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Transperineal Prostate Biopsy

A pre biopsy MRI can identify abnormalities suitable for targeted biopsy. A transperineal prostate biopsy can comprehensively sample the whole gland to find out whether any of your prostate cells have become cancerous or, if you have pre-existing cancer, whether the cancer has changed.  It can also diagnose other conditions such as benign prostatic hyperplasia (enlargement of the prostate), prostatitis (inflammation of the prostate, usually caused by a bacterial infection) or prostatic intraepithelial neoplasia (PIN), which is a change in the cell type but not cancer.

About the procedure

This procedure involves using an ultrasound probe, inserted via the back passage, to scan the prostate.  Overlaying a previously taken high-definition image (MRI) onto the live ultrasound image and an advanced software package, similar to that used for prostate brachytherapy.

Biopsies are taken through a special grid through the skin behind the testicles (the perineum).

The samples are targeted to the abnormal lesion on the MRI scan fused with the live ultrasound image and combined with a systematic biopsy to sample the gland comprehensively. The number of samples taken depends on the size of the prostate, usually ranging from 24 ­- 36 samples.

The reason this approach is taken is because it allows the entire prostate to be accessed, through a clean area.  Transrectal biopsies can carry a greater risk of sepsis if performed in this number.

Why do I need a transperineal prostate biopsy?

You may have been advised to have a prostate biopsy because:

  • Your consultant found a lump or abnormality during a digital rectal examination (DRE). A DRE is where the consultant feels your prostate gland through your rectum (back passage) with the index finger
  • You have had a blood test showing a high level of PSA (prostate-specific antigen). PSA is a protein that is released into your blood from your prostate gland; high levels of PSA may indicate cancer.
  • You may have had previous biopsy results that came back with no evidence of cancer but your PSA blood test is still suspicious.
  • You may have a known diagnosis of prostate cancer that has not required treatment and your consultant wishes further information to plan possible treatment or observation.
  • Your consultant will often send you for a prostate MRI (magnetic resonance imaging), to get a clearer picture of what is going on.

What is a transperineal prostate biopsy?

The transperineal template prostate biopsy is used to gain further information about your prostate over and above the information that could be provided by a transrectal biopsy.  Using an ultrasound probe in your back passage, targeted samples of the prostate are taken, often with MRI fusion targeted special software.  The results from the MRI fusion targeted biopsy helps to guide your future treatment.

The procedure is carried out under general anaesthetic but you will only be admitted to hospital for the day.  You will be asked not to eat for 6 hours prior to your procedure and not to drink for 3 hours prior.  The procedure lasts for 30 ­ 40 minutes and involves taking up to 40 samples through the skin that lies in front of our back passage rather than through the back passage.

An ultrasound probe is inserted into the back passage and the prostate is scanned.  Using a grid with holes placed every 5mm.

How soon will I recover?

1. In Hospital - After the procedure you will be transferred to the recovery area where you can get some rest. You should be able to go home the same day, after you have passed urine.

2. Returning to normal activities - You may experience a little stinging the first few times you pass urine. Make sure that you drink plenty of water to help you pass urine more easily. A flexible cystoscopy is usually not a painful procedure. If you have any discomfort, take simple pain killers such as Paracetamol. You should be able to go back go work the day after the cystoscopy unless you are told otherwise. Do not drive until you are confident about controlling your vehicle and always check with your Consultant and your Insurance Company first.

3. Lifestyle change - If you smoke, try to stop smoking now. Stopping smoking will improve your long-term health. For help and advice on stopping smoking, go to www.gosmokefree.co.uk. You have a higher chance of developing complications if you are overweight. For advice on maintaining a healthy weight, got to www.eatwell.gov.uk.

4. Exercise - Regular exercise can reduce the risk of heart disease and other conditions, improve how your lungs work, boost your immune system, help you to control your weight and improve your mood. Exercise should improve your long-term health. For information on how exercise can help you, go to www.eidoactive.co.uk. Before you start exercising, you should ask a member of the Healthcare Team or your GP for advice.

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