Diagnostic exam

Transperineal prostate biopsy

Diagnostic exam

Transperineal prostate biopsy

Approximate time60 mins

A perineal prostate biopsy involves taking several small fragments of prostate tissue through the skin of the perineum, the area between the anus and the scrotum (this is why it’s called transperineal). Unlike transrectal biopsy, this technique is gaining popularity in North America because the infection rate is almost 0. The infection rates after transrectal biopsy are rising due to increased antibiotic resistance. Additionally, there’s a low risk of sepsis, which is a severe infection that requires hospitalization and intensive care.

Perineal biopsies are rather sterile as they don’t go through the rectum. These biopsies involve taking a sample of tissue from 2 skin sites on either side of the prostate instead of 12 to 14 transrectal sites. As a result, fever caused by bacteremia is almost non-existent.

The sample is taken using a special needle on each side of the space above the rectum. The doctor uses a transrectal ultrasound probe to guide the procedure and locate the area for sampling.

A biopsy may be recommended if a digital rectal exam reveals an abnormality, if the person’s PSA levels are high for their age or if PSA levels continue to increase over time. This is the easiest way to take tissue samples from the prostate without surgery and determine if prostate cancer is present.

Prostate Biopsy by Transrectal Route

What is the Procedure for Prostate Biopsy?

- The patient is positioned on their back with their legs elevated in stirrups to expose the perineal region.

- The urologist begins by inserting an endorectal ultrasound probe to see where they will take the samples.

- An endorectal ultrasound involves using a probe inserted into the rectum to obtain images of the prostate.

- Before inserting the ultrasound probe, the urologist will usually perform a rectal exam to assess the prostate's consistency and lubricate the canal to reduce discomfort.

- Next, after disinfecting the perineal area with proviodine, the urologist administers local anesthesia to the skin and perineum with a skin injector, followed by a subcutaneous injection of xylocaine on each side of the rectum. A larger needle is then used to facilitate the insertion of the prostate biopsies, followed by more local anesthesia closer to the prostate. Patients usually feel a non-painful warm sensation. Generally, anesthesia is the most uncomfortable part of the procedure.

- The urologist then measures the prostate volume and identifies any suspicious areas.

- Finally, the urologist performs a prostate biopsy. The ultrasound probe is equipped with a guidance system that helps the doctor visualize the correct entry point of the needle into the prostate and track its path.

- The doctor uses an automatically triggered needle, which produces a sharp clicking sound. This can be surprising the first time. The injection itself isn’t very painful. The needle enters and exits the prostate very quickly.

- Around 12 samples are taken from different parts of the prostate (more if the prostate is large or if there are suspicious areas). After the biopsy, it’s best to remain seated for 15 minutes in the waiting room to avoid dizziness. Small diachylons will be placed at the 2 skin sampling sites.

- This quick and painless procedure is generally well tolerated by patients. Discomfort may increase with the duration of the exam and the number of samples. Most men only experience mild discomfort.

- The length of the procedure depends on the number of biopsies required. On average, it takes approximately 15 to 20 minutes.

What are the possible complications of a biopsy?

Light bleeding in the urine and ejaculate may be present several days after the biopsy. However, some patients may notice blood in their sperm for a few weeks. The risk of developing a skin infection is very low, at only 0.2%. There is also a relatively low risk of urinary retention. If you’re unable to urinate after the biopsy, you must go to the emergency room to have a urinary catheter inserted. Additionally, you should schedule a follow-up appointment in the coming days.

It's advisable to avoid strenuous physical activity for 48 hours following the exam.

How are the results obtained?

- A prostate biopsy involves collecting tissues, which a pathologist examines under a microscope. This procedure is also called a histopathological examination. It helps determine whether there are any cancer cells in the sample.

- Your urologist will be given the results of the prostate biopsy exam within several weeks. They’ll talk to you about the results of the prostate biopsy in a follow-up appointment about 1 month after the biopsy.

- However, you can now send the prostate biopsy specimens to a private pathology laboratory at your expense. This will allow you to receive the results much sooner (in about 10 to 12 business days). A follow-up appointment will then be scheduled after the biopsy.

- When no cancerous abnormalities are detected in the test results, we refer to them as negative results.

- In some cases, additional biopsies or magnetic resonance imaging of the prostate may be required even after a series of normal biopsies. This is especially true if an abnormality is detected or persists during a digital rectal exam or if the patient’s PSA levels remain high or continue to increase despite being monitored.

- Once your urologist confirms a diagnosis, they’ll provide you with a personalized treatment plan.

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How to prepare for a perineal prostate biopsy

Before the biopsy
Patients must take a single dose of antibiotic treatment before the procedure to reduce the risk of skin infections.
Anxiolytic medication may be offered to patients who feel anxious or nervous. However, they must be accompanied by someone.
It’s important for the patient to inform the doctor about any medication they’re taking, especially aspirin or anticoagulant medication. These medications reduce the quality of blood coagulation and increase the risk of bleeding.
Since the exam is performed under local anesthesia, patient’s don’t need to fast. However, it’s recommended that the patient urinates before the biopsy to be more comfortable.
Is a rectal cleaning necessary?
A rectal enema is no longer required. A single dose of antibiotic treatment before the procedure is necessary to reduce the risk of skin infections.

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