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Transperineal Ultrasound Guided Targeted Prostate Biopsy

Prostatic biopsy is performed to investigate a raised PSA, or a palpable abnormality in the prostate. Transperineal biopsy differs from transrectal prostate biopsy as it is done under general anaesthetic, and as the name implies, is done via the perineum rather than the rectum. 


Transperineal biopsy has several advatages over the transrectal route;


1. It allows accurate sampling or targeting of a lesion seen on MRI.

2. It allows sampling of areas of the prostate that are difficult to access on transrectal biopsy.
3. It effectively eliminates the risk of infection after prostate biopsy. This can be as high as 5% after transrectal biopsy, and can result in hospitalisation.
4. It is performed under general anaesthetic, and therefore is more comfortable than a transrectal approach.


When is a transperineal biopsy recommended?

1. In men who have an abnormality on multi-parametric MRI

2. In men who have a rising PSA despite a previous negative biopsy.

3. In men who we think are good candidates for active surveillance, or who are already part of an act of surveillance program.
4. In men who we are concerned about the risk of significant infection after transrectal biopsy. This can be in men who have had previous biopsies with infection, but most importantly in those men who have had recent overseas travel, particularly to Asia. The bowel can become colonised with bacteria which are resistant to most antibiotics, and any infection can be very difficult to treat.

What is involved in the procedure?
The operation is carried out under general anaesthetic at Grace Hospital. You will be admitted on the morning of surgery. It is important you have nothing to eat or drink for at least six hours prior to your operation. All blood thinners such as clopidogrel and warfarin need to be stopped, usually 3 to 5 days prior to the operation. Aspirin can usually be continued.

Under general anaesthetic, an ultrasound probe is placed in your rectum. We then take multiple samples of your prostate through the perineum (the skin between your anus and scrotum). We use a grid (a bit like Battleships!) to accurately sample all parts of your prostate. While this sounds uncomfortable, there is very little pain afterwards. During the procedure, a catheter is usually placed to help with the accuracy of the biopsy. As long as there is no blood in the urine at the end of the procedure, the catheter is removed. The procedure takes about 40 minutes.
What happens after the procedure?
After surgery, you go to the recovery unit, and then to the day stay unit. Once you are eating and drinking, and have passed urine, you are able to go home.
What are the risks of the procedure?
Transperineal biopsy is a safe procedure, and the risks are low.
They include:
1. Reduced urinary flow and bladder irritability. As we have taken multiple samples of your prostate, it can be swollen after the procedure and you may notice some reduction in your flow. Very occasionally you are unable to pass urine at all, and you would require a catheter. If your flow is particularly bad before the procedure, we may start you on some medication to help your flow.
2. Bruising or bleeding from the perineum. This is usually mild, and can be associated with some tenderness.
3. Blood in the urine (haematuria). This is quite common, and usually nothing to worry about. If you start passing clots, please ring Bay Urology, or if it is after hours ring Grace Hospital. Blood can also be visible in the sperm, and this can persist for several weeks after the biopsy.
Return to Work
It is important that you take it easy for 48 hours. If you have a particularly heavy job, we would advise that you take it easy for 3 to 5 days.
The biopsies usually takes a week to process. We will ring you as soon as we have the result. If cancer is found, then we will see you and talk about treatment options. If the biopsy is clear, we often will discharge you back to your GP. Alternatively, we provide a PSA monitoring service if that is what you prefer.






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