Key Takeaways
- A needle biopsy taken through the perineal skin (between the scrotum and anus) to collect prostate tissue. It is guided by ultrasound, which can be combined with an MRI scan to help locate suspicious areas.
- Designed to bypass the bowel, which is associated with a significantly lower risk of severe infection and sepsis compared to traditional transrectal methods.
- Highly recommended by the National Institute for Health and Care Excellence (NICE) and the European Association of Urology (EAU) as a preferred diagnostic approach.
- Usually performed as an outpatient procedure under local or general anaesthetic, taking approximately 20 to 45 minutes.
- Can frequently be performed safely without preventative antibiotics, which helps to reduce the risk of antibiotic resistance.
- Common side effects include temporary blood in the urine or semen and mild perineal soreness. Most men are able to return home the same day.
- Supports planning targeted treatment such as focal therapy that aim to preserve urinary continence and erectile function.
Prostate cancer is the most common cancer diagnosed in the UK, with recent National Health Service figures showing that more than 64,000 men are diagnosed every year. To confirm or rule out the disease, doctors may recommend a biopsy. Based on clinical evidence, an increasing number of clinics and national guidelines now favour the transperineal approach. This guide will explain what a transperineal prostate biopsy is, why it is performed, how the procedure works, and how it supports targeted treatments such as focal therapy.
A transperineal biopsy of the prostate is a needle-based test intended to detect clinically significant cancer. Instead of passing the biopsy needle through the rectum, the clinician carefully passes it through the perineum (the skin located between the scrotum and the anus). Clinical evidence indicates that this method offers high diagnostic accuracy and is associated with fewer severe infectious complications compared to transrectal techniques.
Watch: What is a transperineal prostate biopsy?
Core benefits and differences
The transperineal approach is increasingly used as the standard for prostate biopsies due to its clinical advantages. It provides great spatial access to the prostate and avoids the specific infection risks linked to transrectal methods.
Key benefits include:
- Lower risk of infection and sepsis
- Better sampling of the entire prostate, including anterior areas
- A significantly reduced risk of rectal bleeding
- Reduced need for broad-spectrum antibiotics, supporting global antimicrobial stewardship
- Increased detection of clinically significant cancer compared to transrectal ultrasound-guided biopsy
Why is a transperineal biopsy performed?
Men are often advised to have a biopsy if their PSA levels are elevated, and/or if MRI scans highlight areas of concern. These signs may indicate prostate cancer, and a biopsy helps confirm whether treatment is needed. The transperineal method is increasingly chosen because it is considered safer and it is precise. Unlike transrectal techniques, this approach passes the needle through sterilised skin rather than directly through the naturally bacteria-rich rectum. This anatomical difference lowers the risk of introducing bacteria into the bloodstream.
How the transperineal biopsy procedure works
A transperineal prostate biopsy is usually performed as an outpatient or day-case procedure, meaning you will typically not need to stay overnight. The active procedure generally takes between 20 and 45 minutes, depending on the imaging used and the number of tissue samples required. Because the recovery is usually straightforward, most men return home the exact same day.
Preparation before the biopsy
Your doctor will provide detailed instructions to follow before your biopsy appointment. If you’re having general anaesthetic, you’ll likely be asked to fast, no food for at least 6 hours and no clear fluids for 2 hours. You may also need to stop taking medications like blood thinners a few days in advance.
Current high-quality evidence, supported by the 2026 EAU guidelines, suggests that routine preventative antibiotics are frequently not necessary for a transperineal biopsy due to the very low baseline infection risk. However, depending on your individual medical history, some clinics may still prescribe them as a precaution. You will also be asked to review and sign a consent form once the benefits and potential risks have been explained to you clearly.
Checklist before your biopsy:
- Follow fasting instructions if required
- Stop specific medications as directed by your doctor
- Take any prescribed antibiotics exactly as instructed (if recommended)
- Arrange for someone to drive you home if you having general anaesthetic or sedation
What happens during the procedure
Upon arrival, you will change into a hospital gown and lie on your back with your legs comfortably supported in stirrups. The perineal skin is cleaned thoroughly with an antiseptic solution to create a sterile field.
If you are having a local anaesthetic, the area will be numbed with an injection, which may sting briefly before taking full effect. A smooth ultrasound probe, covered in lubricating gel, is gently placed into your rectum. It is important to understand that this probe is used as a camera to create a live image of your prostate; no biopsy needles are intended to pass through it.
Guided by these detailed images, the doctor inserts a fine biopsy needle through the perineal skin to collect tissue samples. You will hear a clicking sound as the samples are taken. If your MRI scan showed concerning areas, the doctor will take targeted samples from those specific regions, alongside systematic samples from the rest of the gland.
Use of local or general anaesthesia
Many transperineal biopsies are now performed comfortably under local anaesthetic. This involves numbing the perineal area, making the procedure tolerable for most men while allowing for a rapid recovery without the lingering side effects of heavy sedation.
