Key Points

• Ultrasound-guided transperineal biopsy of your prostate is done to check for prostate cancer.

• Currently, there is no more reliable way than biopsies for checking your prostate 

• Prostate cancer is very common: 20% of Australian men will get prostate cancer by the age of 85.

• Many of the newly diagnosed prostate cancers are not life-threatening; they may require no active treatment and can be carefully monitored.

What does this procedure involve?

• You will often have an MRI scan of th prostate first. The prostate MRI helps to determine if you need a prostate biopsy. It also helps to identify any suspicious lesions or areas that we can target during the biopsy.

• An ultrasound probe is inserted into your rectum (back passage) to scan your prostate.

• Using this ultrasound as a guide, biopsies are taken from your prostate through your perineum (the skin between your scrotum and rectum).

• The procedure is performed under intravenous sedation or general anaesthesia in theatre. 

What are the alternatives?

• Observation with repeat PSA blood tests and possibly repeat MRI scans.

• Transrectal prostate biopsies can be performed but are not recommended by the guidelines due to higher risk of severe infection or urosepsis.

What happens on the day of the procedure?

• Dr Ashrafi will meet with you to confirm your consent and perform a team time-out prior to the procedure.

• The anaesthetist will also see you to discuss the type of anaesthetic used and any pain relief required after the procedure.

How is the procedure performed?

• Before the procedure, we will give you an antibiotic injection.

• We will position your legs in special supports (stirrups) that allow the surgeon to access the skin behind your scrotum.

• We may use tape to move your scrotum out of the way.

• We will use an antiseptic solution to clean your perineum.

• An ultrasound probe is inserted into the back passage (rectum).

• We may use a special grid so that all areas of the prostate can be included in the biopsies.

• The biopsy needles are guided into position using the ultrasound scanner.

• Biopsies are taken from different zones of the prostate with extra samples from any suspicious areas seen on MRI.

• The number of biopsies taken depends on your PSA level, the MRI report, and the prostate volume.

• Dr Ashrafi may inject a local anaesthetic during the case to help with post-operative pain.

• We will apply a dressing to your perineum after the biopsy

• After the procedure, you will go to Recovery and then to the Daystay Ward.

• You should expect to go home after a few hours when you are 1) comfortable and 2) able to void.

• You may need a post-operative catheter into your bladder if you cannot void after the procedure; in this instance, you may be admitted and the catheter is usually removed the next day.

What are the risks and after-effects of the procedure?

Some of the possible after-effects are listed below. The impact of these after-effects can vary a lot from patient to patient. Please ask your surgeon’s advice about the risks and their impact on you as an individual.

• Blood in the urine for up to 2 weeks (almost all patients).

• Blood in your semen which can last up to six weeks; this poses no risk to you or your sexual partner (almost all patients).

• Bruising in your scrotum and perineum (almost all patients).

• Temporary issues with erections after the biopsy (5%).

• Urinary retention or Inability to pass urine (5%); you may need a catheter and admission to hospital.

• Urinary infection (1%).

• False-negative results or failure to detect cancer in your prostate (2-10%).

• Needing a repeat biopsy if the biopsies are inconclusive (2%).

Please contact us on 8119 0961 if you have any questions.

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