Trans-perineal Biopsies: A Safer and More Accurate Approach to Diagnosing Prostate Cancer

By Mr Alan Doherty, Clinical Director Birmingham Prostate Clinic

Prostate cancer is one of the most prevalent cancers affecting men worldwide. Early and accurate diagnosis is crucial for effective treatment and better patient outcomes. Traditionally, transrectal biopsies have been the standard for diagnosing prostate cancer. However, advancements in medical technology have paved the way for a safer and more accurate alternative – trans-perineal biopsies with lower infection risks. When combined with multiparametric MRI (mpMRI), fusion trans-perineal biopsies offers a superior diagnostic solution for prostate cancer, with a significant reduction in the risk of infection.

The Challenge with Transrectal Biopsies

Transrectal biopsies have long been a valuable tool in prostate cancer diagnosis. However, they come with concerns. The risk of infection, though relatively small, is significant. Mr. Alan Doherty, Consultant Urological Surgeon at Birmingham Prostate Clinic, acknowledges this risk, stating, “Transrectal biopsies are associated with a risk of infection, which is a notable concern, and safer alternatives are sought.”

Studies have shown that transrectal biopsy can lead to infection rates as high as 5-7%. These infections can be painful and uncomfortable for patients and may require antibiotic treatment. Very rarely, this approach can lead to sepsis and death.

The Safer Alternative: Trans-perineal Biopsies

Trans-perineal biopsy is a technique that involves taking tissue samples from the prostate gland through the perineum, the area between the scrotum and the anus. Unlike the transrectal approach, which requires inserting the biopsy needle through the rectum, trans-perineal biopsy offers a more direct route to the prostate, minimising the risk of infection and providing several distinct advantages.

“Trans-perineal biopsies provide a safer option for our patients,” notes Mr. Doherty. “The reduced risk of infection and the ability to obtain more comprehensive samples make this a compelling choice for prostate cancer diagnosis.”

Enhancing Accuracy with Multiparametric MRI and Fusion Trans-perineal Biopsies

While trans-perineal biopsies offer a safer alternative to transrectal biopsies, the accuracy of the diagnosis can be further improved by combining them with multiparametric MRI (mpMRI) and fusion trans-perineal biopsies.

Multiparametric MRI (mpMRI): mpMRI provides a more detailed and comprehensive view of the prostate gland, identifying suspicious areas more accurately. By conducting an mpMRI before the biopsy, clinicians can target specific areas, reducing the number of unnecessary biopsies.

Fusion Trans-perineal Biopsies: Fusion technology integrates real-time ultrasound images with mpMRI scans, enabling precise targeting of suspicious areas. “Combining mpMRI with fusion trans-perineal biopsies allows us to significantly improve diagnostic accuracy,” explains Mr. Doherty. “We can precisely target suspicious areas so as to know where the cancer is and where it isn’t. In addition, it reduces the need for unnecessary biopsies and this in turn reduces other possible complications such as pain, difficulty passing urine and blood loss. Unfortunately, this technique is difficult to do well, and is still not readily available.”


Trans-perineal biopsies, when combined with multiparametric MRI and fusion technology, represent a safer and more accurate alternative to traditional transrectal biopsies for diagnosing prostate cancer. The reduced risk of infection, enhanced imaging capabilities, and increased biopsy accuracy make this approach a valuable addition to the arsenal of tools in the fight against prostate cancer. As medical technology continues to advance, the future of prostate cancer diagnosis looks promising, with improved patient safety and more accurate results.