Fusion Targeted Trans-perineal Prostate Biopsy

The purpose of a prostate biopsy is to sample the prostate gland to determine if prostate cancer is present. Prostate biopsies are most commonly performed in men with an elevated PSA level, an abnormal prostate MRI or abnormal prostate examination (a prostate nodule). In a transrectal biopsy the biopsy needle traverses the wall of the rectum before reaching the prostate gland.

Trans-perineal (TP) biopsy differs in that the biopsy needle passes through the skin of the perineum, avoiding the rectum. In a fusion targeted biopsy the abnormality seen on MRI scan is matched up to a live ultrasound probe using special software. This allows the needle to be accurately guided into the abnormal area. There are several advantages to this technique over a transrectal approach including better accuracy and a very low risk of infection (around 1 in 1000).

Procedure

A general anaesthetic is given. The patient's legs are placed in stirrups. An ultrasound probe is inserted into the rectum so as to view the prostate gland. A needle guide with an attached grid is fixed in place near the perineum. The ultrasound image is overlaid on the MRI image. The biopsy needle is inserted through the needle guide into the prostate gland targeting the abnormality. Several biopsies are also taken from the remainder of the gland. The procedure takes 20 minutes to complete. You will be able to go home the same day of surgery. Before leaving you need to pass urine. There will be temporary swelling and bruising of the perineum and scrotum. It is normal for blood to drip from the urethra and be seen in the urine for several days afterward, this may even last for two weeks or more, especially in men who take blood thinners such as aspirin. There will be blood in your semen for up to six weeks following the biopsy.

Pre-procedure

Aspirin, clopidogrel, dabigatran, warfarin, and any other blood-thinning medications will need to be stopped prior to surgery. We will advise you on the timing of when to stop and re-start these medications A urine sample needs to be provided to the laboratory about 1 week prior to surgery.

Risks

There is a very small risk of urinary blockage (urinary retention) following biopsy. If you feel that voiding has become difficult then contact us or attend the Emergency Department, as a catheter may need to be temporarily inserted. Some men experience temporary impairment in erections following biopsy. This is due to bruising of the nerves which cause erection & usually resolves within three months.

Return to Work

Following your biopsy, we recommend that you take two days off work.

Results

The biopsies are sent to the pathology laboratory. We usually have the results within 2-3 weeks. An appointment will be made to discuss the results with you.