Prostate Cancer Diagnosis | Springwood, Brisbane
Transperineal Prostate Biopsy
Have you been referred for a prostate biopsy because of an elevated PSA or an abnormal prostate MRI?
A transperineal prostate biopsy is a procedure used to collect small tissue samples from the prostate to investigate possible prostate cancer.
The biopsy needle passes through the skin between the scrotum and anus, rather than through the rectal wall.
Southside Urology provides specialist prostate assessment, biopsy planning and discussion of pathology results and further management.
Prostate investigations | Specialist consultations in Springwood
Prostate tissue diagnosis
Samples are examined by a pathologist.
Through the perineum
Needle sampling avoids the rectal wall.
Local or other anaesthesia
May involve local, sedation or general anaesthesia.
Usually same-day discharge
Results are discussed at a planned follow-up.
Understanding Prostate Biopsy
What Is a Transperineal Prostate Biopsy?
A transperineal prostate biopsy is a procedure used to collect small samples of prostate tissue.
The prostate is a gland located below the bladder, surrounding the beginning of the urethra.
When there is concern about possible prostate cancer, a biopsy allows the tissue to be examined under a microscope.
Small biopsy needles are passed through the perineum, the area between the scrotum and anus.
Ultrasound imaging helps guide the needles. MRI information may also be used to target suspicious areas.
Reasons for Investigation
Why Might I Need a Prostate Biopsy?
A prostate biopsy may be recommended when other investigations raise concern about clinically significant prostate cancer.
Elevated PSA
PSA is a blood test used to help assess prostate cancer risk.
PSA may rise because of cancer, but also with benign enlargement, inflammation and other causes.
An elevated PSA does not automatically mean a biopsy is needed.
Suspicious Prostate MRI
MRI can identify areas that may represent clinically significant prostate cancer.
If a suspicious lesion is identified, targeted biopsy may be recommended.
Not every MRI abnormality proves to be cancer.
Other Concerning Findings
An abnormal prostate examination, PSA density, family history or other risk factors may contribute to a decision to biopsy.
In selected circumstances, a repeat biopsy may be considered after a previous negative result.
Not Every Elevated PSA Requires a Biopsy
The decision is based on your individual risk. PSA trends, age, prostate size, MRI findings, family history, examination and overall health may all be considered. In some patients, repeat PSA testing and monitoring are more appropriate than immediate biopsy.
Modern Prostate Diagnosis
How Does Prostate MRI Guide the Biopsy?
Prostate MRI is commonly performed before biopsy when clinically appropriate. It helps identify areas that may need targeted sampling.
MRI-Targeted Biopsy
If MRI identifies a suspicious lesion, biopsy samples can be directed towards that specific area.
Targeting may use MRI and ultrasound fusion technology or another accepted image-guided technique.
Regional or Systematic Sampling
Additional samples may be taken from surrounding prostate tissue or selected regions of the gland.
The sampling approach depends on the MRI findings and overall cancer risk.
PI-RADS MRI Score
A prostate MRI commonly reports a PI-RADS score from 1 to 5.
Higher scores indicate greater suspicion of clinically significant prostate cancer, but do not establish a diagnosis.
Can I Have a Biopsy With a Normal MRI?
Yes, in selected cases. A normal or low-suspicion MRI reduces the likelihood of clinically significant prostate cancer, but does not completely exclude it.
If PSA density or other clinical risk factors remain concerning, a biopsy may still be appropriate.
In lower-risk patients, monitoring rather than immediate biopsy may be recommended.
Before Your Procedure
How Should I Prepare for Prostate Biopsy?
Your treating team will provide specific instructions about anaesthesia, medications, infection screening and hospital arrangements.
Review Blood-Thinning Medication
Tell your team if you take warfarin, apixaban, rivaroxaban, clopidogrel, aspirin or other medicines that affect bleeding.
Do not stop these medicines without an individual plan from your treating team.
Check for Infection
Your team may request a urine test before biopsy, particularly if you have urinary symptoms or risk factors for infection.
Report fever, burning urine or other new symptoms before the procedure.
Confirm Anaesthesia & Fasting
Transperineal biopsy may be performed under local anaesthetic, with sedation, or under general anaesthesia.
Fasting is required for some forms of anaesthesia. Follow your facility's instructions.
Arrange Transport & Follow-Up
If sedation or general anaesthesia is planned, arrange transport and support after the procedure.
Confirm how your pathology results will be communicated and when your review will take place.
Will I Need Antibiotics?
Antibiotics are not automatically required for every transperineal biopsy. The approach has a lower infection risk than transrectal biopsy, and antibiotic use depends on your clinical risk factors and the treating facility's protocol. Follow the instructions given by your team.
The Biopsy Procedure
What Happens During Transperineal Prostate Biopsy?
The procedure uses image guidance to collect small tissue samples from selected areas of the prostate.
Anaesthesia & Positioning
Appropriate anaesthesia is provided.
You are positioned to allow safe access to the perineal skin.
Ultrasound Guidance
An ultrasound probe is commonly placed in the rectum to display the prostate in real time.
MRI information may help identify suspicious areas.
