What Is A Transperineal Prostate Biopsy
While that video is very informative, I thought it would still be helpful to write about my LATP from a patient’s perspective . Of course, the web has lots of professional articles and videos about the technical aspects of this procedure, so I have put links to some of them at the end of the article.
Just to be clear, a transperineal prostate biopsy is when a medical professional removes multiple tissue samples from your prostate using a special needle inserted in the area between your rectum and your scrotum, aided by an ultrasound probe inserted in your back passage to visualize the process.
This is usually performed with a local anaesthetic rather than knocking you out . Here’s a diagram, taken from the video above:
If you’ve googled “prostate biopsy” or watched the video above, you’ve probably noted that the transperineal prostate biopsy is a relatively new approach compared to the traditional method known as TRUS or transrectal ultrasound guided biopsy. As you can see from the diagram below, TRUS involves inserting both the ultrasound transducer and the sampling needle through the anus, then piercing the wall of the rectum to get the samples.
The TRUS procedure carries greater risk of causing infection because it pokes holes in area used to store fecal matter. TRUS also has a narrower range of access to the prostate, as noted in the video at the top of this article. In other words, as a patient, if you have a choice, I’d say go transperineal: LATP rather than TRUS.
What Are The Advantages Of The Mri Fusion Transperineal Prostate Biopsy
- MRI fusion transperineal prostate biopsy allows for the collection of a large number of samples efficiently and accurately
- Enables the entire prostate gland to be sampled to visualize cell changes:
- Allows for the diagnosis of prostate cancer
- In cases where prostate cancer has been diagnosed, allows to check for any changes
What Happens During Surgery
You will need to fast prior to your procedure. A general or spinal anaesthetic will be administered before surgery commences. Next the ultrasound probe will be inserted into the rectum, with a biopsy guide placed over the skin over the perineum. A core biopsy needle will then be inserted through this skin. The needle will be guided to the target area with the assistance of the ultrasound probe. A core biopsy will then be taken. This process will be repeated until a tissue sample has been collected from all areas of the prostate.
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Back To Work After Prostate Biopsy
My urologist wants me to have a transrectal prostate biopsy. I’m wondering what the recovery time will be like and if I will be able to go back to work that day or just take the whole day off? He makes it sound like no big deal, 10 minute procedure.
0 likes, 23 replies
Posted 4 years ago
I’ve had two of these without unexpected incident. The first was with me being fully conscious with just some lidocaine but the second was with general anesthetic. Presuming yours is to be more like the first, I’d advise you to have the whole day off. Perversely, I think I took longer with initial recovery with the first because I experienced a mild shock reaction similar to having a filling at the dentist..
Posted 4 years ago
M husband had a general anesectic so you are told not to drive for 48 hours. As his a driving instructor he had to lose two days work as although he felt ok, he couldnt risk his job if there was an accident
Posted 4 years ago
I walked out after mine and onto the bus home. OK, I waddled a bit and declined the generous offer of a seat on the bus, explaining to the would-be seat donor that if she had had what I’d just had done, she would know why I preferred to stand -)
I didn’t go back to work next day, nor forever thereafter, but only because I am retired. Had I still been of working age, I might have taken the next day off but it wouldn’t have been essential.
…. and, hey, why did that lovely young lady offer me a seat at all? Do I look that decrepit?????
How To Get The Best Results
Most men do not find prostate biopsy excessively painful or uncomfortable, and the complications are usually not seriousbut can be. Certain steps taken before, during, and after the procedure can improve the outcome:
Take antibiotics. Taking preventive antibioticsbefore and after the procedurecuts the risk of infection substantially. Most infections are not dangerous but could become so if they get out of control. The overall chance of being hospitalized with an infection after prostate biopsy is 1% to 3%.
Review medications. Before the biopsy, your doctor may advise you to stop taking daily low-dose aspirin or an anticoagulant such as warfarin , dabigatran , edoxaban , rivaroxaban , or apixaban . These drugs reduce the blood’s ability to clot. Your doctor will weigh the chance of bleeding against the need for anticoagulants to prevent heart problems or stroke.
Expect anesthesia. Get local anesthesia for the biopsy. This means an injection of a numbing drug into the prostate gland to reduce pain during the biopsy.
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How To Make Your Prostate Biopsy Go Better
Before a prostate biopsy, discuss all thesteps you or your doctor can take to makethe experience as comfortable, safe, andinformative as possible.
Here is what men need to know to minimize discomfort of a prostate biopsy and get the best results.
Many men choose to have prostate-specific antigen blood tests to check for hidden prostate cancer, despite the uncertain benefits. Having an abnormal PSA test result often leads to a prostate biopsythe only way to confirm the presence of cancer. Biopsies are invasive, but they have become routine.
