LATP Prostate Biopsy

Why do I need this procedure?

This procedure is performed primarily to check for possible prostate cancer. Your doctor will likely have recommended this if you have a raised prostate specific antigen (PSA) blood test, an abnormal-feeling prostate gland and/or a MRI identified abnormality.

What does the procedure involve?

A prostate biopsy involves taking small samples of tissue (biopsies) from the prostate. Approximately 18-24 biopsies will be taken, although this will depend on the size of your prostate and the findings on your MRI scan. These are examined under a microscope by a specialist to check whether there is cancer in the prostate.

A transperineal (TP) biopsy involves taking samples through two punctures on the perineum. The perineum is the area of skin between the scrotum and the rectum (back passage). This is done under local anaesthetic (LA). This is why the procedure is called an LATP prostate biopsy.

What are the alternatives to this procedure?

  • Transrectal ultrasound guided prostate biopsies, which are usually carried out under local anaesthetic, where the biopsies are taken through the rectum.
  • Transperineal biopsies under a general anaesthetic (where you are unconscious).
  • Further monitoring of your PSA or MRI. An MRI scan may detect early high-grade cancers, but can fail to detect low-grade cancer.

The most suitable option will have been discussed with you at your consultation.

What happens before the procedure?

You will be provided with antibiotic tablets. It is important to take these as directed, usually two hours before the procedure.

Please inform the team if you have any drug allergies or sensitivities. Please let us know if you are taking any blood-thinning medication (e.g. clopidogrel, warfarin, dabigatran, rivaroxaban, apixaban). We will usually have asked you to hold off these prior to the procedure. You can continue to take low dose (75mg) aspirin. You will be advised what to do by letter/email.

Please confirm with your treatment team when you should restart your anticoagulants before you leave the hospital after the biopsy.

Please telephone the Urology Department if you are unsure which medications you should stop taking.

Tel: 0117 414 5004

Coming into hospital and what to expect when I arrive?

Your appointment letter will contain full details. As this is a local anaesthetic procedure you can eat and drink normally before coming to the hospital. Make sure that if you are on blood pressure medication, you take it as you would
do normally.

When you arrive, you will be given a specimen pot and asked for a urine sample. This is to check that you do not have a urine infection. If you do, this may mean we cannot go ahead with the biopsy until it has been treated.

A nurse will go through your medications with you and ask you some questions. You will be given antibiotics (if you have not taken them already before attending on the day). These are to help prevent infection and need to be taken before your biopsy. You will be asked to change into a hospital gown and remove your lower clothes.

What should I expect during the biopsy?

The procedure will be undertaken by either a doctor or a surgical care practitioner who has been trained to do this.

You will be asked to lie on your back on a recliner chair, with your legs slightly elevated (like the giving birth position). To get you into the correct position to take the biopsies, the doctor/surgical care practitioner will apply some tape to elevate your scrotum out of the way. If you find the position too uncomfortable please tell the doctor or surgical care practitioner, as you will be in this position for about 20 minutes.

The doctor or surgical care practitioner will feel your prostate by placing a finger in your back passage. (This is called a digital rectal examination, or DRE.)

The doctor/surgical care practitioner will use an antiseptic solution (iodine) to clean your perineum (the area through which the biopsies will be taken).

They will then insert an ultrasound probe, covered in lubricating jelly, into your back passage. This allows the person performing the procedure to see an image of your prostate, which they will use to guide the collection of the biopsies.

Inserting the probe may be uncomfortable but should not hurt.

You will then be given an injection of local anaesthetic (lidocaine), to make the perineum area go numb. This is given in two stages, first into the skin of your perineum, to numb the entry point, and then deeper, to anaesthetise around your prostate.

This will sting for the first few seconds but should soon go numb. Once the local anaesthetic is complete, it will then be given a few minutes to take full effect. We will check the area is numb before we proceed.

A guide needle will be inserted through the numb skin to take samples from the left side of your prostate and then again from the right side.

If you feel pain when the first biopsy needle is inserted you should let us know, as we can give you more anaesthetic.

You will hear a loud ‘click’ sound and feel a flicking sensation as the biopsy is taken. You may find the whole procedure uncomfortable, but you should not find the biopsies painful.

How long does the procedure take?

10-20 minutes.

What should I expect after the biopsy?

After the biopsy you can get up slowly and get dressed. It is important to take this slowly, as you may feel quite lightheaded after the procedure.

If you feel faint or unwell after leaving the biopsy room, please tell the nurse. We would recommend that you have someone to drive you home. We recommend that you have a drink and something to eat before you leave the hospital.

What are the risks and side effects of having a transperineal prostate biopsy?

Almost all patients:

  • Blood in your urine for up to 10 days
  • Blood in your semen which can last up to six weeks (this poses NO risk to you or your sexual partner)

Between 1 in 2 and 1 in 10 patients (10-50%):

  • Bruising in your perineal area
  • Discomfort in your prostate caused by bruising from the biopsies

Up to 1 in 20 patients (5%):

  • Temporary problems with erections caused by bruising from the biopsies
  • Inability to pass urine (acute retention of urine) and needing a catheter in the bladder

Up to 1 in 50 patients (2%):

  • Blood in your urine preventing you from passing urine (clot retention)

Between 1 in 10 patients and 1 in 50 patients (1-2%):

  • Failure to detect significant cancer in your prostate
  • Need for repeat procedure if biopsies are inconclusive or your PSA level rises further

Up to 1 in 100 patients (1%):

  • Blood in your urine requiring emergency admission for treatment
  • Infection in your urine requiring antibiotics
  • Septicaemia (blood infection) requiring emergency admission for treatment
  • Local Anaesthetic toxicity

What happens following the procedure?

You will be free to leave the hospital, after you have passed urine. We will provide you with a copy of your discharge letter, which also gets sent to your GP. You will be contacted with the biopsy results after they have been reviewed by our multi-disciplinary team. This can take 2-3 weeks. Please contact our specialist nurses if you haven’t heard from us after
3 weeks.

Tel: 0117 414 0512

Please seek medical advice in your nearest Accident & Emergency (A&E) Department immediately:

  • You start to experience lots of pain in your tummy or when passing urine
  • You have high temperature and/or shivering and shaking
  • You feel nauseous and/or vomit
  • You do not pass urine for more than six hours, or you start to feel uncomfortable/full and have difficulty in passing urine.
  • You start passing large clots of blood

Do not wait for an appointment with your GP if any of the above happens.

Further information

British Association of Urological Surgeons
www.baus.org.uk

Southmead Hospital urology department
0117 4145000

Southmead Hospital urology cancer specialist nurses
0117 4140512

Prostate Cancer UK
www.prostatecanceruk.org 0800 074 8383

Macmillan Cancer Support
www.macmillan.org.uk 0808 808 00 00

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

How to contact us:

Urology Department
0117 414 5000

Urology cancer specialist nurses
0117 414 0512

© North Bristol NHS Trust. This edition published October 2020. Review due October 2022. NBT002040