Tissue Sampling
A biopsy needle is passed through the cleaned perineal skin into the prostate.
Several small tissue samples are collected.
Recovery & Discharge
Samples are sent to pathology.
You are monitored after the procedure, including your ability to pass urine when appropriate.
How Are Different Areas of the Prostate Sampled?
The surgeon selects a sampling strategy according to your MRI and clinical findings. Not every patient has the same number of biopsies.
Targeted Cores
Samples are directed at specific areas identified as suspicious on MRI.
Regional Samples
Additional tissue may be collected from the area surrounding a suspicious lesion.
Systematic Sampling
Samples from other regions may be recommended based on clinical suspicion and biopsy strategy.
Will I Feel the Biopsy?
This depends on the anaesthetic used.
With local anaesthetic, you may feel temporary pressure, a tapping sensation or some discomfort during sampling.
Under general anaesthesia, you are asleep during the biopsy.
Your anaesthetist and urologist will discuss the most suitable approach.
After Your Biopsy
Recovery After Transperineal Prostate Biopsy
Most patients recover without significant difficulty. Mild bleeding and bruising are common during the early recovery period.
Recovery & Passing Urine
You are monitored after the procedure and anaesthesia.
Some patients experience mild perineal discomfort, burning when passing urine or blood in the urine.
Most patients return home the same day.
Temporary Bruising & Urinary Symptoms
You may experience bruising or discomfort around the perineum or scrotum.
Small amounts of blood in the urine and some urinary irritation may occur.
These symptoms usually improve as the tissues heal.
Blood in the Semen
Blood in the semen is common after prostate biopsy.
Semen may appear red, brown or rust-coloured.
This may continue for several weeks and sometimes longer.
Review Your Pathology Results
The biopsy samples are examined by a specialist pathologist.
Results are commonly reviewed within approximately one to two weeks, although timing varies.
Your urologist will explain the findings and next steps.
Returning to Work & Exercise
Many patients can return to light activities within a day or two, depending on comfort and anaesthesia.
Heavy lifting, cycling, running and strenuous exercise may need to be avoided for several days or longer according to your discharge instructions.
Driving, Fluids & Sex
After sedation or general anaesthesia, follow the hospital's driving restrictions, commonly at least 24 hours.
Drink fluids normally or as advised, especially if you have medical fluid restrictions.
Resume sexual activity when comfortable and permitted by your treating team.
Is Blood in the Semen Normal After Prostate Biopsy?
Yes. Haematospermia, or blood in the semen, is a common temporary effect of prostate biopsy. It may persist for several weeks and can look alarming, but usually settles without treatment. Discuss ongoing or worsening symptoms with your urologist.
Understanding Your Results
What Will My Prostate Biopsy Results Show?
The pathologist examines the tissue samples to determine whether prostate cancer or another abnormality is present.
Three Possible Categories of Findings
No Cancer Identified
The samples may show benign prostate tissue, enlargement or inflammation.
A negative biopsy is reassuring but does not exclude every possible prostate cancer.
Prostate Cancer Detected
If cancer is found, the report describes the grade and distribution of cancer within the samples.
These results help guide treatment and surveillance decisions.
Atypical or Uncertain Results
Some samples show unusual or uncertain changes requiring further review.
Your urologist will explain whether monitoring or further investigation is appropriate.
What Is Gleason Grade or ISUP Grade Group?
If prostate cancer is diagnosed, the pathology report describes how the cancer cells look under the microscope.
The Gleason system and ISUP Grade Groups help describe the biological aggressiveness of the cancer.
ISUP Grade Groups range from 1 to 5. Higher groups generally indicate more aggressive cancer characteristics.
The number and proportion of biopsy samples containing cancer also contribute to treatment planning.
What If My Biopsy Is Negative but PSA Remains High?
A negative result does not always end the investigation. Small or difficult-to-sample cancers can occasionally be missed by biopsy. Your urologist may recommend continued PSA monitoring, reassessment of MRI findings or further testing if clinical concern remains.
Safety & Informed Consent
What Are the Risks of Transperineal Prostate Biopsy?
Transperineal biopsy is an established diagnostic procedure with a relatively low infection risk. However, complications remain possible.
Bleeding & Bruising
Temporary bleeding is a common after-effect of biopsy.
- Blood in the urine
- Blood in the semen
- Perineal or scrotal bruising
- Minor bleeding from needle entry sites
- Rarely, significant bleeding or clots
Urinary Retention
Biopsy-related swelling, bruising or bleeding can temporarily affect urinary flow.
- Weak or slower urinary stream
- Difficulty starting urination
- Incomplete bladder emptying
- Occasionally inability to pass urine
Temporary catheterisation may be required if urinary retention occurs.
Infection
Infection risk is lower with transperineal biopsy than with transrectal biopsy, but is not zero.
- Urinary tract infection
- Prostate infection
- Rarely, severe infection or sepsis
Fever, shaking chills or feeling seriously unwell after biopsy requires urgent assessment.
Other Potential Complications
- Temporary perineal discomfort
- Temporary urinary irritation
- Occasionally temporary erectile difficulties
- Failure to detect a clinically significant cancer
- Possible need for repeat investigation
- Anaesthetic complications when applicable
Your urologist will discuss risks specific to your health and planned biopsy.
