A transperineal prostate biopsy is a diagnostic procedure used to detect prostate cancer by obtaining tissue samples through the perineum—the area between the scrotum and the anus. This method offers improved accuracy and a lower risk of infection compared to the traditional transrectal approach, making it an increasingly preferred technique for evaluating suspicious prostate lesions.
When Is Transperineal Prostate Biopsy Recommended?
This biopsy may be recommended when:
- A PSA (prostate-specific antigen) blood test shows elevated levels
- A digital rectal exam reveals abnormalities in the prostate
- MRI imaging identifies lesions suspicious for prostate cancer
- Previous transrectal biopsy results were inconclusive or negative despite ongoing concern
- A more targeted or comprehensive sampling of the prostate is needed
The transperineal approach allows for better access to all zones of the prostate, especially the anterior regions, which are more difficult to sample via transrectal biopsy.
How the Procedure Works
Transperineal prostate biopsy is typically performed under local or general anesthesia. The patient lies on their back with legs elevated. The perineal skin is sterilized and numbed before small needles are inserted through the skin into the prostate using ultrasound guidance.
- MRI-ultrasound fusion may be used to precisely target suspicious areas
- A grid or freehand technique guides the sampling pattern
- Multiple core samples are taken for accurate diagnosis
- The procedure usually takes 30 to 60 minutes
- Patients are monitored briefly before discharge the same day
Because the needles do not pass through the rectum, the risk of introducing bacteria into the prostate or bloodstream is significantly reduced.
Benefits of Transperineal Prostate Biopsy
- Lower Infection Risk: Avoids the rectum, reducing the likelihood of post-procedural infections
- Improved Accuracy: Better access to all areas of the prostate, including anterior zones
- MRI-Guided Precision: Enables targeted biopsy of suspicious lesions
- Fewer Repeat Biopsies: More thorough sampling reduces the chance of missing clinically significant cancer
- Outpatient Convenience: Typically performed without the need for hospital admission
Minor side effects may include temporary blood in the urine, mild discomfort in the perineal area, or difficulty urinating. These symptoms generally resolve within a few days.
Next Steps
If you’ve had abnormal PSA results or prostate imaging findings, a transperineal prostate biopsy may be the most accurate and safest method to assess for cancer. Your urologist will determine the best approach based on your history, imaging, and risk factors.