Targeted biopsy · London
MRI-US fusion prostate biopsy - private in London.
A targeted transperineal biopsy of the prostate, guided by your multiparametric MRI overlaid onto live ultrasound. Near-zero infection risk compared with traditional transrectal (TRUS) biopsy, and a much higher detection rate for clinically significant cancer.
What it is
The modern way to biopsy the prostate.
MRI first to find the target. Ultrasound to steer the needle in real time. The two images fused into a single guidance map on the theatre screen.
Every fusion biopsy starts with a good multiparametric prostate MRI (mpMRI): T2-weighted, diffusion-weighted and dynamic contrast sequences. A specialist uroradiologist reports it using the PIRADS score. Only lesions rated PIRADS 3, 4 or 5 need a biopsy; PIRADS 1 and 2 studies have a very high negative predictive value and often let men avoid biopsy altogether.
When a target is present, the mpMRI is uploaded into a fusion platform in theatre. Common systems include Koelis Trinity, BiopSee, BK Medical bkFusion, Eigen Artemis and Philips UroNav. The software registers the MRI onto live transrectal ultrasound, correcting for gland movement in real time. The consultant urologist then aims each needle directly at the outlined PIRADS lesion rather than sampling the gland blindly.
This is the standard of care recommended by NICE, the European Association of Urology and the British Association of Urological Surgeons for any man with a suspicious PSA and an MRI-visible lesion.
Why fusion beats blind biopsy
- Detects around 30 per cent more clinically significant (Gleason 3+4 or higher) cancers than systematic TRUS alone.
- Reaches the anterior and apical zones that TRUS routinely misses.
- Fewer, better-placed cores mean lower rates of over-diagnosis of indolent Gleason 6 disease.
The transperineal route
Through the skin, not through the rectum.
The single biggest safety upgrade over traditional TRUS: the needle never crosses bowel wall, so bacteria never reach the prostate.
Traditional transrectal (TRUS)
- Needle passes through rectal wall to reach prostate.
- 1 to 2 per cent risk of urosepsis, often needing hospital admission.
- Long fluoroquinolone antibiotic courses now discouraged by MHRA.
- Poor access to anterior and apical tumours.
Transperineal (fusion)
- Needle enters through cleaned skin of the perineum, behind the scrotum.
- Sepsis rate close to zero across published UK series.
- Single-dose antibiotic prophylaxis is enough.
- Full access to every zone of the prostate, including anterior tumours.
The perineal approach can be performed through a fixed grid (BiopSee) or with a freehand needle guide (PrecisionPoint, Koelis Trinity). Both are equivalent in accuracy in experienced hands, and both are now offered under local anaesthetic and sedation in most London centres.
Who it is for
Four common reasons men are referred.
If you recognise your situation on this list, a fusion transperineal biopsy is almost certainly the right next step.
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Rising PSA with a suspicious mpMRI
Multiparametric MRI has shown a PIRADS 3, 4 or 5 lesion that needs tissue confirmation.
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Active surveillance
Confirmed low-risk cancer being monitored, where a targeted re-biopsy is due.
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Previous negative TRUS biopsy
A traditional transrectal biopsy was clear, but PSA is still climbing or an MRI lesion persists.
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Strong family history
Father or brother with prostate cancer, BRCA carriers, or Lynch syndrome families in surveillance.
Preparation
A short list, sent in advance.
Everything is written up on your pre-admission letter. If anything is unclear, the theatre team calls you 48 hours ahead.
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Bowel prep enema
A small self-administered enema on the morning of the procedure to clear the rectum and sharpen ultrasound images.
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Antibiotic prophylaxis
A single dose of oral or intravenous antibiotic on arrival. The transperineal route needs far less cover than TRUS.
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Anticoagulation review
Warfarin, DOACs, clopidogrel and similar are paused per your haematology team. Aspirin is usually safe to continue.
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Fasting if you are having GA
Nothing to eat for six hours and only clear fluids up to two hours before. Under LA and sedation a light breakfast is fine.
The procedure
A day case. Home by lunchtime.
Around 30 to 45 minutes in theatre. Total time in the day-unit is usually four to five hours, including admission and recovery.
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01
Check-in and consent
You meet the consultant urologist and anaesthetist. Consent is reconfirmed and prophylactic antibiotic is given.
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02
Positioning
You are positioned in lithotomy. The perineum is cleaned and draped. Local anaesthetic infiltrates the skin and periprostatic nerves, or you are anaesthetised for GA.
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03
MRI overlay
Your prior mpMRI is loaded into the fusion platform (Koelis, BiopSee, BK Medical, Artemis or UroNav) and registered to live transrectal ultrasound.
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04
Targeted and systematic cores
3 to 5 targeted cores per PIRADS lesion, plus 12 to 24 systematic cores across the whole gland through a transperineal grid or freehand needle guide.
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05
Recovery and discharge
You rest for one to two hours in the day-unit. Most people are home by lunchtime and back to office work within 24 to 48 hours.
