This page explains what a transperineal biopsy of the prostate is. It gives information about the benefits and risks, and the care you can expect after the procedure. If you have any questions about the biopsy, speak to the team caring for you.
What is a transperineal prostate biopsy?
The prostate is a small gland, about the size of a walnut. It sits below the bladder and in front of the rectum. It makes the white fluid that mixes with sperm to form semen.
© Cancer Research UK [2002] All rights reserved. Information taken 04/02/2025
A prostate biopsy involves taking small tissue samples from the prostate using a needle. A specialist doctor (histopathologist) looks at these samples under a microscope to check for cancer.
During the transperineal biopsy, a doctor inserts the needle into the prostate through the skin of the perineum. The perineum is the area between the testicles and the back passage (anus).
The transperineal prostate biopsy can be done under local anaesthetic or sedation. If you choose to have a local anaesthetic, you will be awake but should only feel some discomfort. If you choose to have sedation, you will be asleep during the biopsy.
Why do I need a prostate biopsy?
A prostate biopsy helps to find out if prostate cells have become cancerous. If you already have prostate cancer, it can check if the cancer has changed. It can also help to diagnose other conditions, such as prostate growth that occurs with ageing or prostate inflammation.
Your doctor may recommend a prostate biopsy if:
- A blood test shows high levels of prostate-specific antigen (PSA). PSA is a protein made by the prostate. High levels can suggest cancer but can also be caused by other conditions.
- An MRI scan shows an abnormal area in the prostate.
- A previous biopsy found no evidence of cancer, but your PSA levels are still high.
- You have prostate cancer, but no treatment is needed yet. The biopsy helps to monitor the cancer.
- A lump or abnormality is found during a rectal exam.
What are the risks?
Every procedure has risks, but serious problems with a transperineal prostate biopsy are rare. Below are some common side effects you may have. They will affect each man differently and you may not get all of them.
- Infection – About 1 in 100 men may get an infection. You will have antibiotics during the biopsy to reduce this risk. If you develop a fever or feel a lot of pain when peeing, contact the prostate clinical nurse specialists (CNSs). If it is outside of usual office hours or at the weekend, call NHS 111. Sepsis, a life-threatening condition that develops when your body’s response to an infection damages vital organs, is very rare. It affects about 1 in 500 men. If you feel unwell with fever and tiredness a few days after a biopsy, go to your nearest Emergency Department (A&E).
- Blood in the urine – This is very common, affecting more than 10 in 100 men. Drinking plenty of fluids should help to clear it. If bleeding continues for more than five days, contact your CNS or GP. If your pee is the colour of red wine, you pass blood clots or you cannot pee, go to your local Emergency Department (A&E).
- Blood in semen – This is normal and most men experience it. You may notice blood in your semen for up to 3 months.
- Erection problems – This is uncommon, affecting less than 1 in 100 men. If you have a temporary difficulty getting an erection, this should improve on its own.
- Bruising – Perineum, the skin between the testicles and rectum, may bruise. This is very common, affecting more than 10 in 100 men, and usually fades within 2 to 4 weeks. Bruising of the scrotum is rare.
- Prostate swelling – In about 1 in 100 men, swelling may make it hard to pee. If this happens, contact your CNS or hospital doctor as you may need a catheter.
What happens if I choose not to have a transperineal prostate biopsy?
This depends on your circumstances. Your hospital doctor or CNS will talk to you about your options.
How do I prepare for the biopsy?
You can have the biopsy with local anaesthetic or sedation. Your doctor or CNS will discuss this with you.
If you choose local anaesthetic:
- You will be awake during the procedure.
- You can eat and drink as normal before the biopsy.
- You do not need someone to take you home.
- Continue to take your blood pressure or diabetes medication as normal.
- If you take aspirin 75mg, you can continue as normal.
- If you take other blood thinners (such as warfarin, clopidogrel, rivaroxoban or apixaban), talk to your hospital doctor or CNS about when to stop them.
- Try to do a poo before the biopsy.
If you choose sedation:
- You will be asleep during the procedure and may not remember it.
- You will need to fast: No food for six hours before the biopsy and no water for two hours before the biopsy.
- You will need someone to take you home and stay with you overnight. If this isn’t possible but you still want sedation, tell your CNS before the biopsy. You will need to stay in hospital overnight, and they will arrange it for you.
