If your doctor has advised you to undergo a prostate biopsy, you may wonder what the procedure involves. Freehand LATP Biopsy is a modern technique that collects prostate tissue samples through the perineum rather than the rectum, helping reduce the risk of infection while maintaining high diagnostic accuracy.

This guide explains how the procedure works, who it is suitable for, and what you can expect before, during, and after the biopsy.

What Is a Freehand LATP Biopsy?

A freehand LATP biopsy is a diagnostic procedure used to collect small tissue samples from the prostate to determine whether cancer or other abnormalities are present.

Let’s break down the terminology:

• Freehand refers to the technique where the urologist guides the biopsy needle using a specialised needle guide attached to the ultrasound probe rather than relying on a fixed template grid. This allows greater flexibility when targeting suspicious areas of the prostate.
• Transperineal means the biopsy needle enters through the skin of the perineum instead of passing through the rectum.
• LATP (Local Anaesthetic Transperineal) means the procedure is performed using local anaesthetic to numb the biopsy area while the patient remains awake.

Throughout the procedure, transrectal ultrasound (TRUS) provides real-time imaging of the prostate, allowing the clinician to accurately target suspicious lesions identified on MRI as well as systematically sample different regions of the gland.

Because the needle avoids the rectum entirely, the risk of introducing bowel bacteria into the prostate or bloodstream is significantly reduced.

Why Is the Transperineal Approach Becoming the Preferred Choice?

Over the past decade, prostate biopsy techniques have shifted from the traditional transrectal ultrasound-guided (TRUS) biopsy to the transperineal approach, largely because of its improved safety profile. Today, many hospitals and urology centres are adopting transperineal biopsy as a preferred method for diagnosing prostate cancer.

Some of the key reasons include:

• Lower risk of infection: The biopsy needle passes through the perineal skin rather than the rectal wall, significantly reducing the chance of introducing bacteria into the prostate or bloodstream.
• Reduced risk of serious complications: Because the rectum is avoided, the likelihood of infections such as urinary tract infections, prostatitis, and sepsis is much lower compared with the transrectal approach.
• Comparable cancer detection: Studies have shown that transperineal biopsy detects clinically significant prostate cancer as effectively as transrectal biopsy.
• Better access to the prostate: The transperineal route provides improved access to the anterior (front) region of the prostate, where some cancers can be more difficult to sample using the transrectal technique.
• Supported by clinical guidelines: Growing evidence has led many national and international urological guidelines to recommend wider adoption of transperineal prostate biopsy where appropriate.

Who May Need a Freehand LATP Biopsy?

Your urologist may recommend a freehand LATP biopsy if prostate cancer needs to be confirmed or ruled out.

Common reasons include:

• An elevated prostate-specific antigen (PSA) level.
• An abnormal digital rectal examination (DRE).
• Suspicious findings on multiparametric MRI (mpMRI).
• Active surveillance for low-risk prostate cancer that was previously diagnosed.
• Repeat biopsy after an earlier negative result despite ongoing suspicion.

The procedure is suitable for many men and can often be performed as an outpatient procedure, allowing patients to return home on the same day.

How Is a Freehand Transperineal Prostate Biopsy Performed?

Although individual hospitals may follow slightly different protocols, the overall procedure is relatively straightforward.

1. Preparation

Before the LATP biopsy, your doctor will review your medical history and any medications you take, particularly blood thinners, which may need to be stopped temporarily. 

Since the needle does not pass through the rectum, extensive antibiotic preparation is usually unnecessary. 

2. Positioning

You will usually lie on your back with your legs comfortably supported in a lithotomy position, allowing the urologist easy access to the perineum. The skin is cleaned using an antiseptic solution to minimise the risk of infection.

3. Local Anaesthetic

One of the biggest advantages of LATP is avoiding general anaesthesia. The doctor administers local anaesthetic into the skin and deeper tissues around the prostate using a fine spinal needle. 

Patients typically experience brief discomfort during the injections, after which the biopsy itself is generally well tolerated.

