Transperineal biopsy vs. transrectal ... - Prostate Cancer N...

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Transperineal biopsy vs. transrectal biopsy


I have Gleason 6 prostate cancer (2 cores - 1% and 3% - of 14) and have been on AS since 2017. A recent MRI revealed a PIRADS-3 lesion, and the doctor at MSKCC would like to move ahead with a transperineal biopsy targeting a specific region.

Up to this point, I have only had transrectal biopsies.

If anyone has some experience with transperineal biopsies and could share some perspective, that would be greatly appreciated.... especially comparisons between the two.

I know this type of biopsy requires anesthesia.

Thanks very much in advance for any replies!

16 Replies

They can do a nerve block instead of general anesthesia. The top centers are all moving to transperineal because of the lower risk of infection.

cesces in reply to Tall_Allen

Interesting. Infection was a long time known risk.

Why only now are they switching to transperineal do you think?

Tall_Allen in reply to cesces

Sepsis rates increasing.

cesces in reply to Tall_Allen

That's even more intriguing... as to what would cause an increase in sepsis rates over a 10 to 20 year period of time.

I guess they are making more punctures by taking more samples now.

dentaltwin in reply to cesces

Greater sepsis--some of it related no doubt to antibiotic resistance. They usually seem to be using fluoroquinolones, which have their own set of potential problems (though the use in biopsy is short-term).

Tall_Allen in reply to cesces

Resistant e. coli mostly

cesanon in reply to Tall_Allen

hmmm... not a good sign that this has changed so much in the last 10 to 20 years.

My biopsy was a targeted trans perineal biopsy done under general anaesthesia. In my case no problems at all post biopsy, other then obvious blood in my ejaculate, which cleared pretty quickly. No pain as such, slight discomfort at the perineal site. No antibiotic coverage required. Day off work on the day of the procedure and the next day. Needed to fast from midnight, early morning procedure, home post recovery ward. I’m in Australia so covered by our public health system, no out of pocket expenses. Gleason 6. PIRADS 4. 80% in two cores, 5% in one other. Active Surveillance.

Hope it all goes well for you.

I had a transperineal biopsy without general anesthesia and only local. It wasn't particularly painful on the table, though had I been given the option of a general, i might have taken it because the ultrasound wand in the rectum for 20 minutes is not that much fun. There was blood in the urine for about 36-48 hours. Some mild pain afterwards but it cleared up after a a few days. I would take the following day off of work, but I probably could have worked the following day if absolutely necessary.

I've had 2 Saturation Transperineal 3Dimension Prostate MAPPING Biopsies, first yielding 100+ core samples and 2nd only needing 64 core samples. Done under General, using a Brachy Grid for needle insertion with Ultrasound. Performed by Dr. Gary Onik

Not what you asked about, just wonder if you are aware of >>>

Hey addicted2cycling!

Dr. Onik is in many ways ahead of other doctors. The fact is, some areas of the prostate aren't accessible or are difficult to biopsy unless a transperineal biopsy is used.


Thanks very much for all the replies and info!

Hey Hope4Happiness!

If a drug is used as a prophylactic to prevent sepsis insist on Cefdinir or Rocephin rather than any of the fluoroquinolone drugs such as Cipro and Levaquin. Fluoroquinolones can cause nightmare adverse reactions including aortic aneurysms. As T_A noted, the risk of infection is greatly reduced. A betadine cleansing on the outside maybe.

The transperineal biopsy can also reach areas of the prostate that are difficult to biopsy or can't be biopsied with the transrectal. That is another important reason the top docs are switching to transperineal biopsies.

A link:


Transrectal or transperineal biopsy: which is best ...


An excerpt:

"In addition, perhaps the biggest downside of the transrectal approach is that it is harder/impossible to reach the part of the prostate (the anterior, or frontal aspect) that is furthest away from the biopsy needle. This leads to poor ‘sampling’ – in that the tissue samples collected by the needles may miss any cancer found in this part of the prostate, leading to an inaccurate biopsy. Playing devil’s advocate, you could imagine that in a worst-case scenario cancer is present in the anterior portion while no cancer is present in the other parts of the prostate. A transrectal approach might miss the cancer in the anterior, with the biopsy coming back clear from the other parts of the prostate. In essence, all parts of the prostate need to be sampled completely for the most accurate biopsy result."


I've had both types of biopsies. The transrectal was painful and left me with ongoing pain for about 6 months. Took only about an hour though from the time I walked in the door till I walked out. The transperineal one was under general anesthesia and I was there a total of about 5 hours. No pain, no infection, found a lesion that was Gleason 7 closer to the middle of my prostate that a transrectal biopsy would have likely missed, and my urologist was able to do a cystoscopy at the same time which aren't too pleasurable if you are awake. I figure you can guess which was my favorite way to biopsy! I wish you the best.

I received a transperineal biopsy and was denied anesthesia except for a local that had little or no effect. I would highly recommend that you insist on anesthesia, whether a nerve block, deep sedation, or nerve block. It hurt like hell without any significant pain control. Yeah, it's over in 15 minutes and you just move on from there, but there's no reason to endure the pain.

Very much appreciate all the replies! I've scheduled my transperineal biopsy for June. I receive my second COVID vax in mid-May, so I'll be good to go.

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