LATP Prostate Biopsy

This procedure is usually performed 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.

• A prostate biopsy involves taking small samples of tissue (biopsies) from the prostate. 
• Around 12-24 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.

• Transperineal biopsies under a general anaesthetic (where you are unconscious).
• Further monitoring of your PSA or MRI. 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.

Due to the low risk of infection, you won’t normally need antibiotics, but in some cases these are necessary. This will be discussed with you before the procedure. Please tell the team if you are allergic to any medications. 

Please tell us if you are taking any blood-thinning medication (e.g. clopidogrel, warfarin, dabigatran, rivaroxaban, apixaban). We will usually have asked you to stop taking these before 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 blood-thinning medication before you leave the hospital after the biopsy.

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

Phone: 0117 414 5004

• Your appointment letter will contain full details. This procedure uses a local anaesthetic, so 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 do the biopsy until it has been treated.
• A nurse will go through your medications with you and ask you some questions. You will be asked to change into a hospital gown and remove your lower clothes.

The procedure will be done by either a doctor or a nurse 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 this too uncomfortable, please tell the clinician, as you will be in this position for about 20 minutes.
• The clinician will feel your prostate by placing a finger in your rectum (back passage). This is called a digital rectal examination, or DRE.
• They will insert an ultrasound probe, covered in lubricating jelly, into your bottom. 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.
• It will take a few minutes for the local anaesthetic to be effective. 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.

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

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

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 10 and 1 in 2 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 50 patients and 1 in 10 patients (2-10%):
• 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.
• Sepsis (blood infection) requiring emergency admission for treatment.
• Local anaesthetic toxicity.

You will be free to leave the hospital, after you have passed urine (gone for a pee). We will give 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 team. This can take 2-3 weeks. Please contact our specialist nurses if you haven’t heard from us after 3 weeks.

Phone: 0117 414 5009

British Association of Urological Surgeons

Home | The British Association of Urological Surgeons Limited (baus.org.uk)

Southmead Hospital Urology department

0117 414 5004

Southmead Hospital Urology Cancer  Specialist Nurses

0117 414 5009

Prostate Cancer UK

Prostate Cancer UK | Prostate Cancer UK

0800 074 8383

Macmillan Cancer Support

Macmillan Cancer Support | The UK's leading cancer care charity

0808 808 0000