Transperineal MRI-Fusion Prostate Biopsy

What is this procedure?

A transperineal MRI-fusion prostate biopsy is a method of sampling prostate tissue to investigate a suspected prostate cancer. Needles are passed through the skin of the perineum (the area between the scrotum and the back passage) — not through the rectum — which greatly reduces the risk of serious infection. Your pre-operative MRI scan images are fused in real time with an ultrasound to precisely guide the needles to any suspicious areas identified on MRI, as well as providing a systematic sample of the whole prostate. The procedure is performed under local or general anaesthesia.

Before your procedure

• Fasting: If you are having general anaesthesia, do not eat or drink for six hours beforehand. For local anaesthesia, a light meal is acceptable — follow the specific instructions given at your pre-assessment.
• Antibiotics: A short course of prophylactic antibiotics is prescribed to prevent infection; take them exactly as directed.
• Medications: Inform the team of all blood thinners. These will need to be paused according to specific guidance. Do not stop any medication without instruction.
• Bowel preparation: An enema is not required with the transperineal approach.
• What to bring: Your MRI images or report, insurance documents, photo ID, and comfortable loose underwear/shorts for discharge.

What happens during the procedure

You will be positioned lying on your back. Local anaesthetic is injected into the perineal skin and prostate; you may also be offered sedation or a general anaesthetic for comfort. An ultrasound probe is placed gently into the rectum to visualise the prostate — this is not uncomfortable once anaesthesia is working. The MRI images are digitally overlaid on the live ultrasound picture, and fine biopsy needles are passed through the perineal skin to take tissue samples (usually 12–18 cores). The procedure takes approximately 30–60 minutes. You will normally go home on the same day.

After the procedure and recovery

• Perineal area: Bruising and soreness around the perineum is normal and settles within one to two weeks. A small pad may be useful for any minor ooze on the day.
• Urine: It is normal to see blood-stained urine for a few days and occasionally in semen for several weeks — this is harmless.
• Urination: Some men find it temporarily harder to pass urine due to prostate swelling; drink plenty of fluids. If you cannot pass urine at all, attend hospital.
• Activity: Rest on the day of the procedure. Light activities can resume the following day; avoid cycling and strenuous sport for one week.
• Driving: Do not drive on the day if you have had sedation or general anaesthesia.
• Results: Biopsy results are usually available within 1–2 weeks; Dr Hadjipavlou’s team will contact you to arrange a results appointment.

When to seek medical help

Contact the secretary on 22 444 444 or El Greco Medical Centre +357 22 782 000 if you experience:

• Fever above 38 °C or rigors (shivering episodes)
• Inability to pass urine for more than 6–8 hours
• Heavy, persistent bleeding from the perineum
• Severe perineal pain not relieved by prescribed analgesia

Attend the nearest Accident & Emergency department immediately if you feel acutely unwell.