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.