When to Seek Urgent Medical Attention
After prostate biopsy, seek urgent medical assessment if you develop:
- Fever, shaking chills or feeling seriously unwell
- Inability to pass urine
- Heavy bleeding or significant blood clots
- Severe or worsening lower abdominal or pelvic pain
- Persistent vomiting, confusion or severe weakness
Serious infection and urinary retention may require immediate hospital treatment. Do not wait for a routine appointment. Attend an emergency department or call 000 for a life-threatening emergency.
Common Questions
Transperineal Prostate Biopsy FAQs
What does transperineal mean?
Transperineal means the biopsy needle passes through the perineum, the skin between the scrotum and anus. It does not pass through the rectal wall.
Is transperineal prostate biopsy safer than transrectal biopsy?
Transperineal biopsy has a lower risk of infectious complications than transrectal biopsy. This is a major reason contemporary guidelines favour the transperineal approach. However, infection, bleeding and urinary retention can still occur.
Is prostate biopsy painful?
Discomfort depends on the anaesthesia used. Transperineal biopsy may be performed with local anaesthetic, sedation or general anaesthesia. Your treating team will explain what to expect.
Do I need a general anaesthetic?
Not always. Transperineal biopsy can be performed under local anaesthetic, but some patients receive sedation, spinal or general anaesthesia. The choice depends on the biopsy plan, facilities and individual circumstances.
Is the ultrasound probe inserted into the rectum?
Often, yes. The ultrasound probe provides images used to guide the biopsy. However, the needle itself passes through the perineal skin rather than through the rectal wall.
Do I need a prostate MRI before biopsy?
Prostate MRI is generally recommended before biopsy when investigating suspected organ-confined prostate cancer. Exceptions exist, and your urologist will recommend the appropriate pathway.
What if my MRI shows a PI-RADS 3 lesion?
PI-RADS 3 indicates an indeterminate MRI finding. The decision to biopsy depends on other factors including PSA density, family history and overall cancer risk. Some men can be monitored, while others benefit from targeted sampling.
How many biopsy samples will be taken?
The number depends on the prostate MRI, size of the gland, previous biopsies and sampling strategy. Targeted, regional and systematic samples may be used. There is no single number appropriate for every patient.
Will I need antibiotics?
Not necessarily. The transperineal approach carries a lower infection risk, and antibiotics may not be needed in patients without additional infection risk factors. Follow your hospital and surgeon's protocol.
Will I see blood in my urine afterwards?
A small amount of blood in the urine is common after biopsy and usually settles. Heavy bleeding, clots or inability to pass urine require urgent medical assessment.
How long does blood in the semen last?
Blood in the semen may remain visible for several weeks and occasionally longer. It may appear bright red, brown or rust-coloured. This usually settles without treatment.
Can prostate biopsy cause urinary retention?
Yes. Swelling and bleeding after biopsy can occasionally prevent normal bladder emptying. Some patients require a temporary urinary catheter. Complete inability to pass urine is an emergency.
Can I go home on the same day?
Most transperineal prostate biopsies are performed as day procedures. Hospital admission may occasionally be required because of medical factors or complications.
When can I drive after prostate biopsy?
If you receive sedation or general anaesthesia, follow the facility's driving restrictions, commonly at least 24 hours. Driving advice may differ when local anaesthetic alone is used.
Can I return to work the next day?
Some patients can return to sedentary work within a day or two. Jobs requiring heavy lifting or strenuous activity may require additional recovery. Follow your discharge instructions.
Will a prostate biopsy spread cancer?
Prostate biopsy is an established method of diagnosis. Needle-tract spread of prostate cancer is exceptionally rare and is not ordinarily a reason to avoid a clinically indicated biopsy.
When will my biopsy results be available?
Results commonly take several working days to approximately one or two weeks. Additional pathology testing may take longer. Your treating team will explain the review arrangements.
What is a Gleason score?
A Gleason score describes how prostate cancer cells appear under the microscope. It is used alongside ISUP Grade Groups, PSA and other findings to assess cancer risk and guide treatment decisions.
Does a positive biopsy mean I need surgery?
No. Not every prostate cancer requires immediate treatment. Some lower-risk cancers can be managed with active surveillance. Other patients may consider surgery, radiotherapy or alternative treatments according to risk.
Does a negative biopsy rule out prostate cancer?
A negative biopsy is reassuring, but no sampling procedure can completely exclude a small or missed cancer. Further PSA monitoring or investigation may be appropriate if clinical concern remains.
What should I bring to my appointment?
Bring your GP referral, PSA results, prostate MRI report and imaging if available, medication list and previous prostate biopsy or treatment records. Information about family history is also useful.
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Southside Urology | Springwood
Need Assessment for an Elevated PSA or Abnormal MRI?
Contact Southside Urology about a specialist consultation for elevated PSA, suspicious prostate MRI findings or prostate biopsy assessment.
Your urologist can review the investigations and discuss whether biopsy, monitoring or further testing is appropriate.
Suite 7/2 Murrajong Road, Springwood QLD 4127.