Transperineal Grid Prostate Biopsy

What is this procedure?

This is an alternative biopsy technique to sample the prostate looking for prostate cancer.

Like the transrectal technique, an ultrasound probe is used to direct the biopsies that are taken through a special “grid” (hence the name) that is placed against the perineal skin – the area between the anus and the scrotum.

Who might require a transperineal grid biopsy?

Men in whom there is a suspicion of prostate cancer are usually offered the opportunity for prostate biopsy. This usually occurs in one of the following circumstances:

  • An elevated PSA level.

  • Abnormal feeling prostate on rectal examination.

  • A suspicious area on a prostate MRI scan.

In addition to the above, transperineal biopsy is usually only proposed if:

  • There has been a previous negative biopsy.

  • MRI would suggest the transrectal route to be inadequate.

  • Certain infectious risks are present.

What happens during the procedure?

You will be given a light general anaesthetic. You will then be positioned in the “lithotomy” position with your legs in specially designed supports.

A grid is then placed over the perineal skin, between the scrotum and the anus. Using an ultrasound probe sited in the rectum, samples of the prostate are taken in a pre-determined pattern according to the guide provided by the grid. Any risk area identified on an MRI scan can also be specifically targeted.

What should I expect after going home?

For a few days after your procedure, it is normal to experience any of the following:

  • A mild burning when you pass your urine.

  • A need to pass urine more frequently, and occasionally more urgently than you usually do.

  • Some blood in the urine, semen or stool – all settle quite quickly (blood in the semen can last a few weeks).

All usually settle quite rapidly without the need for any treatment.

What can I do to help?

  • Drink plenty of water.

  • Take Ural or Citravescent in a glass of water 4 times a day.

  • Take 2 Panadol every 4 hours.

  • Take any antibiotics you have been prescribed – most important.

  • Avoid constipation.

Are there any possible side effects?

Most procedures have possible side effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.

Relatively Common

  • Blood in your urine.

  • Blood in your semen for up to 6 weeks; this is harmless and poses no risk to you or any sexual partners.

  • Bruising in your perineal area.

  • Sensation of discomfort due to bruising.


  • Urinary infection.

  • Failure to detect a significant cancer of the prostate.

  • The procedure may need to be repeated if the biopsies are inconclusive or your PSA level rises further.

  • Inability to pass urine (retention of urine).


  • Blood infection (septicaemia) needing hospitalisation (<1%).

  • Haemorrhage (bleeding) needing hospitalisation (<1% risk).