Urology - Transperineal Prostate Biopsy

What is a prostate?

Prostate glands are only found in men and are about the size of a walnut. Your prostate is just below your bladder and surrounds the tube that your urine passes through. Your prostate is in front of your rectum.

The prostate makes the fluid that mixes with sperm to make semen.

Why do I need a prostate biopsy?

You have had specific tests that show you need a prostate biopsy.

What will your prostate biopsy find?

The biopsy of your prostate is performed to confirm or exclude prostate cancer.

Before your biopsy

The doctor or specialist nurse will explain why you need a biopsy and how the biopsy is performed.

They will discuss the risks and benefits and answer any questions you may have.

You must let the doctor or specialist nurse know if you are taking anticoagulants or antiplatelet tablets (blood thinners) including:

• Aspirin (Aspirin 75mg is ok to continue taking)
• Warfarin
• Clopidrogrel
• Rivaroxaban
• Dipyridamole
• Ticagrelor
• Prasurgrel
• Sinthome
• Dabigatran
• Apixaban

You will be advised if you need to stop taking your medication, how long for and when to start taking it again.

Please tell your doctor or specialist nurse if you have:

• Allergies to any medication, including anaesthetic
• Ever had bleeding problems
• An artificial heart valve
• Diabetes

On the day of your biopsy

• Eat and drink as normal
• If you are currently taking antibiotics or have a urine infection – tell the doctor or specialist nurse
• You will not be able to drive yourself home, please bring someone with you who can drive you, or accompany you home if travelling by public transport
• You should continue to take your medications as usual, except for any blood thinning medication you have been asked to specifically stop for the biopsy
• A urine sample will be required. A sample pot will be given to you on arrival at the department
• Once you have been given and understood the biopsy information, had any questions answered and are comfortable to proceed with the biopsy, you will be asked to sign a consent form
• You will be asked to wear a hospital gown
• The biopsy takes approximately 30 minutes, but you may be in the department for up to 3 hours

How is the biopsy performed?

You will lie on the examination couch and your legs will be raised. Your doctor or specialist nurse will examine your prostate. An antiseptic solution is used to clean the skin between your scrotum and your rectum, this area is known as your perineum.
This is the where the biopsy needle will pass through to take samples from your prostate (see diagram below).

The lubricated ultrasound probe is gently inserted into the rectum. The probe will be in your rectum throughout the procedure so your doctor or specialist nurse can see your prostate on the ultrasound screen.

An injection of local anaesthetic will numb the biopsy area. Once the anaesthetic has had time to work you may find the procedure uncomfortable but you should not feel pain.

The needle is inserted into the prostate and removes tissue samples very quickly. You may feel a slight discomfort as the biopsy needle is inserted into the prostate. You will hear clicks as the needle takes the biopsy. A few samples will be taken.

 What are the risks?

• Blood in your urine: This affects almost all patients and can be for up to 10 days. If you pass clots of blood or have persistent bleeding or heavy bleeding every time you pass urine you must go to your nearest A&E department
• Blood in your semen: Your semen may be discoloured (pink or brown) for up to six weeks, occasionally longer. This affects almost all patients
• Bruising around the biopsy site (perineum)
• Discomfort in your prostate caused by bruising from the biopsy
• Temporary problems with erection caused by bruising from the biopsy: This can affect up to 1 in 20 patients
• Difficulty passing urine: This can affect up to 1 in 20 patients. Should you have difficulty passing urine, you will need to go to your nearest A&E department for assessment
• Infection in your urine: This can happen in up to 1 in 100 patients. However, if you develop a need to pass urine suddenly or more than usual, you have a burning sensation when passing urine or the urine is smelly or cloudy then you should seek advice from your GP
• Infection in your blood: (septicaemia or sepsis). This can happen in fewer than 1 in 200 patients. If you have a high temperature or feel unwell with flu-like symptom’s you should go to your nearest A&E department

After the biopsy

• Once we have checked you are feeling well, you can go home
• We suggest you rest at home after the biopsy and for the remainder of the day
• You may have mild discomfort in the biopsy area for one or two days
• The prostate biopsy samples will be sent for testing
• Occasionally there is a need for a repeat biopsy, for example if the biopsy samples are inconclusive, this happens in about 1 in 50 patients
• You will have an appointment usually two weeks after your biopsy. Which could be at the hospital or a phone call

Contact us

If you have any questions about this procedure or your results, please contact one of the Urology Specialist Nurses on 0161 206 5380 (Monday to Friday 8am to 5.30pm).

This number will go to an answer machine, please leave your name and telephone number and we will return your call.
Email: urologycns@nca.nhs.uk

Further information

Both of these charities below provide useful information:

Prostate Cancer UK- www.prostate-cancer.org.uk
0800 074 8383

Macmillan Cancer Support - www.macmillan.org.uk
0808 808 0000