Transperineal Prostate Biopsy Under Local Anaesthetic

Why have I been given this leaflet?

You have been given this leaflet because your consultant has referred you for transperineal ultrasound guided biopsies to be taken of your prostate. This will be performed under local anaesthetic (LA). You will be awake and the area will be numbed with a local anaesthetic injection.

This will take place in the Outpatient Department at Dorset County Hospital.

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

What is a transperineal ultrasound prostate biopsy?

A prostate biopsy involves taking a small sample of tissue (a biopsy) from your prostate. Approximately 12 to 24 samples will be taken, although this may vary depending on the size of your prostate.

A transperineal biopsy involves taking the tissue sample through the perineum, which is the area of skin situated between the scrotum and the rectum (back passage).

These tissue samples will then be sent to the laboratory to be examined under a microscope by a specialised pathology doctor to check for prostate cancer cells.

You may have been offered a transperineal prostate biopsy because:

• You have a suspicious area which has been identified on your MRI scan or on digital rectal examination of your prostate.
• You have a raised PSA but unable to have an MRI scan for a number of reasons.
• You have known prostate cancer that has not required treatment, but the doctor wants to check whether the cancer has progressed and may now require treatment.

What are the alternatives to this procedure?

• Transrectal ultrasound guided biopsies; these are also carried out under local anaesthetic. The samples are taken through the rectum
• 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.

What are the alternatives to this procedure?

• Transrectal ultrasound guided biopsies. These are also carried out under local anaesthetic, but the samples are taken through the rectum. There is therefore a high infection risk with transrectal biopsies.
• Transperineal biopsies under a General anaesthetic (when you are fully asleep). This option is usually not the first line option due to higher risk of urine retention, infection and other complications.
• Further monitoring of your PSA or MRI results without prostate biopsies.

The most suitable option(s) will have been discussed with you at your consultation if/as necessary.

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 medications on the day of my biopsy?
Most medications can be taken as normal. However, there are some medications that do need to be stopped prior to the procedure.

Anticoagulants
If you are taking Warfarin, this needs to be stopped five days before your biopsy. Your INR will be checked in the hospital on the day of your procedure. Your urology doctor will have discussed your medications with you and decided whether or not you will need any heparin injections whilst you are off your Warfarin (this is known as bridging therapy). If you are on warfarin and bridging therapy was not discussed with you, please contact the Urology Department (contact details on last page of this document).

If you are taking Apixaban, Dabigatran, Edoxaban or Rivaroxaban, these should be stopped 48 hours prior to the procedure.

Antiplatelets
You can continue to take low dose Aspirin 75mg. If you are taking clopidogrel, ticagrelor, prasugrel or any other similar antiplatelet medications, these need to be stopped seven days prior to the biopsy. If you are taking this medication because you have had coronary (cardiac) stents inserted within the last 12 months, please contact the Urology Department to discuss before you stop taking your medication.

Following the procedure, please discuss with the clinician carrying out the prostate biopsy on when it is safe for you to restart your anticoagulant or antiplatelet medication.

What do I need to bring with me?

Please bring a urine sample to the appointment with you. If unable to come with a urine sample, then please attend with a full bladder so the urine sample can be taken on arrival. We need the sample to check that you do not have a urine infection prior to the procedure. Unfortunately, if there are signs of a urine infection the procedure will have to be postponed until the infection has been successfully treated.

Kindly attend with a list of your medications if possible. One of the nurses will go through your medications with you and ask you some questions.

What should I expect during the biopsy?

You should expect to be in the hospital for about an hour. This gives us time to prepare you for your biopsy and make sure that you are well following the procedure. The actual biopsy should take approximately 30 to 45 minutes or less.

A blood pressure check will be done before the biopsy. You will be asked to change into a hospital gown and remove your underwear. Thereafter, you will be asked to lie on your back on the operating trolley, and your legs will be placed in supportive hydraulic leggings. In order to facilitate taking the biopsies, some tape will be applied to the scrotal area to move the scrotum out of the way. Your legs will be raised and bent at the knees. If you find this position too uncomfortable, please inform a member of our team and we will try and make you more comfortable. You will remain in this position for approximately 30 to 45 minutes or less. 

