What is a transperineal prostate biopsy?

What is a transperineal prostate biopsy?

Transperineal (template or targeted) biopsy

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This test is a needle biopsy to look for cancer cells in the prostate. Your doctor puts a needle into the prostate through the perineum, which is the skin behind the testicles. They take a number of samples, which are sent to the lab to be looked at under a microscope.

A Transperineal Ultrasound guided prostate biopsy (TPUS) is an investigation used to diagnose prostate cancer. In general, a TPUS prostate biopsy is performed in men with an abnormal PSA, a palpable irregularity on a digital rectal examination (DRE) or a quickly increasing PSAlevel. It is slightly different and more complicated than a TRUS (transrectal ultrasound guided) prostate biopsy and requires specialized equipment.

This type of procedure can sometimes find a prostate cancer that has been missed by other types of biopsy.

A transperineal biopsy can be targeted to a specific area of the prostate using MRI scans. It is then called a targeted biopsy or fusion biopsy.

There are 2 main types of transperineal biopsy:

  • targeted (regular) transperineal biopsy – a relatively small number of biopsies are taken
  • saturation biopsy – done under general anaesthetic and many biopsies are taken


Preparing for the template biopsy

You have the biopsy under local or general anaesthetic.

Having the biopsy under local anaesthetic means you should be capable to eat and drink usually before the test.

Having the biopsy under general anaesthetic means that you won’t be capable to eat or drink for a number of hours beforehand. You usually stop eating at least 6 hours before the biopsy and stop drinking at least 4 hours beforehand. Your team will give you instructions.

Take your usual medicines as normal, unless you have been told otherwise. If you take warfarin to thin your blood, you should stop this before your biopsy. Your doctor will tell you when to stop taking it.

What happens during the template biopsy?

If you have your biopsy under general anaesthetic you are fully asleep during the whole process. You won’t feel or hear anything. You might feel a bit drowsy or confused when you wake up.

If you have your biopsy under local anaesthetic the doctor injects anaesthetic into the perineum. This numbs the area.

The doctor puts a template (or grid) with lots of holes over your perineum. They put an ultrasound probe into your back passage to show the prostate gland. They use the ultrasound to guide a biopsy needle through the template and into the prostate. They may take between 30 to 50 samples.


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