Transperineal Biopsy | Urological Surgeon Casey

Transperineal Biopsy of the Prostate


Where is the prostate gland?

The prostate is a walnut-size gland, situated below the bladder. It completely surrounds the urethra. Its main function is to continuously produce a thin, fluid.

Why am I having this test?

Prostate biopsy is performed if there is a lump in the prostate or if the level of Prostate Specific Antigen (PSA) is high from your blood test. The biopsy will determine if the findings are significant and therefore if any treatment is needed.

How do I prepare for this test?

You need to fast for 6 hours as the procedure is performed under general anaesthesia
Cease Aspirin/warfarin 7 days prior
You will be given a script for six (6) antibiotic tablets; these should be taken one hour prior to eating. Start these the day before the procedure, taking one antibiotic in the morning and one in the evening.
Your bowel needs to be emptied prior to the procedure.
You will need to use the suppository 2 hours prior to the procedure (even if you have opened your bowels naturally).
Using gel insert the suppository up to the 2nd joint of your index finger into the rectum (back passage). You should hold the suppository in your bowel for a minimum of 15 minutes and then empty your bowel..

Morning Evening
Day before procedure Take Antibiotic Take Antibiotic
Day of procedure Take Antibiotic
Empty bowels
Take Antibiotic
Day after procedure Take Antibiotic Take Antibiotic

You should inform your doctor if:

You have an artificial heart valve as you will require stronger antibiotics
You are taking blood thinning medication (such as Warfarin, Aspirin, Iscover or Plavix). These should be ceased one week prior to the biopsy.
If you have urine, bladder or prostate infections as the biopsy will need to be postponed until infection is cleared.

What happens during the test?

The procedure involves placing an ultrasound probe into the rectum (back passage) and taking detailed images of the prostate gland and surrounding structures. The prostatic biopsies performed with needle through the perineum with a special brachytherapy grid guide. (more than 32 cores of prostatic tissue can be taken compare to the routine 12)

Are there any Complications?

As with any medical procedure complications may occur.

Complications with this procedure are uncommon, but the two most common are:

Urinary Retention
There is very small chance of post-operative retention needing insertion of small urinary catheter for 24-48 hours.

Excessive bleeding
If your urine becomes quite red, or the bleeding form your back passage is heavy, phone your doctor

Minimal risk (0.3%). Antibiotic should cover this possibility, but if you develop fever, shivers, shakes, phone your doctor

What to expect when you get home:

For 2-3 days you may experience:

Some bleeding and blood clots in the bowel
Some bleeding and blood clots in the urine
(Urine maybe quite pink)

You may get some old, brown blood in the semen for the next 3-4 weeks

What to do when you get home:

For 2 days you should:

Drink 1.5-2 litres of fluid to flush out blood
Take antibiotics until course finished
NO LIFTING as bleeding may start again
Avoid constipation
When do I get the results?
When a biopsy is performed the tissue samples are sent to pathology for analysis. It may take several days to get the results. An appointment will be made for you to see your specialist to discuss the ultrasound and biopsy results.