- You will have a pre-assessment appointment with a nurse to check your health. During the appointment, the nurse will also tell you if you should continue taking your medicines.
- Try to do a poo before the biopsy.
Asking for your consent
We want to involve you in decisions about your care and treatment. If you decide to go ahead with the transperineal prostate biopsy, we will ask you to sign a consent form. This confirms that you agree to have the biopsy and understand what it involves.
Before you sign, your doctor or CNS will explain the risks, benefits and alternatives. You will also have a chance to ask questions if you are unsure about anything.
What happens during the biopsy?
Before the biopsy, you will see a doctor or your CNS. They will make sure that you are ready for the procedure.
Once in the procedure room, staff will help you onto the procedure bed. You will lie on your back with your legs in stirrups. This position allows the surgeon to reach your perineum. If you are having sedation, you will receive it at this stage.
The surgeon will first examine your prostate through your back passage (anus). Then, they will gently insert a small ultrasound probe into your rectum, using gel to make this easier. The surgeon will see an image of your prostate on a screen, which will help them to guide the biopsy needle. You will receive an injection of local anaesthetic to numb the prostate and area around it. This helps to reduce pain during and after the procedure. You will also have an injection of antibiotic around the same time to lower your risk of infection.
The procedure may feel uncomfortable, especially if you are awake. Please tell your doctor if it’s very painful and they will give you more pain relief.
After the biopsies are taken, the surgeon will apply a firm dressing to the perineum and secure it with disposable underwear. Sometimes, a painkiller suppository (painkiller inserted in your bottom) is also given.
The transperineal biopsy takes about 20 to 30 minutes to complete.
What happens after the biopsy?
Your doctor or nurse will explain how the procedure went and discuss the next steps. Let them know if you feel any discomfort or pain.
You can go home the same day if you can pee normally. The surgeon will check on you before you leave.
If you had sedation:
- Someone must take you home and stay with you overnight. If there isn’t anyone to do that, you will need to stay in hospital overnight.
- You should not drive for 24 hours.
What to expect at home
Before you leave, we will give you a discharge summary. This contains important details about your biopsy and hospital stay. If you see your GP or another doctor within a few days of your biopsy, show them this summary.
To help your recovery, make sure to:
- Have 8 glasses of water per day for the first 2 days.
- Keep your bowel movements regular.
- Avoid heavy physical activity for the first 2 days.
It’s normal to have some discomfort when peeing for a few days after biopsy. You may also feel some discomfort in your perineum where the needle went in. Simple painkillers should help with that.
What should I look out for at home?
Contact your CNS or go to your local Emergency Department (A&E) if you:
- Have a fever or feel shivery.
- Feel unwell or very tired.
- Have symptoms of cystitis (frequent peeing and burning when peeing).
- Notice heavy bleeding in your pee, especially with clots of blood.
These could be signs of infection. If confirmed, you will need a course of antibiotics.
When will I get my biopsy results?
A team of specialists will review your biopsy results before deciding on any further treatment. You will usually receive your results within 1 to 2 weeks.
You and your GP will get a copy of the results and a summary of the discussion. Sometimes, we may need to arrange more tests, such as a bone scan, CT scan or PET scan. If needed, you will receive appointments for these tests.
Where can I get more information?
Prostate Cancer UK
Tel: 0800 074 8383
UCLH Macmillan Support and Information Service
Ground floor, University College Hospital Macmillan Cancer Centre, Huntley Street, London WC1E 6DH
Tel: 020 3447 8663
Email: uclh.
Macmillan Cancer Support
Tel: 0808 808 00 00
University College London Hospitals NHS Foundation Trust cannot accept responsibility for information provided by external organisations.
Contact details
Prostate Clinical Nurse Specialists (CNSs), Monday to Friday, 9am to 5pm
Contact through their support worker:
Tel: 07984 391124
Email: uclh.
Pathway Coordinator for admin queries (for example changing your appointment), Monday to Friday, 9am to 5pm
Tel: 020 3447 9194
Email: Uclh.
Out of hours, please contact your GP or go to your nearest Emergency Department (A&E).
Services
Page last updated: 12 March 2025
Review due: 01 March 2027