4. Ultrasound Guidance

A lubricated ultrasound probe covered with a sterile sheath is gently inserted into the rectum to provide real-time images of the prostate. If an MRI has already identified suspicious areas, the ultrasound can be used to target those regions during the biopsy accurately.

5. Freehand Needle Guidance

Instead of a fixed template grid, the clinician uses a specialised freehand needle guide attached to the ultrasound probe. This allows precise, flexible needle placement while maintaining continuous ultrasound guidance. A coaxial introducer needle may also be used to collect multiple tissue samples through a single skin puncture, helping improve patient comfort.

6. Tissue Sampling

Using a spring-loaded biopsy device, the urologist collects several small tissue samples from different areas of the prostate. The number of samples varies depending on the clinical findings and MRI results. These samples are then sent to a pathology laboratory for examination.

Also read: Why local anesthesia is preferred in TP biopsy

Benefits of Freehand Transperineal Prostate Biopsy Under LATP

Freehand LATP offers several advantages over the traditional transrectal biopsy approach, making it an increasingly preferred option for prostate cancer diagnosis.

Lower Risk of Infection

Because the biopsy needle does not pass through the rectum, the risk of introducing bacteria into the prostate or bloodstream is significantly reduced. As a result, serious infections such as sepsis are far less common than with transrectal biopsies.

Accurate Cancer Detection

When performed under real-time ultrasound guidance, freehand transperineal biopsy provides excellent cancer detection rates. It also offers improved access to the anterior region of the prostate, where clinically significant cancers can sometimes be more difficult to reach using the transrectal approach.

Performed Under Local Anaesthetic

Most patients can undergo the procedure without general anaesthesia. This reduces preparation time, avoids the risks associated with anaesthesia, and allows patients to return home on the same day.

Flexible Needle Placement

Unlike template-guided biopsies, the freehand technique allows the urologist to adjust the needle angle and position during the procedure. This flexibility helps target suspicious areas more precisely while adapting to individual prostate anatomy.

Are There Any Risks or Side Effects?

Although freehand LATP is considered a safe procedure, no biopsy is entirely risk-free. Most side effects are mild and temporary.

Common side effects include:

• Mild discomfort or soreness around the biopsy site
• Causes blood in the urine for a few days
• Blood in the semen for several weeks
• Minor bleeding from the perineal skin
• Temporary difficulty passing urine in a small number of patients

Serious complications, including infection and sepsis, are uncommon compared with transrectal biopsy. However, patients should seek medical attention if they develop a high fever, severe pain, heavy bleeding, or are unable to urinate after the procedure.

Recovery and Aftercare

Recovery following a freehand transperineal biopsy is generally straightforward. Most men can return home shortly after the procedure and resume normal daily activities within 24 to 48 hours.

Patients are usually advised to:

• Drink plenty of fluids for the first 24 hours.
• Avoid strenuous exercise and heavy lifting for one to two days.
• Follow any medication instructions provided by their healthcare team.
• Contact their doctor if symptoms worsen or signs of infection develop.

Biopsy results are typically available within one to two weeks, after which the urologist will discuss the findings and any further treatment or monitoring that may be required.

Conclusion

Freehand transperineal prostate biopsy under LATP has become an important advancement in the diagnosis of prostate cancer. By accessing the prostate through the perineum rather than the rectum, it significantly reduces the risk of infection while maintaining excellent diagnostic accuracy.

Performed under local anaesthetic, the procedure is well tolerated by most patients, requires minimal recovery time, and allows many men to return home the same day.

Contact a surgeon for any kind of queries related to your prostate health!!!

Key takeaways

• Freehand LATP Biopsy is a minimally invasive transperineal prostate biopsy performed under local anaesthetic.
• The biopsy needle passes through the perineum instead of the rectum, significantly reducing the risk of infection and sepsis.
• Real-time ultrasound guidance helps accurately target suspicious areas of the prostate, including lesions identified on MRI.
• The freehand technique allows flexible needle placement for improved access to different areas of the prostate, including the anterior gland.
• Most patients can go home the same day and return to normal activities within 24–48 hours with minimal recovery time.

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