Transperineal Prostate Biopsy
A biopsy of the prostate gland is usually required when there is a suspicion of prostate cancer. It involves taking multiple small samples of prostate tissue using a biopsy needle, which are then assessed microscopically by a pathologist. The prostate biopsy has traditionally been performed via the rectum (transrectal ultrasound-guided – TRUS – biopsy), because the prostate sits directly in front of the rectal wall and is therefore easily accessible via this route.
TRUS biopsy has significant potential drawbacks. In some cases, the front part of the gland may not be accessible to biopsy via the rectum. Secondly, the TRUS biopsy has a small but significant risk of serious infection, where bacteria may enter the bloodstream (septicaemia). It is for this reason that TRUS biopsy has essentially been replaced by transperineal prostate biopsy.
In men, the perineum is the part of the body between the scrotum and anus. A transperineal biopsy of the prostate, performed under a general anaesthetic, is therefore carried out via the skin overlying this area. Excellent imaging is obtained by an ultrasound probe passed into the rectum. Biopsy needles are able to access all aspects of the gland. This approach has the potential for improved sampling, with a substantially reduced risk of sepsis.
A higher number of tissue samples are usually taken by transperineal biopsy. At times, some of the samples need to be taken from areas closer to the urethra, which runs through the prostate. As a result, there may be transient blood in the urine, and rarely (approximately 1%) urinary retention – the inability to pass urine. Fortunately, this typically lasts for only a day or two, and is easy to treat.
Urologists at AUA are experts in transperineal biopsy of the prostate.
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