To reduce discomfort and get the best results, discuss the procedure in detail with your doctor. Certain practices can improve the overall outcomefor example, make sure you get a shot of anesthetic into the prostate to numb pain during the procedure. “Local anesthesia makes a world of difference between having a tolerable biopsy experience and an unpleasant one,” says Dr. Marc B. Garnick, Gorman Brothers Professor of Medicine and a prostate cancer expert at Harvard-affiliated Beth Israel Deaconess Medical Center.
When Should You Speak To Your Gp About A Transperineal Biopsy
If your GP suspects there is a possibility you may have prostate cancer, they will discuss your options with you, including having a prostate biopsy to test for prostate cancer.
Speak to your GP if you have any of the following symptoms which can be an indication of prostate cancer:
- The need to pass urine more often, especially during the night
- An urgent need to pass urine
- Difficulty in starting to pass urine
- A weak flow or trickling when you pass urine
- A feeling that you havent emptied your bladder even though youve just been to the toilet
- Blood in your urine or semen
However, most men with localised prostate cancer dont have any symptoms, and have a high prostate blood test called prostate specific antigen .
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What To Watch For Afterward
Here are the most common complications of prostate biopsy:
- Pain in the area between the anus and scrotum for a few days to a week.
- Blood in your urine for a few days to several weeks.
- Blood in the stool for a day or so. If it lasts longer, notify your physician.
- Blood in the semen for three to six weeks, and possibly longer.
Make sure to notify your doctor if rectal or urinary bleeding get worse. Also, be on guard in the first 24 to 48 hours for signs of a serious infection in the urinary tract or prostate gland. “The alarm signs are fever or chills,” Dr. Garnick says. “If you experience this, get to a hospital immediately for intravenous antibiotics.” A runaway infection can be dangerous, so don’t ignore the signs.
Another uncommon but dangerous complication is urinary retentionthe inability to pass urine caused by an infection. Seek care immediately if you stop being able to urinate after a biopsy.
A Major Clinical Event Following Transperineal Prostate Biopsy: An Unexpected Duodenal Perforation
A 73-year-old Caucasian male underwent an ultrasound-guided transperineal prostate biopsy in an outpatient setting. Prostate cancer was suspected because of persistently rising prostate-specific antigen levels. The procedure was concluded early because the patient complained of extreme discomfort after the transrectal probe was inserted. After less than an hour, the patient described an acute abdominal pain that began suddenly after completion of the biopsy. Results of a computed tomography scan led to an emergency exploratory laparotomy. This procedure revealed a small duodenal perforation that was caused by a peptic ulcer and immediately repaired. The major clinical event of duodenal perforation following the execution of a transperineal prostate biopsy posed an immediate diagnostic challenge. The closely related timing of these 2 distinct and unlinked events represents the most unusual aspect of the case. It is a reminder that a concurrent disease always has to be considered and excluded despite the temporal closeness of reckoned occurrences.
KEYWORDS: Transperineal prostate biopsy Peptic duodenal perforation Complication
CORRESPONDENCE: Dr. Rafael Boscolo-Berto, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Via Giustiniani 2, 35100 Padua, Italy .
Transperineal Biopsy Procedure
Correct Diagnosis: Duodenal Peptic Ulcer Perforation
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What Is A Transperineal Biopsy
This is where the doctor inserts the biopsy needle into the prostate through the skin between the testicles and the back passage . In the past, hospitals would only offer a transperineal biopsy if other health problems meant you couldnt have a TRUS biopsy. But many hospitals have stopped doing TRUS biopsies and now only do transperineal biopsies.
A transperineal biopsy is normally done under general anaesthetic, so you will be asleep and wont feel anything. A general anaesthetic can cause side effects your doctor or nurse should explain these before you have your biopsy. Some hospitals now do transperineal biopsies using a local anaesthetic, which numbs the prostate and the area around it, or a spinal anaesthetic, where you cant feel anything in your lower body.
The doctor will put an ultrasound probe into your back passage, using a gel to make this easier. An image of the prostate will appear on a screen, which will help the doctor to guide the biopsy needle.
If youve had an MRI scan, the doctor may just take a few samples from the area of the prostate that looked unusual on the scan images. This is known as a targeted biopsy.
What Can I Expect After The Procedure
- Urethral bleeding most men do pass a small amount of blood in the urine or leak blood from their penis after this procedure for up to 4-6 weeks.
- Haematospermia blood in the semen or dark staining of the semen can persist for up to 3 months after the procedure. There is nothing to be concerned about and sexual activity can continue as normal.
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Why Is A Prostate Biopsy Done
A prostate biopsy is done to screen for prostate cancers. This is to confirm whether cancer is present, or if a prostate cancer diagnosis is aggressive. In a prostate biopsy, small samples of the prostate are removed and then observed under the microscope. Doctors usually recommend a biopsy of the prostate gland based on certain findings.
- If prostate-specific antigen blood test results are higher than the average age
- If the doctor detects signs of a prostate problem during a digital rectal exam
- If a biopsy is the only method to confirm the cancer
A prostate biopsy involves:
- Collecting minute samples of the prostate gland. A computed tomography or magnetic resonance imaging scan is also used to guide them through the procedure.
