Exploring Transperineal Prostate Biopsy Facts

April 01,2021 |

Outside of skin cancer, prostate cancer is the most common cancer that affects men in the United States. Due to the constant growth of cells within the prostate, the gland is at a higher risk for mutations and problems. In conjunction with benign prostatic hyperplasia, many men find themselves victims of prostate cancer at some point in their lives. However, this doesn’t mean that there’s no hope. There are millions of prostate cancer survivors walking around today thanks to early detection and effective treatments. In fact, prostate cancer has one of the highest curability rates of cancers. However, curability inevitably decreases the longer the cancer goes undetected. To make sure that you have the best chance, digital rectal exams and PSA tests are encouraged. From there, you have a few options for prostate biopsies. Here, we’ll explore transperineal prostate biopsy facts and why they’re becoming one of the preferred methods for diagnosis in the urology world.

Understanding Your Prostate

The prostate is a small, walnut-sized gland that plays a role in the male reproductive system. It’s located right below your bladder and in front of your rectum. The function of the prostate is to aid in the process of creating semen—the fluid that carries sperm out of the testicles during ejaculation. The thing that’s unique about the prostate is that it never stops growing. While this growth tends to occur slowly over time, it has the potential to almost triple in size.

Sometimes, this increase in size causes no problems. Other times, it can cause problems with the functionality of your urinary tract. Enlarged prostate, also known as benign prostatic hyperplasia, can squeeze the urethra, making it difficult to urinate. Benign prostatic hyperplasia is not cancerous, but it can lead to a diminished quality of life if the urinary symptoms are severe. BPH is not linked to cancer and there are no correlations between the two. However, in both BPH and prostate cancer, the prostate is growing larger.

This is why getting annual digital rectal exams is important. Your doctor will be able to help clarify between the two conditions using diagnostic tools and medical questionnaires. If you’re experiencing any symptoms of either BPH or prostate cancer, seeing your doctor is essential. There are ways to treat enlarged prostate and prostate cancer.

The Risk of Prostate Cancer

The risk for developing prostate cancer is largely based on environmental exposures, location, fitness levels, diet, and family history. Those who work heavily with chemicals may be at an increased risk and men in North America and Western Europe are disproportionately more likely to develop prostate cancer than those in other countries. Sedentary lifestyles and poor diet can increase your risk of any cancer, including prostate cancer.

When caught early, prostate cancer has a high cure rate, but it can also come back.. Depending on the stage, your doctor may recommend active surveillance, surgery, radiation therapy, cryotherapy, or hormone therapy for treatment. These will depend on the stage of your prostate cancer, which is determined by undergoing a prostate biopsy.

An Overview of Prostate Biopsies

If you receive a test that indicates high, or rising, levels of protein-specific antigens (PSA), or present other symptoms that are indicative of prostate cancer, your doctor will recommend undergoing a biopsy. This does not mean that you have prostate cancer. It means that your doctor wants to rule out any possibilities. There are varying reasons for raised PSA levels and to make sure that you’re getting the proper care, biopsies are performed.

Almost all of the biopsies performed for prostate cancer are transrectal. Transrectal prostate biopsies have been the norm for many years, but new information is showing that there are better ways to obtain a sample. The problem with transrectal biopsies is that they create a very high risk for infection. Because of this, the risk for sepsis also increases. About 1 to 2 out of every 100 men who undergo a transrectal biopsy will get sepsis, which requires hospitalization and immediate attention.1  

Another downside to transrectal prostate biopsies is that due to the area the sample is drawn from, some clinically significant prostate cancers may go undetected.1 This can be detrimental to early detection and subsequent treatment, which is essential in overcoming prostate cancer. Luckily, there are new methods for prostate biopsies that are underway.

Understanding a Transperineal Prostate Biopsy

Thanks to ongoing research and understanding the shortcomings of transrectal biopsies, doctors at Mayo Clinic and beyond have begun to implement transperineal prostate biopsies. It is believed that in doing so, more cases of prostate cancer will be detected without the risk of submitting patients to potentially life-threatening complications.

A transperineal prostate biopsy is a biopsy that’s performed by inserting a needle through the perineal skin rather than the rectum.1 This allows the procedure to bypass contaminated fecal matter and therefore, decreases the risk of sepsis to 1 in 500.1 To make sure that the biopsy is accurately performed, the needle is guided through an ultrasound.

Techniques When Performing a Transperineal Prostate Biopsy

When performing the biopsy, doctors have a choice of a number of different techniques. The choice is usually based on whether a fusion or a systematic biopsy is needed alongside sedation levels or requirements.

The first technique uses a stepper to help cradle the ultrasound probe and provide necessary guidance for needle insertion.1 The device is the same one used when performing a brachytherapy for prostate cancer. The main problem with using a stepper is that it requires extra skin punctures, which then increases the need for more local anesthesia.

Instead, it’s recommended that doctors learn and practice how to perform a freehand transperineal prostate biopsy. This sounds intimidating, but it’s less invasive as it requires fewer skin punctures. The needle enters through the perineum and the biopsy needle can be reintroduced for multiple samples without repeatedly puncturing the skin.1 This improves overall patient comfort and provides a number of benefits to those who are suffering from inflammatory bowel disease, rectal complications, prostatitis, or a history of infections.

The detection for both transperineal and transrectal biopsies are similar, but there is far less risk of infection when performing a transperineal prostate biopsy.

Complications of a Transperineal Biopsy

While there is a reduced chance at becoming sepsis for transperineal prostate biopsies, there are still potential complications that can arise. Again, the risk of developing sepsis is about 1 in every 500 men (compared to 1 to 2 in every 100 men with transrectal biopsies). In addition, some of the risks associated with transperineal biopsies include:1

  • Hematuria (blood in urine) – this affects most men and tends to be fairly mild
  • Blood in semen – this also affects most men and lasts up to three months post-biopsy
  • Temporary erectile dysfunction – affects less than 5% of men
  • Bruising of the skin – another common side effect, albeit bruising is mild
  • Urinary retention requiring a catheter – affects less than 1% of men

One complication or risk factor that you will not experience is rectal bleeding. If you have any questions or concerns regarding prostate biopsies and which approach is best for you, talk to your urologist today. The important thing is detecting prostate cancer early on, as curability rates greatly increase for those who find and treat it early.

When to See a Doctor

Aging is inevitable and as a man, that means that you’re going to need to pay attention to your prostate health. You should begin regularly seeing your urologist at around 45 – 50 for yearly digital rectal exams. This will allow your doctor to examine the size of your prostate to help determine your risk for problems or cancer. If you have a family history of prostate cancer, or have already had prostate cancer, talk to your doctor about what measures you can take for preventative screenings. While it may seem scary, prostate cancer has an extremely high curability rate when it’s caught early. However, as with many cancers, later stages become more difficult to treat. By localizing the cancer and removing it before it spreads, you’ll ensure you’re in a strong position for recovery. If you notice any symptoms of prostate cancer or are suffering from a urologic condition, call your urologist for an appointment. It’s always better to be safe than sorry.

If you need more information regarding the health of your prostate, screening techniques, and understanding prostate surgery, utilize Byram Healthcare as your trusted resource. We supply both information and necessary products for men and women undergoing treatment for a variety of urologic conditions.



1 https://www.mayoclinic.org/medical-professionals/urology/news/ultrasound-guided-transperineal-prostate-biopsy/mac-20473283