What this test is
A transperineal prostate biopsy is a procedure where your doctor takes small tissue samples from your prostate using a thin needle. The needle goes through the skin between the scrotum and anus (the perineum) instead of going through the rectum.
The samples are sent to a lab to check for prostate cancer and, if cancer is found, to determine the grade (how aggressive it looks).
Why your doctor recommends the transperineal approach.
This approach is often chosen because it can lower the chance of infection compared with the traditional rectal (transrectal) route. In a large randomized trial, there were 0 infections after transperineal biopsy (done without preventive antibiotics) compared with 1.4% infections after transrectal biopsy (done with targeted antibiotics).
Some guidelines recommend transperineal biopsy over transrectal biopsy.
How it is done (what to expect).
You will lie on your back with your legs supported (similar to a pelvic exam position).
The area is cleaned, and local anesthetic (numbing medicine) is injected in the skin and deeper tissues to reduce pain.
An ultrasound probe is placed in the rectum to help guide the needle (the needle itself still enters through the perineal skin).
Your doctor takes multiple small biopsy samples, sometimes including targeted samples if an MRI showed a suspicious spot.
The procedure is often done in an office or outpatient setting.
Benefits
Lower infection risk than the rectal route in several studies and analyses.
Can often be done with little or no antibiotic use, which supports safer antibiotic practices.
Similar ability to find clinically important prostate cancer compared with the rectal route in randomized trials.
Common side effects (usually temporary)
These are expected and typically improve over days to a few weeks:
Blood in urine (pink or red urine)
Blood in semen (rusty or red semen; may last longer than urine bleeding)
Soreness or bruising in the perineal skin
Burning with urination or needing to urinate more often for a short time
Less common but important risks
Infection (fever, chills, feeling very unwell). Infection risk is generally low, and may be lower than with the rectal route.
Trouble urinating / urinary retention (cannot pass urine). In the PREVENT randomized trial, urinary retention occurred in 0.3% of men after transperineal biopsy.
More short-term pain or urinary bother compared with the rectal route for some patients. In a randomized trial of patient-reported outcomes, clinically significant pain during numbing injections was reported in 38% with transperineal vs 3% with transrectal biopsy, and pain the evening of the procedure in 19% vs 11%.
How to prepare.
Follow the instructions from your urology team. Common steps include:
Tell your doctor if you take blood thinners (for example: warfarin, apixaban, rivaroxaban, clopidogrel, aspirin). Do not stop these on your own—your doctor will give you a plan.
Tell your doctor if you have a urinary tract infection symptoms (burning, urgency, fever) before the procedure.
Arrange a ride home if you will receive sedation (some centers use local anesthetic only).
After the biopsy: home care.
Drink extra fluids for the first day (unless your doctor told you not to).
Avoid heavy lifting/strenuous exercise for about 24–48 hours (or as instructed).
Mild discomfort is common; take only the pain medicine your doctor recommends.
Seek urgent medical advice if you have
Fever (especially ≥38°C / 100.4°F), chills, or feel very ill
Cannot urinate
Heavy bleeding or large blood clots in urine
Severe or worsening pain not controlled with recommended medications
When results are ready.
Biopsy results are commonly available within about 1–2 weeks (timing varies). Your doctor will review:
Whether cancer is present
The grade group (how aggressive it looks)
How many samples were positive and where they were taken
This guide is not a substitute for professional medical advice. If symptoms worsen or you have new concerns, contact your doctor or seek emergency care.