Transperineal prostate biopsy: how it is done, what it feels like and what happens after

A biopsy is the only way to confirm prostate cancer. Trust leaflets list the usual reasons: a raised PSA, an abnormal feel of the prostate on examination, an abnormal MRI scan, or monitoring a cancer already found. The NHS describes the MRI scan as giving a clearer view of the prostate and showing whether you need further tests.

Not every raised PSA leads to a biopsy. PSA can rise with infection, an enlarged prostate or recent ejaculation, and a normal MRI may allow monitoring rather than a needle test. One leaflet notes that the team may occasionally recommend observation with regular PSA tests. You are entitled to hear the pros and cons of each path before you agree.

The older approach passes the needle through the wall of the rectum. The transperineal route goes through the skin, avoiding the bowel, which is why it is increasingly favoured; the comparative infection figures are not given on the pages we retrieved, so we have not quoted any. Many hospitals now offer it under local anaesthetic in an outpatient room.

If your MRI showed a suspicious area, the team can take extra samples from it as well as a spread from the rest of the gland. A leaflet describes up to 18 samples in one unit, and another gives between 12 and 28; the number depends on the hospital and what the scan showed.

You will be asked about blood thinners, allergies including to local anaesthetic or latex, bleeding problems and heart valves. Regular medicines usually continue unless told otherwise, and with local anaesthetic you can normally eat and drink beforehand. One hospital asks you to avoid alcohol the day before.

Arrange for someone to accompany you if sedation is planned, and wear loose clothing. A urine infection should be treated first, so tell the team if you have burning or fever beforehand.

You lie on your back with your legs raised and supported. The skin of the perineum is cleaned and local anaesthetic is injected under the skin and deeper around the prostate, which stings for a short time and then numbs the area. An ultrasound probe is placed in the back passage to show the prostate, and a biopsy needle is passed through the skin to take the samples, sometimes with a click you can hear.

Some people find it uncomfortable rather than painful. You are usually observed afterwards, and a leaflet says you will be asked to pass urine before going home. The same leaflet gives up to four hours in the department in total, including preparation and recovery. Another says you wait about an hour after the procedure.

Rest for the rest of the day, drink fluids and avoid heavy lifting and straining. Blood in the urine is common for several days, and blood in the stools or semen can occur; one trust describes bleeding lasting up to two weeks and another says discoloured semen for up to 12 weeks. A bruise in the perineum is also common.

One hospital advises that you should not drive after a biopsy, so plan your journey home. Simple painkillers such as paracetamol are usually enough. You will be told how and when results will come, usually in clinic or by phone.

Bleeding, bruising and discomfort are common. Infection is uncommon but important, because it can become serious; leaflets ask you to seek urgent help if you develop a fever or feel hot and sweaty, have pain in the back passage, or have persistent pain when passing urine. Difficulty passing urine, sometimes needing a short-term catheter, can develop immediately or within a few days.

Erection problems, usually temporary, and an inconclusive sample that means a repeat test are also listed. One leaflet gives specific percentages for each; they are one trust's figures, and hospitals differ, so ask your own team what they quote.

The NHS says it can take a few weeks to get the results of tests, and that if you are still waiting after 2 weeks you can call the hospital. Trust leaflets describe two to three weeks. The result is discussed by a multidisciplinary team, and you may then see a specialist nurse or surgeon.

Seek urgent help via NHS 111, your hospital contact number or A&E for fever, heavy bleeding or clots, or an inability to pass urine. Questions: Will it be local anaesthetic or sedation? Will targeted samples be taken from the MRI area? What will happen if the result is normal but my PSA stays high? NHS and private biopsies use the same technique; private care may be faster and should itemise the pathology fee.