Transperineal MRI-Guided Prostate Biopsy

Many men are advised to be screened annually or every other year for prostate cancer. Screening may consist of a blood test, prostate-specific antigen (PSA) and digital rectal exam (DRE). If the patient has a confirmed elevated or rising PSA, or an abnormal DRE, the next step is often to proceed with a prostate biopsy.

The overwhelming majority of prostate biopsies are conducted trans-rectally. This approach unfortunately brings several risks – Infections continue to be the greatest risk associated with trans-rectal prostate biopsies; the risk of sepsis, a severe life-threatening infection, is approximately 1 to 2 in 100. In addition, some areas of the prostate, including the anterior prostate, are under-sampled with a systematic trans-rectal approach, which means that some clinically significant prostate cancers may be missed. Both of these problems can be addressed by performing the prostate biopsy via a transperineal approach.

Transperineal MRI-Guided Prostate Biopsy at Kingston Men’s Health Clinic

In transperineal biopsy, the urologist passes the biopsy needle through the perineal skin and into the prostate, rather than passing the biopsy needle through a potentially contaminated rectum. The biopsy needle is still guided by an ultrasound placed in the rectum. This approach lowers the risk of sepsis to 1 in 500, rather than the approximate 1 to 2 in 100 risk of sepsis related to trans-rectal biopsy.

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

• History of infection after a previous trans-rectal biopsy
• History of prostatitis
• Inflammatory bowel disease
• Rectal bleeding complications after previous biopsy
• Previous negative trans-rectal biopsy with suspicion of anterior prostate tumour

Studies show a higher detection rate with the transperineal approach. The main benefit is safety, due to the lower risk of severe life-threatening infection. Also, with a transperineal approach it is much easier to access the anterior prostate, which is not well sampled with trans-rectal biopsy.

Contact MHC Kingston, to arrange a consultation to discuss the possibility of a transperineal MRI-Guided Prostate Biopsy.