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This leaflet is written for patients, their family and carers. It provides information on local anaesthetic transperineal biopsy of the prostate for men undergoing this procedure.
The prostate gland is a chestnut sized gland, found only in men, that contributes to the production of semen. It surrounds the urethra (though which urine flows from the bladder to the outside of the body).
A biopsy involves taking small samples of tissue from the prostate gland. These samples are then analysed. The biopsy can find out whether any of the prostate cells have become cancerous, or, if there is pre-existing cancer, or whether the cancer has changed.
The procedure involves using an ultrasound probe, inserted via the back passage, to scan the prostate.
Biopsies are taken through the skin between the testicles and the back passage (the perineum). The sampling is targeted to the suspicious areas seen on MRI. Additional samples may be taken from the rest of the prostate, even if normal on MRI. The number of samples taken depends of the size and number of abnormalities, as well as the size of the prostate
You will be given an appointment to have the procedure done in the outpatient urology department. You will be asked to provide a specimen of urine so that we can check you do not have a urine infection before your procedure. A set of observations will be taken (this will include your blood pressure, pulse and temperature) to ensure you are well enough on the day. You will be asked to change into a gown and will be given a scrotal support to wear during the procedure.
If you are taking blood thinning medication (e.g. Warfarin, Clopidogrel, Rivaroxaban etc.) – you will need to stop this before your biopsy. Please contact the nurse specialist before your appointment for advice on 01752 439903 or 01752 431535.
You will be asked to sign a consent form before your procedure goes ahead.
The perineum will be numbed with a cold spray before you are then given an injection of local anaesthetic into the skin around the perineum. This will numb the area before the procedure starts. The urologist will then examine the prostate through the back passage before inserting the ultrasound probe into the rectum. You will be given a further injection of local anaesthetic deeper into the perineum before any biopsies are taken.
Biopsy needles are inserted into the prostate through the skin of the perineum, guided by the ultrasound probe and images from the MRI.
Blood in your urine for up to 10 days
Blood in your semen for up to 6 weeks; this is harmless and poses no risk to you or any sexual partners
Bruising in your perineal area which can take a few weeks to resolve
Sensation of discomfort due to bruising
Failure to detect a significant cancer of the prostate
The procedure may need to be repeated if the biopsies are inconclusive, or your PSA level rises further, or if further MRI scans show more abnormalities
Problem with erections caused by bruising from the biopsy
Haemorrhage (bleeding) needing hospitalisation
Urinary infection requiring antibiotics
Blood infection (septicaemia) needing hospitalisation
Inability to pass urine (urinary retention)
Hospital Acquired Infection
Colonisation with MRSA (0.9% 1 in 110)
MRSA bloodstream infection (0.02% - 1 in 5000)
Clostridium Difficile bowel infection (0.01% - 1 in 10,000)
You will be asked to remain in the department for a period of time immediately following your biopsy. You will have another set of observations taken to ensure you are well and will be asked to provide a specimen of urine before we let you go home.
Once the team are happy to discharge you – you will be given some information by a member of the nursing team about what you should expect following the procedure. This information will include:
what you can and cannot do after the biopsy
what side effects you may experience
who to contact if you have any concerns
when your follow up appointment will be
You will be given a discharge summary which contains information about the procedure you have had and any follow up that is planned.
It is normal to have blood in the urine for around 2-3 days after a biopsy. This should settle on its own but it is important to continue to drink lots of fluid (at least 2 litres) for the first 48 hours after the procedure. You may also see blood in the semen for up to 6 weeks.
You may experience some discomfort following the biopsy. This should settle but can be treated with simple painkillers such as paracetamol, if required.
If you experience:
a fever, shivering or develop symptoms of cystitis (frequency and burning on passing urine) – you should contact your GP as this could represent a urinary tract infection (UTI)
a lot of blood in the urine, especially with clots of blood – you should contact your GP or go to the emergency department
a fever outside of your surgery opening hours – contact the out of hours GP service via 111
Anna Wilson
Prostate Cancer Nurse Specialist
01752 431535.
Nicky Andrew
Uro-Oncology Nurse Specialist
01752 439903
