Transperineal (TP) biopsy
Doctors use a TP biopsy test to diagnose prostate cancer. They take samples of tissue from the prostate gland to look for cancer cells.
What is a transperineal (TP) biopsy?
If a rectal examination and PSA tests show there is a possibility of prostate cancer, your doctor may talk to you about having a transperineal (TP) biopsy.
During a TP biopsy, samples of the prostate are taken through the perineum. This is the area between the scrotum and the back passage (anus). A doctor called a pathologist looks at the samples under the microscope to check for cancer.
Before a prostate biopsy
Before the biopsy, your doctor will talk with you about the benefits and disadvantages and explain possible risks, such as infection. You will usually be given information to take away and read. It is important you have all the information you need to decide about having the biopsy before you agree (give consent). We have more information about talking to your healthcare team and asking questions.
A prostate biopsy is usually done as an outpatient. But sometimes people go into hospital and have the biopsy under a general anaesthetic, which means they are not awake when they have it. Or they may have a spinal anaesthetic, which is an injection of anaesthetic around the spine. This numbs them from the waist down to have the biopsy.
To reduce the risk of an infection, your doctor or nurse may give you antibiotics before the biopsy and when you go home.
Having a TP biopsy
To have a TP biopsy, you lie on your back and the nurses place your legs in special supports (stirrups) to help the doctor reach the prostate. The doctor may place tape over your scrotum to move it out of the way for the procedure. They will do a digital rectal examination before they gently pass a small ultrasound probe into the rectum using lubricating gel. This shows an image of the prostate on a screen. The images from your MRI scan may also be used.
The doctor uses an antiseptic liquid to clean your perineum and then injects the area with local anaesthetic. This helps reduce any pain or discomfort. A special grid is placed on the perineum. This is called the template. The doctor then passes a needle through the grid into the skin of the perineum.
The doctor can take many small tissue samples from different areas of the prostate using the ultrasound scan and results of your MRI scan (template biopsy). They may take samples from a specific area of the prostate (targeted biopsy) or from the whole prostate. The number of samples taken will depend on your PSA, the size of your prostate and mpMRI scan results.
After the biopsy, the doctor places a dressing over the perineum. A TP biopsy usually takes around 30 to 45 minutes.
Having a TP biopsy
What to expect after a TP biopsy
You can usually go home the same day, but if you had a general or spinal anaesthetic, you may stay in hospital overnight. You may have a tube to drain your pee (urine) while you recover. This is called a catheter. It will come out the same day or the next morning.
It is important to drink plenty of fluids after the test. The nurses can advise you as to how much, and for how long.
When you go home, it is important to follow the advice your doctor or nurse gave you. The nurses should tell you what to expect as your recover. They can talk to you about getting back to your usual activities, such as exercise, sex, work or driving.
If you are unsure about anything, ask questions for more information. Ask who you should call if you have any questions or concerns after you go home.
You will be given a discharge letter. A copy will also be sent to your GP. You may be given some antibiotics to take to help prevent infection.
You may have some pain or discomfort after the procedure. This is bruising from where the samples are taken. Taking painkillers can help – for example, ibuprofen. Check with your doctor which painkillers are suitable for you.
You may have a small amount of blood in your pee for up to 2 weeks. You may also see blood in your semen for a few weeks.
Drink plenty of fluids like water to help reduce the risk of a urine infection. Contact your GP if you have pain passing urine (peeing) or your pee is cloudy or smelly.
Contact a doctor straight away if you:
- have a lot of bleeding
- feel shivery with a temperature over 37.5°C (99.5°F)
- have difficulty passing urine even though you are drinking lots.
Your test results
It can take 2 to 4 weeks to get the results of a biopsy. When your results are ready, you will have an appointment with your urologist. You may also meet a specialist nurse. It may be helpful to take someone with you to this appointment. This can help you to remember what was said. You might also like to write down any questions you have.
Related pages
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
National Institute for Health and Care Excellence (NICE). Prostate cancer: diagnosis and management. NICE Guideline [NG131]. Published: 09 May 2019. Last updated: 15 December 2021. Available from: www.nice.org.uk/guidance/ng131 [accessed March 2024].
Castro E, Fizazi K, Heidenreich A, Ost P, Parker C, Procopio G, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2020; 31(9): 1119–1134. Available from: www.annalsofoncology.org/article/S0923-7534(20)39898-7/fulltext [accessed March 2024].
Reviewer
Consultant Medical Oncologist & Honorary Associate Professor
University College Hospitals, London
Date reviewed
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