Why have I been given this sheet?

You have been given this sheet because you are due to have an ultrasound guided transperineal prostate biopsy.  This will be carried out under local anaesthetic (you will be awake but the area will be numbed) at Yeovil District Hospital.

Please read this leaflet before you come to your appointment.  The doctor or nurse practitioner will go through the information with you at your appointment and answer any questions you may still have.

What is the ultrasound guided transperineal prostate biopsy?

A prostate biopsy involves taking small samples of tissue (biopsies) from the prostate.  Approximately 24 biopsies will be taken, although this will depend on the size of your prostate.  These are examined under a microscope by a specialist to check whether there is cancer in the prostate.

A transperineal biopsy involves taking samples through the perineum.  The perineum is the area of skin between the scrotum and the rectum (back passage).

You may be offered a transperineal biopsy because:

  • You have a suspicious area which has been seen on an MRI scan.
  • You have previously had a transrectal prostate biopsy that shows no cancer, but have a high PSA level (a blood test that can indicate cancer), or have suspicious areas seen on an MRI scan.
  • You have known prostate cancer that has not needed treatment, but your doctor wants to check whether the cancer has changed and may require treatment.

What are the alternatives to this procedure?

  • Transperineal biopsies under a general anaesthetic (where you are unconscious).
  • Further monitoring of your PSA or MRI scan results without further biopsies.

The most suitable option will have been discussed with you at your consultation.

Preparing for your transperineal biopsy

Can I eat and drink before the biopsy?

Yes, you can eat and drink before the biopsy.

Should I take my usual medication on the day of the biopsy?

Most medicines can be taken as usual, but some medicines need to be stopped.

It is advisable to take paracetamol in your usual dosage 30 minutes prior to your prostate biopsy to reduce the biopsy related discomfort during the procedure. Please find advice about the paracetamol dosage according to the medication package leaflet.

Anticoagulants

If you take warfarin, this should be stopped 5 days before your biopsy.  You should have an INR check the day before. 

Your urology doctor should have gone through your medicines with you and discussed whether you need any heparin injections while you are off your warfarin (known as ‘bridging therapy’). 

If you are taking another anticoagulant (rivaroxaban, apixaban, edoxaban, dabigatran), your urology doctor should have advised you when to stop taking these before your biopsy. Usually these anticoagulants should be stopped 48 hours prior to the planned time of prostate biopsy.

Please confirm with your treatment team when you should restart your anticoagulants before you leave the hospital after the biopsy.

Please telephone the urology team if you are unsure which medications you should stop taking. Tel: 01935 384345

Antiplatelets

You can continue to take low dose (75mg) aspirin.

Clopidogrel and other antiplatelet medicines should be stopped 10 days before the biopsy.  If you are taking clopidogrel or another antiplatelet because you have had coronary (heart) stents inserted within the last year, please contact the urology team to discuss, before you stop your medication.

What do I need to bring to the appointment?

Please bring with you:

  • A list of your current medications

What should I expect when I arrive?

Please report to main outpatient reception desk, Level 3 at Yeovil District Hospital, 5 minutes prior to your appointment.  This gives us time to prepare you for the biopsy.  The biopsy takes about 30 minutes.

A nurse will go through your medications with you and ask you some questions.  You will be asked to change into a hospital gown and remove your lower clothes.

What should I expect during the biopsy?

You will be asked to lie on your back on a recliner chair, with your legs placed in supportive stirrups.  To get you into the correct position to take the biopsies, the doctor/nurse practitioner will apply some tape to move your scrotum out of the way.  They will also lift the supportive stirrups to bend your knees. 

If you find the position too uncomfortable please tell the doctor/nurse practitioner, as you will be in this position for about 20 minutes.

The doctor/nurse practitioner will feel your prostate by placing a finger in your back passage (this is called a digital rectal examination or DRE).  We will apply a freezing spray to your perineal skin to reduce the needle related discomfort prior to local anaesthetic injection. The doctor/nurse practitioner will use an antiseptic solution to clean your perineum (the area through which the biopsies will be taken).

