An MRI-guided transperineal prostate biopsy is a highly accurate technique used to sample prostate tissue for signs of cancer or other abnormalities. This approach fuses detailed MRI imaging with real-time ultrasound guidance to allow precise and comprehensive sampling of the prostate.

Who Should Consider an MRI Fusion Prostate Biopsy?

This procedure is typically recommended for patients who:

  • Have a nodule or abnormality detected during a digital rectal examination (DRE)
  • Have enlargement of the prostate
  • Have elevated levels of PSA (prostate-specific antigen) in a blood test
  • Have an elevated PSA but a prior negative ultrasound-guided biopsy
  • Have been previously diagnosed with prostate cancer and require ongoing surveillance

Benefits of MRI-Guided Transperineal Biopsy

  • Greater accuracy in identifying areas of concern using advanced image fusion
  • Comprehensive sampling of the entire prostate, including regions that are often missed by traditional biopsies
  • More reliable cancer detection, and can monitor changes in known prostate cancer
  • Can also detect non-cancerous prostate conditions, including:
    • Benign prostatic hyperplasia (BPH)
    • Prostatitis (inflammation, often due to infection)
    • Prostatic intraepithelial neoplasia (PIN) – a non-cancerous change in prostate cells
  • Lower infection risk compared to transrectal biopsy
  • No rectal bleeding, as the procedure is performed through the perineum
Dr Jimmy Lam

How the Procedure Is Performed

  • Prior to the biopsy, patients undergo a prostate MRI scan
  • The biopsy is usually performed under general anaesthetic, taking about 30–60 minutes
  • A rectal ultrasound probe captures live images, which are then fused with the MRI scan
  • A biopsy grid (with 5 mm spaced holes) is positioned against the perineum (skin behind the scrotum)
  • This allows for precise targeting and sampling of prostate tissue from areas of concern

After the Procedure – What to Expect

  • You will usually go home the same day
  • Mild bleeding from the perineum is normal and easily managed with gentle pressure
  • Discomfort in the perineum or scrotum may last for a day or two
  • You may notice blood in your urine or semen for several days — this is common and not dangerous
  • In rare cases, patients may temporarily be unable to pass urine (urinary retention), which may require a short-term catheter

Recovery and Follow-Up

  • Most patients recover quickly and can resume normal activities within a few days
  • Biopsy samples are reviewed by a pathologist, and your urologist will receive results within a few days to a week
  • The biopsy helps distinguish between cancerous and non-cancerous conditions, guiding appropriate treatment

Post-Operative Care Instructions

What to Expect

  • Blood in urine may occur for a few days (sometimes intermittently)
  • Blood in semen may last several weeks; it may appear red or brown and is not harmful
  • Burning with urination may occur for a day or two, especially if a flexible cystoscopy was also performed; this usually settles on its own
  • Bruising or soreness in the perineum or scrotum is common and temporary

Return to Activity

  • Driving: Avoid for 24 hours post-procedure
  • Work: Take at least 1 day off; return depends on your job type
  • Lifting: Avoid heavy lifting for 48 hours
  • Exercise: Can resume after 48 hours
  • Sexual activity: Avoid for 48 hours; blood in semen is expected and not harmful

Pain Management

  • Use paracetamol or ibuprofen for discomfort
  • Ural sachets (available at pharmacies) can help relieve urinary burning or stinging

How long will my biopsy results take?

Results are usually available within one week, and your urologist will discuss them with you.

When should I seek urgent medical attention?

Go to the nearest hospital if you experience:

  • Inability to pass urine (rare, but may occur due to prostate swelling or clot retention)
  • Fever, chills or shaking (may indicate infection)