Transperineal template biopsy of the prostate

What is a prostate biopsy?


Prostate glands are only found in men and are about the size of a walnut. Your prostate gland is located just below your bladder and in front of your rectum (back passage). Its function is to produce white fluid that becomes part of your semen.

A prostate biopsy is where small samples of tissue are taken from your prostate gland. The samples are then sent to be examined under a microscope by a specialist. Due to the special way in which the specimens are prepared for the histopathologist (specialist in examining the cells of the body) the results take around 1-2 weeks to come back.


Why do I need a prostate biopsy?


You may have been advised to have a prostate biopsy because:


· Your doctor/nurse specialist found a lump or abnormality during a digital rectal examination (DRE). A DRE is where a doctor feels your prostate gland through your rectum (back passage) with his/her index finger.

· You have had a blood test showing a high level of PSA (prostate-specific antigen). PSA is a protein that is released into your blood from your prostate gland. High levels of PSA may indicate cancer.

· You may have had previous biopsy results that came back with no evidence of cancer but your PSA blood test is still suspicious.

· You may have a known diagnosis of prostate cancer that has not required treatment and your doctor/nurse specialist wishes further information to plan possible treatment or observation.


The biopsy can find out whether any of your prostate cells have become cancerous or, if you have pre-existing cancer, whether the cancer has changed. It can also diagnose other conditions such as benign prostatic hyperplasia (enlargement of the prostate), prostatitis (inflammation of the prostate, usually caused by a bacterial infection) or prostatic intraepithelial neoplasia (PIN), which is a change in the cell type but not cancer.



How is a prostate biopsy performed?


Using an ultrasound probe in your back passage we take samples of the prostate from a different angle through the skin between your scrotum and back passage (the perineum) under a short general anaesthetic.


 What is ultrasound?


Ultrasound is a way of seeing different body parts using high frequency sound waves to create images of your internal structures. The sound waves bounce off tissues and organs and are picked up and then displayed on a screen. Because your prostate gland is in front of your rectum, a small ultrasound probe can be inserted into the rectum and create an image of your prostate gland. This is called a trans-rectal ultrasound or TRUS. This will help to guide your doctor or specialist nurse when he/she is performing the biopsy.



Giving my consent (permission)


The staff caring for you need to ask your permission to perform a particular treatment or investigation. You will be asked to sign a consent form that says you have agreed to the treatment and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you. Remember, it is your decision. You can change your mind at any time, even if you have signed the consent form. Let staff know immediately if you change your mind. Your wishes will be respected at all times.


What are the risks?


Although serious complications are rare, every procedure has risks. Your doctor will discuss these with you in more detail:


· Infection: this can happen to one in 100 patients. We give you antibiotics during your biopsy to reduce this risk. However, if you develop a fever, or have pain or a burning sensation when you pass urine, you may have an infection and should seek medical attention from your nearest A&E department.


· Blood when you pass urine: this is not uncommon and can range from peachy coloured urine to rose or even claret coloured. It is rarely a sign of a serious problem. Increasing your fluid intake will usually help “flush the system” and clear any bleeding. However, if there is persistent or heavy bleeding every time you pass urine you should go to your nearest A&E department.


· Difficulty passing urine: it is possible that the biopsy may cause an internal bruise that causes you difficulty passing water. This can happen in two in every 100 cases and is more likely to happen in men who had difficulty passing urine before having the biopsy. Should you have difficulty passing urine you may require a catheter and you will need to go to your nearest A&E department for assessment. A catheter is a hollow, flexible tube that drains urine from your bladder.


· An allergic reaction to the medication we give you. Although the risk of this is low (less than one in 1,000 cases), you can reduce this risk by letting us know if you have had any previous allergic reactions to any medications or food.


Before the biopsy


You should let the doctor or specialist nurse know if you:


· are taking any medications, particularly antibiotics or anticoagulants (medication that helps to prevent blood clots from forming), including aspirin, warfarin, clopidrogrel or dipyridamole

· have allergies to any medications, including anaesthetic

· have or have ever had bleeding problems

· have an artificial heart valve.


You should continue to take all of your medications as normal, unless you have been told otherwise by the doctor who organised your biopsy.



Are there any alternatives?


Template biopsy is an additional diagnostic tool to give your doctor/nurse specialist more information. It is innovative and expanding in its areas of use. The results will guide your future treatment.


What’s going to happen on the day of my biopsy?


The biopsy is usually carried out as a day case, which means you will be able to come in to hospital, have the biopsy and leave on the same day. You will be told when to stop eating and drinking before the procedure. If you are having the biopsy under general anaesthetic, this will be given through a small needle inserted into the back of your hand. This will make you sleep for the whole procedure, so you will not feel any pain or discomfort. You will wake up in the recovery room and your surgeon will see you prior to discharge.


After the biopsy


You can leave as soon you are passing urine normally. You will be asked to rest for about four hours at home after this. Due to the general anaesthetic you will need someone to help you home, as your muscles may ache and you may feel lethargic because of the anaesthetic for a short time. General anaesthetic takes 24 to 48 hours to wear off, so please rest for this period of time. It is usually possible to work from home the next day and travel within 48 hours is possible.


When you are at home


You may have mild discomfort in the biopsy area for one or two days after the biopsy. You may also notice some blood in your urine for a few days. Your semen may be discoloured (pink or brown) for up to six weeks, and occasionally longer, after the biopsy. This is nothing to worry about. You should drink plenty of non-alcoholic fluids while you have blood in your urine.


 If any of the following occur, please go to your local Accident and Emergency (A&E) Department:


· your pain increases

· you have a fever higher than 100.4°F (38 °C)

· you do not pass urine for eight hours

· you start to pass large clots of blood

· you have persistent bleeding.


Further information


The Prostate Cancer Charity – Provides support and information for men with prostate cancer.

t: 0845 300 8383 w:

Macmillan Cancer Support (all numbers freephone)

t: 0808 808 2020 (information on living with cancer)

t: 0808 800 1234 (information on types of cancer and treatments)

t: 0808 801 0304 (benefits enquiry line)