When there is a suspicion of a cancer in the prostate, a biopsy is needed to help with the diagnosis. This is where small samples of tissue are taken from the prostate using a needle.
These tissues are then taken to the laboratory where they are assessed by the pathologist using a microscope. Traditionally the method that has been used to take a biopsy is the transrectal ultrasound guided (TRUS) where a sample is taken from the rectal wall. In some cases, the cancer may be located in the front area of the prostate gland and this can be missed out by the TRUS method. Transperineal biopsy is now being used where all aspects of the gland can be accessed easily.
What Is Transperineal Biopsy?
Perineum is the body part located between the anus and the scrotum. The procedure entails taking samples of tissue from the prostate through the skin underlying the perineum. An ultrasound-guided scope helps in the imaging and this is passed through the rectum.
This allows the surgeon to visualize all aspects of the prostate because a biopsy needle is usually passed in parallel position to the long axis of the gland. This method allows one to have improved sampling because multiple tissues can be taken from all aspects of the prostate gland. Some tissues can also be taken from the area that is located near the urethra.
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How It Is Done?
The procedure is done under general anesthesia where the patient is put to sleep using sedative drugs. The legs of the patient are placed in special supports that allow the surgeon to reach the perineum. The prostate is examined through the prostate and this is done before the surgeon inserts the probe through the rectum.
The ultrasound probe is 4 inches in length and as wide as the thumb of a man. A special grid is used to ensure that samples (biopsies) are taken from all areas of the prostate. The biopsy needles are passed through the perineum into the prostate and the ultra sound probe helps to guide.
After the procedure is done, a firm dressing is applied on the perineum and this is held in place using pants that are disposable. A catheter that remains overnight is fixed and this helps in passing urine. The catheter is removed the following day unless the patient is passing blood in the urine or has a fever. The patient is discharged the same day in cases where they are able to pass urine normally.
Is It Safe?
The procedure is safe because there is a reduced chance of the patient getting an infection. The patient can be given levofloxacin 300mg prophylactically to help with the prevention of any infection that is likely to occur.
There is also a minimal risk of bleeding around the perineum. A pressure bandage should be applied on the perineum and this reduces the risk of bleeding.
The procedure should be done under general anesthesia and this ensures that the safety of the patient is maintained because the patient is kept free of pain.
Why There Is Risk Of Erectile Dysfunction Associated With Transperineal Biopsy
Studies that were done by the urological association of America showed that there is a possibility of erectile dysfunction for a short time after Transperineal Biopsy. This usually recovers six months after the biopsy samples are taken.
The method allows sample tissues to be taken near the urethra and this may interfere with the function of the urethra. This tube allows the urine to be passed from the bladder to the outside. When urethra is tampered with the patient will have problems with passing urine and may have urine retention
What Are The Advantages Of Transperineal Biopsy?
This method has a reduced risk of the patient getting an infection. This is because disinfection of the perinea skin can be done routinely before the procedure is done. This ensures that the ultrasound probes are clean and there is no entry of microbes in to the patient’s blood.
This method allows the surgeon to take multiple samples from the prostate and this helps with the diagnosis. This ensures that all cancerous cells are visualized therefore avoiding missed diagnosis.
The method helps in the diagnosis of prostate cancer where the other methods have failed including TRUS. This is because different samples can be taken from varied sections of the prostate. The procedure provides an accurate map of the location and burden of the disease and this helps in giving the proper treatment to the patient. It also ensures that all the cancerous cells have been destroyed.
There is a reduced risk of the patient requiring a second biopsy. This is because the method is accurate and all sections of the prostate are analyzed for cancer.
What Are The Disadvantages Of Transperineal Biopsy?
The method allows sample of tissue to be taken from the area located near the urethra. This causes an increased risk of difficulty in voiding (passing urine) and may at times cause urine retention.
The procedure cannot be done under local anesthesia. This is because it is more involving and therefore needs the patient to be fully sedated to ensure that he is free of pain. The procedure is usually done under general anesthesia.
The procedure is more invasive and this causes a risk of bleeding. A firm adhesive has to be applied on the perineum after the procedure is done.
Similar Options For Transperineal Biopsy
The other options that can be used in place of Transperineal Biopsy includes:
- Prostate Mapping – This procedure involves the latest imaging techniques of MRI and a biopsy system that is guided by the template. This helps with getting the right diagnosis and treatment.
- Imaging – This is the use of magnetic resonance imaging to know whether the cancer has spread the adjacent parts.
The patient can also be observed and blood tests repeated to check whether the level of PSA is elevated. This can be done without taking other biopsies from the patient.
Transperineal Biopsy is a method that can be used for diagnosis of the prostate cancer where the other methods have failed. This method ensures that all parts of the prostate have been analyzed and that there is no missed diagnosis. This method helps in diagnosis of prostate cancer and therefore patients are able to get treatment earlier. The patient may have a difficulty in urination but this clears within a period of six months after the biopsy is done.