However, some men may be offered a general or spinal anaesthetic. This is often considered if the prostate is particularly large, if extensive sampling is required, or if the patient prefers to be asleep. This will be discussed and decided safely by your anaesthetic team. If you have a general anaesthetic, you will spend some time in the hospital recovery ward until the medical team is satisfied that you are ready to go home.
Image guidance (MRI or ultrasound fusion)
Real-time ultrasound is used to safely guide the biopsy needle. In modern urology clinics, this is frequently combined with the results of a recent MRI scan in a process known as MRI-US fusion.
This advanced fusion technology overlays the highly detailed MRI images onto the live ultrasound feed, allowing the clinician to target suspicious lesions with precision. This approach is especially valuable for identifying tumours in the anterior (front) part of the prostate, which can be challenging to reach using traditional transrectal methods.
Benefits of transperineal vs. transrectal biopsy
The transperineal approach is now recommended as a preferred option by major health bodies such as NICE and the EAU. Landmark clinical trials, including the TRANSLATE and PREVENT studies, have demonstrated its advantages.
Key benefits include:
- Lower risk of infection and sepsis
- A significantly reduced risk of rectal bleeding
- Geometrical access to all zones of the prostate gland
- High detection rates for clinically significant prostate cancer
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Risks and side effects
While a transperineal biopsy is generally safe, it is a medical procedure and carries some potential risks. Most side effects are physiological, mild, and resolve within a few days or weeks.
Common side effects include:
- Blood in the urine or semen
- Soreness or bruising around the perineum
- Temporary mild discomfort
Less common risks include:
- Difficulty passing urine, which may need short-term catheter use
- Temporary erectile dysfunction due to transient bruising
- Urinary tract infections requiring infections
Drinking plenty of fluids after the procedure can help keep your bladder flushed and reduce the risk of complications. Your care team will also advise you on what to look out for and when to get in touch.
Recovery and aftercare
You can usually go home the same day. If you had a local anaesthetic, you may leave shortly after the procedure. If you had a general anaesthetic, you must wait until you are fully awake, have had something to eat and drink, and have successfully passed urine. You should not drive for at least 24 hours after receiving a general anaesthetic.
It is normal to experience some perineal discomfort, which can usually be managed with standard over-the-counter pain relief.
Contact your doctor if you experience:
- A high temperature or chills
- Difficulty passing urine
- Heavy or ongoing bleeding that doesn’t ease
- Any concerning symptoms that worry you
Your biopsy samples will be examined by a specialist pathologist. The results are typically discussed by a multidisciplinary team and should be ready within two to three weeks. Your doctor will then contact you to clearly explain the findings and discuss any appropriate next steps. You may also contact a specialist nurse if you have questions or need support during this time.
How transperineal biopsy supports focal therapy
A transperineal prostate biopsy provides a map of where cancer is located in the prostate, which supports planning focal therapy. This type of treatment targets the specific suspicious area whilst aiming to preserve the surrounding healthy prostate tissue.
The accuracy of transperineal MRI-US fusion biopsy enables detailed characterisation of tumour location, size, and aggressiveness. At The Focal Therapy Clinic, this information helps our specialists design highly personalised treatment plans. By treating only the affected areas, focal therapy aims to preserve urinary continence and erectile function, offering effective cancer control with fewer long-term side effects for carefully selected patients. Many of our patients experience excellent outcomes with minimal disruption to quality of life.
Speak to our specialists
At The Focal Therapy Clinic, our expert clinicians include leading urologists, radiologists, and oncologists who have treated over 2,000 men using the latest imaging and minimally invasive techniques. Every case is reviewed in detail by our multidisciplinary team to ensure the most accurate diagnosis and most suitable treatment plan. Whether you are seeking a second opinion or exploring focal therapy options, we’re here to support you, get in touch today to book a consultation.
FAQs
References
European Association of Urology. (2026). EAU Guidelines on Prostate Cancer. Available at: https://uroweb.org/guidelines/prostate-cancer
European Association of Urology. (2026). EAU Guidelines on Urological Infections. Available at: https://uroweb.org/guidelines/urological-infections
National Institute for Health and Care Excellence. (2023). Transperineal biopsy for diagnosing prostate cancer (Diagnostics guidance DG54). Available at: https://www.nice.org.uk/guidance/dg54
British Association of Urological Surgeons. (2024). Transperineal prostate biopsies. Available at: https://www.baus.org.uk/patients/information_leaflets/112/transperineal_prostate_biopsies
Bryant RJ, Marian IR, Williams R, et al. Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): a multicentre, randomised, controlled trial. Lancet Oncol. 2025;26(5):583-595.
Hu JC, Assel M, Allaf ME, et al. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted and Systematic Prostate Biopsy to Prevent Infectious Complications: The PREVENT Randomized Trial. Eur Urol. 2024;86(1):61-68.