Outcomes
What the numbers actually show.
The evidence base is now large: PRECISION, PROMIS and MRI-FIRST all point in the same direction.
80-90%
Sensitivity for MRI-visible lesions
For clinically significant cancer (Gleason 3+4 and higher) when a PIRADS 4 or 5 lesion is present on mpMRI.
90%
Negative predictive value of mpMRI
A negative mpMRI reliably rules out significant cancer in around 9 of 10 men, which is why biopsy can often be avoided.
~0%
Sepsis rate, transperineal route
Compared with 1 to 2 per cent for traditional transrectal biopsy, which is why the UK has been moving away from TRUS entirely.
Cost in London
£3,500 to £5,500 all-inclusive.
Self-pay quotes across our London panel typically fall in this band. Insurers pre-authorise the same pathway with no out-of-pocket cost when the criteria are met.
| What is included | Indicative |
|---|---|
| Multiparametric prostate MRI (3T, uroradiologist reported) | £550-£950 |
| Consultant urologist consultation and consent | £250-£350 |
| Day-case theatre, anaesthetist, fusion platform, cores | £2,200-£3,400 |
| Histopathology reporting | £350-£600 |
| Results consultation | £200-£300 |
| All-inclusive package | £3,500-£5,500 |
Where in London
The centres we work with.
Every centre on our panel does high-volume fusion transperineal biopsy with fellowship-trained consultant urologists and dedicated uroradiologists.
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University College London Hospital Private
Fitzrovia
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King’s College Hospital Private
Denmark Hill
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HCA The Wellington Hospital
St John’s Wood
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HCA London Bridge Hospital
London Bridge
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Guy’s and St Thomas’ Private Healthcare
London Bridge
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The Royal Marsden Private Care
Chelsea and Sutton
Recovery
Sore for a day, back to work in two.
Recovery is straightforward. A short list of what is normal, what is common, and the small number of things worth calling us about.
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First 24 hours
Rest at home. Mild perineal bruising and soreness are normal. Paracetamol is usually enough.
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Blood in urine
Pink or tea-coloured urine for a few days, occasionally up to two weeks. Drink plenty of water.
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Blood in semen
Rust-coloured ejaculate for four to six weeks. Harmless and expected.
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Back to work
Desk-based work within one to two days. Manual work in three to five days.
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No cycling for two weeks
Avoid saddle pressure while the perineum settles. Walking and light gym are fine after 48 hours.
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When to call
Fever above 38°C, inability to pass urine, or heavy fresh bleeding. Sepsis is rare but urgent.
Related pages
Read next
-
PSA and multiparametric prostate MRI
The test that comes before any biopsy decision.
Read more -
Robotic prostatectomy
Nerve-sparing surgery for localised prostate cancer.
Read more -
Aquablation for BPH
A modern option for an enlarged, benign prostate.
Read more -
Prostate cancer
A full patient guide to diagnosis and treatment.
Read more
Frequently asked
The six questions we get asked most.
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How much lower is the infection risk than a traditional TRUS biopsy?
Traditional transrectal (TRUS) biopsy passes needles through the rectal wall and carries a 1 to 2 per cent risk of sepsis, which is why long antibiotic courses are given. Transperineal MRI-US fusion biopsy passes needles through the sterile skin of the perineum instead, and the infection risk is close to zero. A single dose of antibiotic is usually enough.
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Is it done under local anaesthetic or a general?
Both are offered. Local anaesthetic with intravenous sedation is quicker, avoids a GA, and most men tolerate it very well. A general anaesthetic is preferred if you are anxious, if a very large number of cores are planned, or for very large glands. Your urologist and anaesthetist will recommend the right option at consent.
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Is blood in the ejaculate really normal?
Yes. Rust-coloured or brown ejaculate for four to six weeks is expected and does not mean anything has gone wrong. It reflects small amounts of old blood from the biopsy sites clearing through the seminal vesicles. It does not affect fertility or future function.
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Will my insurance cover it?
Most UK private policies (Bupa, AXA Health, Vitality, Aviva, WPA, Cigna, Healix) cover MRI-US fusion transperineal biopsy when there is a PIRADS 3 to 5 lesion or a clinical indication documented by a consultant urologist. Pre-authorisation is straightforward and we handle it for you.
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How long do results take?
Pathology is usually reported in 5 to 10 working days. Your consultant urologist reviews the histology, correlates it with the MRI, and sees you back for a results consultation to discuss Gleason grade, extent, and next steps.
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What if I have already had a negative TRUS biopsy?
That is one of the strongest indications for MRI-US fusion transperineal biopsy. Traditional TRUS misses up to a third of anterior and apical cancers because the needles cannot reach them safely. Fusion biopsy targets those exact zones and reliably samples MRI-visible lesions that were missed the first time.
Speak to a clinician
A rising PSA is not a diagnosis. Let us help you sort out the next step.
Send us your PSA history and any MRI report you already have. We come back within one working day with a plan, indicative costs, and two or three consultant options.