If your doctor suspects prostate cancer, a biopsy is often the next step. While you might have heard of a “transrectal” biopsy, a different approach called the transperineal prostate biopsy is increasingly becoming the preferred method. Let us understand What is Transperineal Prostate Biopsy, its advanced procedure, its benefits, comparison between transrectal and transperineal and many more.
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What is Transperineal Prostate Biopsy?
A Transperineal Prostate Biopsy is a procedure where tiny tissue samples are collected from the prostate gland for examination under a microscope. Unlike the transrectal biopsy, the coaxial needle in a transperineal biopsy goes through the perineum, which is a small area of skin between the scrotum and the anus.
Transperineal Prostate Biopsy method allows urologists to access the prostate without passing through the rectum, which is a key difference with significant advantages. It’s guided by an AI enhanced Ultrasound Machine to ensure precise sampling often combined with MRI images.
Know What is Prostate Biopsy.
How is a Transperineal Prostate Biopsy Done?
The process for a transperineal biopsy of the prostate is carefully planned and executed.For the ease of the procedure, the whole process can be divided into 2 phases: Phase 1 and Phase 2, before procedure and during procedure respectively.
Phase 1: Preparation (Before the Procedure):
Upon initial consultation, your doctor will explain the procedure, its risks, and benefits based on your medical history, current medications (especially blood thinners), and allergies. You might be asked to stop certain medications temporarily which the doctor finds is not good for your health. An MRI scan of your prostate is performed beforehand. This helps identify any suspicious areas (lesions) that the urologist can then specifically target during the biopsy. This is called MRI Fusion Biopsy.
Transperineal biopsies are typically performed under local anesthesia (numbing the perineal area), sedation (making you drowsy), or general anesthesia (putting you to sleep). Doctors will discuss the best option for the patient before the procedure. For having sedation or general anesthesia, the patient needs to fast for a certain period before the procedure. While the risk of infection is lower than compared to transrectal biopsies, your doctor might still prescribe a short course of antibiotics as a precautionary measure.
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Phase 2: During the Procedure:
During the Procedure the patient will be lying on the back, often with hips flexed and legs supported in stirrups, similar to a gynecological exam. The perineal area will be thoroughly cleaned with an antiseptic solution and sterile drapes will be placed.
Later, an ultrasound probe is gently inserted into the rectum. This provides real-time images of the prostate, allowing the urologist to precisely visualise the gland and guide the biopsy needles. If an MRI was done, the images are often fused with the real-time ultrasound to guide the biopsy needles directly to suspicious areas.
If local anesthesia is chosen, numbing injections will be given into the perineum. With the help of a special Surefire Needle Guide, the urologist will pass thin, hollow needles through the skin of the perineum and directly into different areas of the prostate. Each time a sample is taken, you might hear a “clicking” sound. Multiple samples (typically 12-24, or more if targeting specific lesions or doing a saturation biopsy) are collected to ensure thorough sampling. Once enough samples are collected, the needles and ultrasound probe are carefully removed. No stitches are usually needed, as the skin punctures are very small.
Which is better Transrectal or Transperineal Prostate Biopsy?
The transperineal prostate biopsy is increasingly favored over the traditional transrectal approach for several key reasons, making it often considered “better” in terms of safety and accuracy for many patients. Let us understand here, which is better Transrectal or Transperineal Prostate Biopsy.
| Feature | Transrectal Prostate Biopsy (TRUS) | Transperineal Prostate Biopsy (TP) |
|---|---|---|
| Needle Path | Through the rectum wall | Through the skin of the perineum |
| Infection Risk | Higher (needle passes through bacteria-rich rectum) | Much Lower (avoids bowel, cleaner path) |
| Antibiotics | Routinely required to reduce infection | Often reduced or not required, good for antibiotic stewardship |
| Access to Prostate | Good for posterior prostate; can be harder to reach the anterior (front) or apex (tip) of the prostate. | Excellent for all areas of the prostate, including anterior and apex. |
| Accuracy | Effective, but may miss anterior cancers. | Potentially higher detection rate, especially for anterior cancers and using MRI fusion. |
| Anesthesia | Often local anesthesia only | Can be local, but often sedation or general anesthesia for comfort and precision. |
The key advantage of Transperineal prostate biopsy is its significant lower risk of infection (especially severe infections like sepsis). Additionally, better access to all areas of the prostate means potentially improved accuracy in detecting cancers that might be missed by the transrectal approach.
How Accurate is a Transperineal Prostate Biopsy?
The accuracy of a transperineal prostate biopsy is considered very high, especially when combined with prior MRI imaging (MRI-fusion biopsy). In the section, we can understand more on the accuracy level.
- Improved Sampling: Because the transperineal approach allows access to all areas of the prostate, including the anterior and apical zones (which are harder to reach transrectally), it can detect cancers in these regions that might otherwise be missed.
- MRI Fusion: When MRI images showing suspicious areas are “fused” with real-time ultrasound during the biopsy, the urologist can precisely target these areas. This significantly increases the chance of finding clinically significant prostate cancer compared to random biopsies alone.
- Systematic Sampling: Even without MRI fusion, the template-guided nature of many transperineal biopsies allows for very systematic and thorough sampling of the entire prostate gland, contributing to its accuracy.