The doctor/nurse will firstly examine your prostate by placing a finger in your back passage (digital rectal examination/DRE). An antiseptic solution will then be used to clean the perineum from where the biopsies will be taken. You will be given an injection of local anaesthetic under the skin of the perineum, to numb the entry point for the biopsies.

An ultrasound probe will then be inserted into your rectum; which allows the doctor/nurse to see an image of your prostate on the ultrasound machine and this will be used as a guide for taking the biopsies. This part of the procedure may be uncomfortable and you might feel pressure in your back passage or a desire to pass urine due to pressure of the ultrasound probe on your bladder.

A needle guide will then be inserted into the perineum. Further local anaesthetic injections will at that point be delivered into a deeper location to numb around the prostate. Initially these local anaesthetic injections may sting. The anaesthetic will be given time to take effect.

The biopsy needle is then placed through the needle guide to take the biopsies. Samples may be taken from both sides of the prostate. The biopsies are taken with a device that contains a spring-loaded needle, so it makes a clicking sound. A flicking sensation or pressure may be felt as the biopsy is taken. You may find the procedure uncomfortable, but you should not find it painful. If you feel any pain during the procedure, please inform the clinician carrying out the biopsy straightaway and further anaesthetic injections will be given.

What should I expect shortly after the biopsy?

After the biopsy we will check your blood pressure after which you can get up slowly and get dressed. It is important to take your time as you may feel lightheaded after the procedure. 

You may have an absorbent dressing applied to the biopsy area as there may be a small amount of bleeding from the puncture sites. 

If you feel faint or unwell just after leaving the biopsy room, please inform the nurse. We recommend that that you have a drink and/or something to eat prior to leaving the hospital.  We also advise that you have someone with you to drive you home after the biopsy. 

What should I look out for at home?

• You may feel discomfort in the perineum following the procedure which may last a couple of days. You can take regular analgesia such as paracetamol or your usual pain relief as directed on the packaging.
• Transient bleeding from the biopsy site in the perineum is possible.
• It is not unusual to have bleeding from the urethra (water pipe), urine or back passage for a few days. Drinking plenty of fluids can help this to settle quicker. Bleeding might occur in the semen which might last for few months if it does occur.
• The risk of urine infection is minimal (one in 100) which is why we don’t routinely give antibiotics prior to the biopsy procedure. If you develop pain on passing urine or offensive, smelly, or cloudy urine, these may be signs of a urine infection. Please contact your GP with a urine sample and you may require a short course of antibiotics.

Please go to your nearest Emergency Department if you experience any of the following:

• You develop a high temperature (above 38^oc), feel unwell, experience rigors or flu-like symptoms. This might represent a severe infection which might rarely occur (one in 1,000).
• Urine retention (five in 100) can occur up to a few days after the biopsy. If you are unable to pass urine despite bursting to do so, sometimes with associated lower abdominal pain, this might represent urine retention, and you have to visit the nearest emergency department to have a catheter fitted.

When can I go back to work?

You can usually go back to work one to two days after you have had the biopsies taken, but only if you feel ready to do so. You may find sitting for prolonged periods of time uncomfortable for the first few days.

When can I drive again?

It can take two to three days before you feel comfortable to drive. Before driving, you need to feel comfortable performing an emergency stop. 

How do I get the biopsy result?

The prostate biopsy result should be available usually within two to four weeks. If you have not heard anything after four weeks, please contact the Urology Department by emailing +urologysecretaries@dchft.nhs.uk or on 01305 253184.

We will contact you by letter, telephone or face to face in clinic. If you are offered a telephone or face-to-face clinic appointment to discuss the biopsy result, we advise you have someone with or accompanying you if possible.

Possible outcomes from the biopsy are:

• Clear result and recommendation to continue PSA monitoring either in hospital or with your GP.
• Need for repeat biopsy either under local or general anaesthetic.
• Finding of prostate cancer which needs monitoring only.
• Finding of prostate cancer which needs treatment. Sometimes, further scans might also be required.

Contact information

We hope that you have found this information useful. If you have any questions or are worried about anything, please speak to your family doctor (GP) or contact the Urology Department by emailing +urologysecretaries@dchft.nhs.uk or on 01305 253184.

About this leaflet

Author: Andy Goffe, Lead Nurse Consultant; Rotimi David, Consultant Urologist
Written: July 2023
Updated: January 2026
Review date: January 2029
Edition: v4

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk