Transperineal Prostate Biopsy
The modern standard for prostate biopsy — safer than the transrectal approach, with lower infection risk and more accurate sampling using MRI-ultrasound fusion guidance.
A prostate biopsy is the only way to definitively diagnose prostate cancer. During a transperineal biopsy, thin biopsy needles are inserted through the perineum — the skin between the scrotum and the rectum — rather than through the rectal wall. This approach avoids passing needles through the bacteria-laden rectum entirely, virtually eliminating the risk of serious post-biopsy infection.
The transperineal approach has become the recommended technique by the American Urological Association (AUA) and European Association of Urology (EAU). Dr. Radtke performs all prostate biopsies via the transperineal route, combining this approach with MRI-ultrasound fusion technology for the most accurate sampling available.
Why Transperineal Is Superior to Transrectal
For decades, prostate biopsies were performed through the rectum (transrectal). The transperineal approach addresses the key limitations of that technique.
Near-Zero Infection Risk
Transrectal biopsies carry a 2–4% risk of serious infection (sepsis), because each needle pass pushes rectal bacteria into the prostate. Transperineal biopsies bypass the rectum entirely — the needle passes through clean, prepped skin. Sepsis rates drop to essentially zero, and most patients do not require prophylactic antibiotics beyond a single dose.
Better Sampling of the Anterior Prostate
The transrectal approach enters from behind the prostate, making it difficult to reach the anterior (front) zone — where up to 25% of clinically significant cancers are found. The transperineal route provides direct access to the anterior prostate, improving detection of cancers that transrectal biopsies commonly miss.
More Uniform Sampling
Because the needles enter from below, the transperineal approach allows a more systematic, evenly distributed sampling pattern across the entire prostate gland, including the apex and midline — regions that are harder to reach transrectally.
No Rectal Discomfort
Since the rectum is not involved at all, patients experience no rectal pain or bleeding after the procedure. Mild perineal soreness and temporary blood in the urine are the most common side effects, both of which resolve quickly.
Targeted Precision Beyond Standard Biopsy
A standard prostate biopsy uses ultrasound guidance to systematically sample the prostate, but ultrasound alone cannot see most prostate cancers. MRI-ultrasound fusion combines the detailed imaging of a pre-procedure prostate MRI with real-time ultrasound during the biopsy, allowing Dr. Radtke to target suspicious areas identified on MRI with pinpoint accuracy.
Before the biopsy, you undergo a multiparametric MRI (mpMRI) of the prostate. The MRI is reviewed by a radiologist, and any areas suspicious for cancer are marked and assigned a PI-RADS score (a standardized rating of how likely the area is to contain clinically significant cancer). During the biopsy, this MRI is digitally fused with the live ultrasound image, creating a merged view that guides the biopsy needle directly into each target.
How Fusion Improves Detection
MRI-ultrasound fusion biopsy detects more clinically significant (Gleason 7+) cancers compared to standard systematic biopsy alone, while simultaneously reducing the detection of low-grade, clinically insignificant cancers that might otherwise lead to unnecessary treatment. In practice, Dr. Radtke performs both — targeted cores directed at MRI lesions and systematic cores sampling the remainder of the prostate — to achieve the highest diagnostic accuracy.
Fusion biopsy is particularly valuable for:
- Patients with a prior negative biopsy but persistently elevated PSA
- Patients on active surveillance who need repeat monitoring biopsies
- Patients with an MRI lesion (PI-RADS 3–5) that warrants targeted sampling
- Anyone undergoing a first-time biopsy where MRI is available
What to Expect
From MRI to results, here is the typical transperineal biopsy timeline.
MRI & Planning
A multiparametric MRI of the prostate is obtained and reviewed. Dr. Radtke identifies any areas of concern and develops a biopsy plan that includes both targeted and systematic sampling.
Outpatient Biopsy
The biopsy is performed as an outpatient procedure under local anesthesia or light sedation. The MRI is fused with real-time ultrasound, and biopsy cores are taken through the perineum. The entire procedure typically takes 15–30 minutes. You go home the same day.
Recovery
Most patients return to normal activities within one to two days. Mild perineal soreness, blood in the urine, and blood in the semen are common and temporary. Serious infections are exceedingly rare with the transperineal approach.
Results & Next Steps
Pathology results are typically available within one to two weeks. Dr. Radtke will review the results with you in detail and discuss next steps — whether that is reassurance, active surveillance, or treatment options if cancer is found.
Clear diagnosis and personalized planSchedule a Prostate Biopsy Consultation
Dr. Radtke will review your PSA, MRI, and clinical history to determine if a biopsy is appropriate.
Schedule an Appointment
Dr. Radtke sees patients through Prevea Health. You can book an appointment online or call our office directly.
Clinic Information
(920) 458-6664
Monday – Friday: 8:00 AM – 5:00 PM
Saturday – Sunday: Closed