While no biopsy is 100% foolproof, the transperineal approach, particularly with MRI fusion, offers a robust and highly accurate method for prostate cancer detection.
What is the Transperineal Prostate Biopsy Recovery Time?
Transperineal prostate biopsy recovery time is generally short, with most men feeling mostly back to normal within a few days.
- Immediately After:
- If you had sedation or general anesthesia, you’ll spend time in a recovery area until you’re fully awake and alert. You won’t be able to drive yourself home.
- You might feel some soreness or tenderness in the perineal area.
- First 24-48 Hours:
- Blood in Urine or Semen: It’s very common to see pink or red urine for a few days. You might also notice blood in your semen for several weeks or even months after the biopsy – this is normal and harmless, but can be alarming if unexpected.
- Discomfort: Mild discomfort, bruising, or swelling in the perineal area is common. Over-the-counter pain relievers can help.
- Urinary Frequency/Urgency: You might feel the need to urinate more often than usual.
- Activity:
- Avoid strenuous activities, heavy lifting, and sexual activity for about a week to allow the prostate to heal and minimise bleeding risk.
- Most men can return to light daily activities within 1-3 days.
- Hydration:
- Drink plenty of fluids to help flush your urinary system and reduce discomfort.
- Monitoring for Complications:
- Be vigilant for signs of infection (fever, chills, severe pain), inability to urinate, or heavy, persistent bleeding.
Transperineal Prostate Biopsy Results
After the transperineal prostate biopsy, the tissue samples are sent to a pathologist who examines them under a microscope. The results are crucial for determining next steps. Here are the possible outcomes:
- No Cancer Found (Benign):
- This is good news! It means no cancer was detected in the samples taken.
- It doesn’t 100% rule out cancer, as a tiny cancer might have been missed. Your doctor will discuss continued monitoring (Eg., PSA tests) and whether a repeat biopsy might be needed in the future based on your risk factors.
- Benign Prostatic Hyperplasia (BPH):
- This is a non-cancerous enlargement of the prostate, a very common condition in aging men. The biopsy might show benign prostate tissue.
- Inflammation (Prostatitis):
- The biopsy might show signs of inflammation in the prostate, which could be due to infection or other causes.
- Atypical Small Acinar Proliferation (ASAP) or Atypical Glands Suspicious for Malignancy:
- This result means the pathologist saw some abnormal cells, but they couldn’t definitively say it’s cancer. It’s a “suspicious” finding.
- This outcome often prompts a recommendation for a repeat biopsy in the near future, as there’s a higher chance of finding cancer on a subsequent biopsy.
- High-Grade Prostatic Intraepithelial Neoplasia (HGPIN):
- HGPIN means some cells look abnormal, but they haven’t spread beyond the normal prostate structures. It’s considered a potential precursor to cancer.
- If HGPIN is found in multiple biopsy cores or in certain patterns, the doctor might recommend close monitoring or sometimes a repeat biopsy.
- Prostate Cancer:
- Prostate Cancer means cancer cells were found in one or more of the biopsy samples.
- The pathologist will assign a Gleason Score (Eg., Gleason 3+4=7, Gleason 4+3=7, Gleason 8, 9, or 10). This score indicates how aggressive the cancer appears under the microscope. A lower score (Eg., 6) indicates less aggressive cancer, while a higher score (Eg., 8, 9, 10) indicates more aggressive cancer.
- They will also report the number of positive cores (how many samples contained cancer) and the percentage of cancer in each core.
- These details, along with the PSA level, clinical exam, and MRI findings, are used to determine the grade group and overall risk category of your cancer (Eg., very low, low, intermediate, high, very high risk). This information is crucial for deciding on the best treatment plan, which could range from active surveillance to surgery, radiation, or other therapies.
Conclusion
In conclusion, understanding What is Transperineal Prostate Biopsy is a significant advancement in detecting prostate cancer. Its cleaner approach significantly lowers infection risk, while its improved access to all areas of the prostate, especially when guided by MRI, enhances its accuracy. Getting an idea for the procedure and its potential results empowers the patients to have an informed discussion with your healthcare provider about your prostate health and any necessary next steps. Get detailed guide from the Best Urologist in UK.
FAQs
The main difference is the needle’s entry point. In a transperineal biopsy, the needles go through the disinfected skin of the perineum, directly into the prostate. This avoids passing through the rectum, significantly reducing the risk of infection compared to the older transrectal method.
It’s preferred primarily due to a much lower risk of infection, as it bypasses the bacteria-rich rectum. It also offers better access to all areas of the prostate, especially the anterior (front) part, potentially leading to higher cancer detection rates, especially when combined with MRI imaging.
Discomfort is typically managed as it is often performed under local anesthesia (numbing the perineal area), but sedation (making you drowsy) or even general anesthesia (putting you completely to sleep) can be used, especially for more extensive biopsies or patient preference.
It is considered highly accurate, particularly when guided by prior MRI scans. This precision targeting increases the likelihood of finding clinically significant cancers that might be missed by less targeted methods, improving detection rates.
Recovery is generally quick. Most men feel mostly normal within 1-3 days. Common side effects include mild soreness in the perineal area, some blood in urine for a few days, and blood in semen for several weeks. Strenuous activity and sexual activity are usually advised against for about a week.