- A prostate biopsy takes about 10 minutes and is usually done in the doctors office. The samples will be sent to a lab and will be looked at under a microscope to see if they contain cancer cells.
- If cancer is detected in the patient, it will also be assigned a grade. The results are available after one to three days, but it can sometimes take longer.
A prostate biopsy may be done in several different ways which may include:
What To Expect After An Mri Fusion Transperineal Prostate Biopsy
- You will be able to go home on the same day following your procedure
- You may have some light bleeding in the perineal area, which is easily managed with gentle pressure
- You may feel some discomfort in the area for a day or two following the procedure
- Some patients notice a small amount of blood in their urine or ejaculate in the days following the procedure, but this usually goes away within a week or so
- Very rarely, the temporary inability to pass urine occurs this can be fixed by temporary placement of a urinary catheter.
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What Is Benign Prostatic Hyperplasia
In January of 1999, a urologist in Maryland diagnosed me having BPH or Benign Prostatic Hyperplasia. This diagnosis was based on a digital rectal exam and the results of a prostate biopsy.
Based on an article in urologyhealth.org, BPH is an enlarged prostate. As men age, BPH often happens during the second growth state of the prostate which starts at about age 25. The first growth stage occurs early in puberty.
As the prostate gets bigger, it can squeeze down on the urethra. This narrowing of the urethra and accompanying urinary retention cause many of the problems related to BPH. Although BPH is benign, BPH and cancer can occur at the same time. About 50 percent of all men in their 50s have BPH. Over the age of 80, up to 90 percent of men suffer from BPH.
What Are Some Common Uses Of The Procedure
A prostate biopsy is currently the only way to definitively diagnose prostate cancer. It also helps differentiate cancer from benign prostatic hyperplasia or nodular enlargement of the prostate, a very common condition in middle-aged and older men that requires a different treatment approach than that of cancer.
A prostate biopsy may be ordered if the physician detects a nodule or other abnormality on the prostate during a digital rectal examination , a common prostate cancer screening test.
A biopsy also may be ordered when a blood test reveals elevated levels of prostate-specific antigen. While there are several reasons for an elevated PSA level, higher PSA levels are sometimes associated with cancer. PSA trends over time may trigger your physician to order a biopsy.
MRI-guided prostate biopsy may be used in patients who have a rising PSA level yet a negative ultrasound-guided biopsy. It also may be used in situations where a diagnostic prostate MRI performed due to rising PSA demonstrates a very small abnormality that may not be easily targeted by ultrasound. MRI is also useful in patients who have previously undergone a biopsy and want to improve the sensitivity of the procedure and the precision of the biopsy.
A biopsy not only detects cancer it also provides information on the aggressiveness of the cancer and helps to guide treatment decisions.
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What Does A Prostate Biopsy Involve
If you decide to have a biopsy, youll either be given an appointment to come back to the hospital at a later date or offered the biopsy straight away.
Before the biopsy you should tell your doctor or nurse if youre taking any medicines, particularly antibiotics or medicines that thin the blood.
You may be given some antibiotics to take before your biopsy, either as tablets or an injection, to help prevent infection. You might also be given some antibiotic tablets to take at home after your biopsy. Its important to take them all so that they work properly.
A doctor, nurse or radiologist will do the biopsy. There are two main types of biopsy:
- a trans-rectal ultrasound guided biopsy, where the needle goes through the wall of the back passage
- a transperineal biopsy, where the needle goes through the skin between the testicles and the back passage .
Transrectal Or Transperineal Prostate Biopsy
At present, my doctor is trying cipro on me to try and reduce my recent spiked PSA down from 13 back to its usual 2.4. My MRI provided a PIRAD 2 score, with no lesions or Gleason 4 or 5 evident. My doctor said “we” may need to consider a prostate biopsy. So…a bit of research indicates they come in two distinct types:
1. Transrectal – the most common version, though prone to urinary infections, some very serious afterwards.
2. Transperineal – the least used, though best for finding difficult to find PCa, and virtually no infections afterwards.
From a little research, it appears the medical profession use the transrectal method 97% of the time. This means one to 25 biopsy needles will be inserted through the rectum wall into the prostate. The procedure usually takes 15-25 minutes. The biopsy if blind, meaning a 12-16 needle gun will punch holes through the rectum into the prostate. If the biopsy is guided via MRI or ultrasound, then a single needle, one at a time, is used. Usually, the guided method requires less needle samples because the lesion to test is seen.
This inevitably means faecal matter from the bowel is often inserted deep into the prostate. This in turn can lead to serious infections, including sepsis requiring a hospital stay, and can be life threatening. To reduce the chance of infections, patients are given some sort of course of antibiotic prior, during and after the biopsy. This often does not prevent infection.
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