You will then be given an injection of local anaesthetic (lidocaine) to make the area go numb.  This is given in two stages, first under the skin of your perineum to numb the entry point and then deeper to anaesthetise around your prostate.  This will sting for the first few seconds, but should soon go numb.  The anaesthetic will then be given a few minutes to take full effect.

They will then insert an ultrasound probe covered in lubricating jelly, into your back passage.  This allows them to see an image of your prostate on the ultrasound screen, which they will use to guide the collection of the biopsies.  Inserting the probe can be uncomfortable, but should not hurt.

A guide needle will be inserted into your perineum; once to take samples from the left side of your prostate and then again to take samples from the right side.  The biopsy needle is inserted through the guide tube to take the samples.

If you feel pain when the first biopsy needle is inserted you should let us know, as we can give you more anaesthetic.

The biopsies are taken with a device that contains a spring-loaded needle.  You will hear a loud ‘click’ sound and feel a flicking sensation as the biopsy is taken.  You may find the whole procedure uncomfortable but you should not find the biopsies painful.

What should I expect after the biopsy?

After the biopsy you can get up slowly and get dressed.  It is important to take this slowly as you may feel quite lightheaded after the procedure. 

You will be given an absorbent pad to place inside your underwear.  This is because there may be a small amount of bleeding from the skin punctures and your urethra (water pipe).

If you feel faint or unwell after leaving the biopsy room please tell the nurse.  We would recommend that you have someone to drive you home, but if you are driving yourself home then you must make sure that you are feeling well.  We recommend that you have a drink and something to eat before you leave the hospital.

What are the risks and side effects of having a transperineal prostate biopsy?

Most procedures have possible risks and side effects.  Your doctor/nurse practitioner will go through these with you before the procedure.  Please let them know I you have any questions or concerns.

What should I look out for at home?

  • You may have discomfort in the biopsy area for a couple of days.  If you need to, you can take paracetamol or your usual pain relief (following the dosage instructions with the packaging).
  • You are likely to see blood in your urine and semen. This is a transient bleeding after the prostate biopsy. Drink plenty of non-alcoholic fluid while there is blood in your urine to flush any blood through.
  • If you think you are getting a urine infection please contact your GP and take a urine sample to your GP surgery to be tested.
  • Signs of a urine infection include: cloudy and offensive smelling urine and/or pain when passing urine.
Risk and Side Effects How many men does this affect?
Blood in your urine for up to 10 days Almost all men
Blood in your semen which can last up to 6 weeks. This may be red or brown in colour Almost all men
Bruising in your perineal area and discomfort in your prostate caused by bruising from the biopsies Up to 5 out of 10 men
Temporary problems with erections caused by bruising from the biopsies 1 in 20 men
Inability to pass urine (acute retention of urine) 1 in 20 men
Blood in your urine, preventing you from passing urine (clot retention) 1 in 50 men
Failure to detect a significant cancer in your prostate Up to 5 out of 50 men
Need for repeat procedure if biopsies inconclusive or your PSA level rises further Up to 5 out of 50 men
Blood in your urine, requiring emergency admission for treatment 1 in 100 men
Infection in your urine requiring antibiotics 1 in 100 men
Septicaemia (blood infection), requiring emergency admission for treatment 1 in 1,000 men

Please go immediately to your nearest Emergency Department if:

  • You develop a high temperature (above 38.0 C⁰) or chills and shivering.
  • After trying for 2 hours you are unable to pass urine, despite having a full bladder and drinking plenty of fluid.

Further Information

Prostate Cancer UK
Website: www.prostatecanceruk.org
British Association of Urological Surgeons
Website: www.baus.org.uk/patients

If you need an interpreter or would like this information leaflet in another format, such as Easy Read, large print, Braille, audio, electronically or another language please speak to the department where you are being seen. You can contact us with calling on phone. Tel: 01935 384564

Ref: 18/21/55
Review: 02/23