Transperineal Prostate Biopsy

Transperineal biopsy of the prostate

This is a biopsy of the prostate done under a general anaesthetic in hospital. The goal is to confirm that a suspicious lesion on MRI is cancerous. It takes around 30 minutes. Multiple needles are passed through a grid (template) into the prostate via the skin between the scrotum and anus (perineum) with an ultrasound probe in the rectum using high frequency sound waves to create images of your prostate.

What Preparation do I need for the biopsy?

  • Antibiotics – Antibiotics will be administered during the procedure. No pre-op antibiotics are required
  • Fasting (nil by mouth) for 6 hours prior to the procedure
  • Blood thinners often omitted for short period before biopsy (except aspirin). Dr Menogue will advise you.
  • Microlax enema: Self-administer one micloax enema on the morning of the procedure to empty your rectum of faeces which will optimize vision of the prostate during biopsy.

What are the side effects of transperineal prostate biopsy?

  • Blood in urine (1-2 weeks), blood in ejaculation (up to 2-3 months) and mild discomfort in the prostate area for a few days are expected after the procedure
  • Bruising around the scrotum/penis is common and subsides after a few weeks
  • Difficulty passing urine (retention) requiring a catheter especially in men who already have an enlarge prostate/slowing of their stream. Temporary and usually less than 24 hours.
  • Infection is uncommon (<1%) with this method of prostate biopsy
  • Transient Erectile Dysfunction

ADVANTAGES

  • Lower infection risks
  • More thorough sampling of different areas especially for larger prostates and anterior tumours
  • More accurate biopsies utilizing MRI information and real time ultrasound images

You would be suitable to return to normal activities including work within 48 hours of your procedure, however if discomfort or bleeding persists, then you may need a few days longer.

Results of your biopsy will be discussed at a follow-up appointment usually in 1-2 weeks

Microlax enema instructions

Purchase from local chemist
  1. Twist off the cap and squeeze a drop of the solution out of the tube – that will make it even easier to insert the tip of the tube.
  2. Sit down on the toilet in your usual position or just squat down a little and insert the neck of the tube completely into your rectum. The small rounded tip is thinner than a suppository, and can be inserted safely and painlessly when used as directed, even for children under 3.
  3. Gently squeeze out the entire contents (only 5ml) of the tube into the rectum.
  4. Keeping the tube squeezed tightly, withdraw the tip from the rectum. Tighten your buttox muscles to prevent the solution from running out. Important: To allow stool to soften, it is important not to have a bowel movement immediately; you should wait at least 5 minutes.
  5. There will be a gentle bowel movement within 30 minutes after use. It will likely be a normal bowel movement that can be controlled.