Preparing for Transperineal Prostate Biopsy

Transperineal prostate biopsy refers to the insertion of a needle through the perineum (the area between the scrotum and anus) into the prostate to obtain prostatic tissue for testing. This procedure is indicated when you have an elevated prostate specific antigen (PSA), abnormal digital rectal examination or magnetic resonance imaging (MRI) findings. A small amount of prostatic tissue is obtained in order to determine if there are any cells suspicious of prostate cancer. 

You will be put under general anaesthesia (GA) for the surgery, which usually takes 30 minutes – 1 hour to perform. This is a minimally invasive procedure in which no open surgical wounds are made on the skin. It is done in “lithotomy” position which involves flexing of the hip and knee joints with you lying on the back, thus it is important that you inform your doctor if you have any serious hip or knee problems that may limit the joint movements. 

An ultrasound probe is inserted into the rectum for visualisation of the prostate. These images will be fused with the images previously obtained from the prostate MRI that you have underwent earlier, in order to aid the surgeon in targeting the suspicious areas seen on the MRI. Samples of the prostate are taken using a biopsy needle gun inserted through the perineum. After the procedure is complete, a simple dressing is applied to the needle entry points in the perineum. 

Prior to the procedure, you will usually be prescribed a suppository or enema to clear the rectum so that good quality images can be obtained from the ultrasound for an accurate biopsy. In some situations, you might also be provided with a course of oral antibiotics to minimise the risk of infection – in this case, you will need to start taking the antibiotics 2 days prior to the procedure and complete the course after the procedure is done.

Your urologist or a member of their team will review your history and medications before the surgery and discuss with you regarding your surgery to confirm your understanding and consent for surgery. The anaesthetist will perform their final assessments before putting you under anaesthesia for the procedure. The operation lasts an average of 1 - 2 hours depending on the complexity. 

Most of the time, the procedure can be performed as day surgery and you will be discharged after your procedure. In general, this is not a painful procedure, and most patients experience only slight discomfort in the perineal skin. For most, a mild painkiller such as Paracetamol is adequate. However, some may require stronger pain relief which will be provided before you go home. 

There will be a dressing in the perineal skin over the needle marks which should heal promptly. There are no stitches needed for these small needle puncture wounds. The dressing can be safely removed the next day after the biopsy. You may also notice a small bruise around the perineal skin, which will resolve spontaneously over the next few weeks.

Although there is no biopsy done through the rectum, it is filled with gel to facilitate optimal scanning of the prostate by the ultrasound probe that is inserted into the rectum during the biopsy. As a result, you will pass out some gel-like material when you first open your bowels after the procedure. As you have just undergone a general anaesthetic procedure, you may feel drowsy, nauseous or have a sore throat when you first recover from the anaesthesia. You may want to avoid driving, operating machinery or making important decisions soon after the procedure.  

There may be a potential risk of urinary retention (unable to pass urine) after the procedure. This is due to the swelling of the prostate after the biopsy which may aggravate obstruction of urinary flow through the prostate. After biopsy, you will be ensured that you are able to pass urine satisfactorily before discharging you. However, if you experience urinary retention after the biopsy, you may require bladder catheterisation (inserting a urinary tube into the bladder) and have the catheter with you temporarily for a few days before returning to the clinic to remove the catheter; you will also be assessed if your urination is back to baseline.