Diagnostics

Perineal prostate biopsy

What is a perineal biopsy of the prostate?

A perineal biopsy of the prostate consists of taking several small fragments of the prostate tissue through the perineal skin. This is the region between the anus and the scrotum (we speak of the trans-perineal route).
The new technique is expanding in North America since the infection rate is almost zero, contrary to transrectal biopsy. Infection rates after transrectal biopsy are increasing as a result of increased resistance to antibiotics. Also, there is a low risk of sepsis (severe infection) requiring hospitalization in the intensive care unit.

Perineal biopsies are rather sterile without passing through the rectum.

It is done by 2 sites of skin samples, one site per right and left prostate side instead of 12 to 14 transrectal sites.
The fever secondary to bacteremia is almost non-existent.

This sampling is done with a special needle on each side of the space above the rectum. The doctor is guided by a transrectal ultrasound probe which allows him to clearly visualize the place where he will take his sample.

A biopsy may be indicated when an abnormality has been detected by a digital rectal examination when the value of PSA is high for the age of the man, or it increases with the time. This is the easiest way to remove prostate fragments without surgery.

How is a prostate biopsy done?
- The patient is placed in position on the back with the legs elevated in stirrups to expose the perineal area.

- As a first step, Dr Marois introduces an endorectal ultrasound probe to clearly visualize where he will take the samples.

- An endorectal ultrasound consists of obtaining images of the prostate using an ultrasound probe introduced through the anus into the rectum.

- In general, the urologist makes a digital rectal examination before introducing the ultrasound probe, which allows him to examine the consistency of the prostate, but also to lubricate the canal so that the introduction of the probe is the least uncomfortable possible.

- In a second step, after desinfection of the perineal region , local anesthesia of the skin and perineum is performed using a skin injector, followed by a subcutaneous injection of xylocaine on each side of the skin. rectum. A larger needle is then introduced to facilitate straight-line guidance of prostate biopsies. A second anesthesia is then performed deep near the prostate. Patients generally feel a sensation of warmth that is not painful. Usually. Anesthesia is the most unpleasant moment of the procedure.

- In a third step, measurements of the prostatic volume are made. Suspicious areas are also identified.

- Finally, the urologist performs the biopsies of the prostate. The ultrasound probe is equipped with a guidance system that allows you to visualize the correct point of entry of the needle into the prostate and follow its path.

- The doctor uses an automatic triggering needle. This mechanism produces a snap that may surprise the first time. The sting itself is not very painful: the needle penetrates very quickly into the prostate and comes out as quickly.

- Approximately 12 samples are taken from different parts of the prostate (more if the prostate is large or there are suspicious areas). When the collection is complete, it is best to sit for 15 minutes in the waiting room to avoid dizziness. Small diachylons will be placed at the two sites of cutaneous samples.

- These rapid and painless samples are generally well supported by the patient. The discomfort increases with the duration of the examination and the number of samples. Most men experience only mild discomfort.

- The duration of sampling is variable depending on the number of biopsies required. It is about 15 to 20 minutes.
What are the possible complications of a biopsy?
- Slight bleeding in the urine and sperm may be present several days after the biopsy. Sometimes they remain for a few weeks in the sperm.

- The antibiotic treatment prescribed before the examination is intended to prevent mostly skin infection.

- It is advisable to avoid intense physical exercise within 48 hours after the exam.
Recommendations after a perineal prostate biopsy?
- It is advisable to avoid intense physical exercise within 48 hours after the exam.

- Finish your course of antibiotics for a total of 5 days.

- Tissues collected are examined under a microscope by a pathologist who performs an anatomopathological examination. We also talk about the histopathological examination. This examination makes it possible to establish the presence or absence of cancer cells in the sample.

- The results of the examination of the prostate biopsies are communicated to the doctor after a delay of several weeks. The doctor then sends you the results.

- An appointment is offered approximately 1 month after the biopsy.

- When the results show no cancer abnormalities, we speak of negative results.

- When the doctor has established his diagnosis, he then proposes a treatment adapted to the patient's situation.
Preparation before a perineal prostate biopsy?
- It is important for the patient to inform the doctor of the medicines he is taking, especially those of the aspirin or anticoagulant type. Indeed, these drugs reduce the quality of blood clotting and increase the risk of bleeding.

- An enema of the rectum is no longer required.

- Prior antibiotic treatment in single dose before the intervention is necessary in order to decrease the infections of the skin.

- Since the examination is done with local anesthesia, the patient does not need to be fasting. To be more comfortable, it is advisable to urinate before the biopsy.

- Anxiolytic medication may be suggested for anxious or rather nervous patients. However, we must be accompanied.
References
JOURNAL OF UROLOGY 2019:
Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1,287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability.
https://www.auajournals.org/doi/10.1097/JU.0000000000000156

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Dr. Marois is a urologist who is not a member of the Régie d’Assurance Maladie du Québec (RAMQ). As such, the clinic can not claim the RAMQ for the payment of his services. If you consult Dr Marois, you must pay for the services rendered.

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