Transperineal Prostate Biopsy for Prostate Cancer

Our Approach to Transperineal Prostate Biopsy

A prostate biopsy is a key step in confirming a possible diagnosis of prostate cancer. It involves using thin needles to take small samples of prostate tissue, which are then examined by a pathologist for histology (tissue) and possible genetic testing. A biopsy may target specific suspicious areas of the prostate (targeted biopsy) with MRI fusion, or take samples from different areas of the prostate (systematic biopsy).

Currently, the overwhelming majority of prostate biopsies are done using the transrectal ultrasound-guided (TRUS) technique. This approach will pass the needle through the wall of the rectum which may be complicated with bleeding, infection, and sepsis. Importantly, it is becoming more common for a transperineal (TP) technique to be used. This approach passes the needle instead through the perineum, which is the skin behind the scrotum, thereby avoiding the rectum and greatly minimizing the aforementioned risks.

In the Greater Toronto Area, we offer the first Outpatient Rapid Access Transperineal Prostate Biopsy Program (+/- MRI fusion) under local anesthesia. This is an OHIP covered procedure which will require a referral from your family physician.

What We Offer You With Rapid-access Transperineal Prostate Biopsy Program

Committed to the safest and highest quality care

In addition to prostate biopsy, we also offer Prostate Cancer Precision Diagnostic testing and multi-disciplinary prostate cancer treatments to include Nanoknife focal therapy, surgery, radiation treatment, and advanced prostate cancer program.

State-of-the-art technology

We offer advanced prostate-dedicated imaging platforms with systematic and MRI fusion biopsy options for diagnosis and treatment planning. When indicated, specialized tissue and genomic testing is available.

Multi-disciplinary team of specialist experts

Including doctors who have specialty training in prostate diagnostic procedures and MRI prostate imaging. We are a high volume biopsy program, with over 2000 prostate biopsies performed to date.

What Is Transperineal Prostate Biopsy?

Benefits of Transperineal Prostate Biopsy

Near zero risk of infection or sepsis
No need for pre-procedural antibiotics or enema
Reduced risk of complications (blood in urine, urinary retention, rectal bleeding)
Improved sampling of the prostate and improved cancer detection rate

When is Transperineal Prostate Biopsy indicated?

Transperineal ultrasound prostate biopsy (TP prostate biopsy) is performed in men with a suspicion of prostate cancer. This suspicion may be due to an elevated prostate specific antigen (PSA) blood test, elevated risk result on prostate cancer biomarker testing, abnormal examination, or recommendation as per prostate imaging findings.

Transperineal biopsy is appropriate for all patients, but may specifically benefit patients with the following conditions:

History of infection after a previous transrectal biopsy
History of prostatitis
Inflammatory bowel disease
Rectal bleeding complications after previous biopsy
Previous negative transrectal biopsy with suspicion of anterior prostate tumor

Learn more about prostate cancer Here.

Risks of Transperineal Prostate Biopsy

Blood in the urine which may last up to several days (Almost all men)
Blood in the ejaculate which may last up to 6 weeks (Almost all men)
Difficulty passing urine (1 in 20 men)
Urine infection (1 in 100 men)
Blood infection (1 in 1000 men)

What to Expect with Transperineal Prostate Biopsy

BEFORE

Before the Procedure:

You may eat and drink normally before the biopsy however avoid having a heavy meal before the procedure
You may take your regular medications, except for blood thinners as per direction by your doctor
You will be prescribed an inhaler called Penthrox (methoxyflurane), a rapid-acting, pain-relieving medication, that will be used during your biopsy. You will be provided with instructions on how to use the inhaler immediately before your biopsy procedure. Penthrox is not appropriate for patients with severe kidney disease, severe liver disease, or history of malignant hyperthermia.

DURING

During the Procedure:

You will need to lie on your back with your legs placed in stirrups for support
The doctor will then insert an ultrasound probe into the rectum
Additional local anesthetic will be administered by injection to further numb the prostate
Prostate biopsies are taken through the perineum with a minimum of 12 samples taken

AFTER

After the Procedure:

Pain: You may experience some mild discomfort. This can usually be controlled with acetaminophen (Tylenol).
Diet: You will be able to eat your normal diet before and after the biopsy.
Activity: Heavy lifting (more than 10-20 pounds), running and vigorous exercise should be avoided for 1 week after your biopsy. Sexual activity should be avoided for 1 week.
Work: Most people can return to work the day after the biopsy.
Antibiotics: Antibiotics are usually not required following transperineal prostate biopsy.
Follow-up appointment: You will need an appointment to visit your Urologist several weeks after your biopsy to review the results. Please call your urologist to schedule this appointment if it has not been done prior to your biopsy.

Our Centre

We offer a central location north of Toronto, conveniently located near Hwy 7 and Hwy 404 in Richmond Hill, Ontario.

Treatments and consultations are performed on an outpatient basis in a new private, modern clinic setting with easy-to-access free underground/ surface parking with direct access by VIVA public transit or car. We are adjacent to hotel facilities (Sheraton Parkway Toronto, Courtyard and Residence Inn by Marriott, and Hilton Garden Inn) for our out-of-town patients and their families.

Our center is also fully accessible to individuals with disabilities.

Transperineal Prostate Biopsy for Prostate Cancer