate blood test (Prostate Specific Antigen – PSA) is higher than expected or because the prostate feels abnormal.

It is hoped that these notes will help you in preparation for the procedure.  If you have any questions please do not hesitate to ask Philip.

What is the prostate gland?

The prostate is a small organ that lies between the bladder and urethra (the tube we pass water through) – see picture.  It can vary in size from a walnut to an orange and tends to get bigger in most men as we age.  The main function of the prostate is to produce the fluid that is ejaculated with sperm.  PSA is a normal constituent of that fluid.  When it is found in the blood stream it can mean some prostate cells are damaged either by benign growths, cancer, trauma or infections.  The cells must be examined under a microscope to make the correct diagnosis.     

Before the procedure

No special preparation is required for the procedure though there may be some restrictions on eating or drinking as a general anaesthetic is often used.

The procedure

The first part of the procedure involves placing a specially designed ultrasound probe into the rectum to examine the prostate in detail and measure its size.  A special grid is then attached to the probe to allow the biopsy needle to be pushed through the skin in the perineum (the area between the back of the scrotum and the anus, on the picture above) into the prostate.  The ultrasound is used to confirm which parts of the prostate are biopsied.  Usually, numerous biopsies are taken to sample areas from the whole gland in addition to the suspicious areas from the MRI.  The small biopsies are labelled and sent to the lab.

After the procedure

There will almost certainly be some blood in the urine and in the semen.  This should settle down after a few days and will be improved if you drink plenty. 

There is a small chance that you may not be able to pass water after the procedure.  This is because the prostate will be swollen.  You will be asked to pass water before you go home.

Some patients have noted a slowing of their urine stream and difficulty with erections following the procedure.  This may last a number of weeks.

If you have had an anaesthetic you should not drive a car for 24 hours.

There is a very small chance of infection following this procedure (considerably less than following a trans-rectal biopsy) and if you do develop a high temperature either see your GP or go to an emergency department.

You will be given a date for review before you leave hospital so that you can be told the biopsy results.