Transperineal Biopsy for Prostate Cancer

The different transperineal biopsy procedures
  • Systematic transperineal and Saturation biopsy
  • Transperineal 3D fusion targeted biopsy
  • Systematic biopsy VS 3D fusion targeted biopsy
transperineal prostate biopsy for cancer

A relatively recent procedure, the transperineal biopsy (TPBx) is growing in popularity thanks to the latest advances in technology.

Coupled with MRI-Ultrasound fusion, today the transperineal biopsy is particularly well received among urologists in search of new & more efficient techniques.

It offers a wealth of benefits, with the arguments put forward in favour of transperineal over transrectal biopsies being as follows:

  • Reduced risk of infection
  • Access to anterior targets
  • Incorporates a high-volume prostate
  • Identical orientation to focal therapies typically conducted via the perineum
  • Technique possible under local anesthetic
  • Less discomfort for the patient during the procedure
  • Improved detection of clinically significant prostate cancer 1,2,3


1Bajeot et al. Managing Discordant Findings Between Multiparametric Magnetic Resonance Imaging and Transrectal Magnetic Resonance Imaging–directed Prostate Biopsy—The Key Role of Magnetic Resonance Imaging–directed Transperineal Biopsy. European Urology Oncology, 2021.

2Jacewicz et al. Cancer Detection Rates in Targeted Transperineal MRI-TRUS Elastic Fusion-guided Prostate Biopsies Performed Under Local Anesthesia. Anticancer Res, 2021.

3Jacewicz et al. Multicenter transperineal MRI-TRUS fusion guided outpatient clinic prostate biopsies under local anesthesia. Urol Oncol, 2021

The procedure can be performed in the supine position (majority of procedures) or lateral position. The endocavitary ultrasound probe is positioned in the rectum, whereas the sampling needle is inserted via the patient’s perineum.

It is then directed towards the targets to be sampled by means of a guide fixed onto the ultrasound probe.

transperineal prostate biopsy ultrasound

The different transperineal biopsy procedures

Systematic transperineal and Saturation biopsy

Systematic transperineal biopsy

A systematic biopsy entails evenly spreading out all of the samples taken from within the prostate (following a template with or without a guidance grid). To this end, the doctor follows a standardised protocol for distributing the biopsies and removes in the region of a dozen samples, in order to cover a volume representative of the organ.

Saturation biopsy

One alternative to systematic biopsy is widely referred to as “saturation” biopsy, whereby a greater number of specimens are taken – 30 to 50 samples.

Covering virtually the entire prostate, this technique enables the detection of more cancer sites in comparison with traditional approaches, as well as of indolent lesions that do not require any treatment. However, it causes greater discomfort for the patient.

The main disadvantage of these two methods: even with the use of a guide, it is impossible for the doctor to locate, target and record over time the suspect areas sampled, unlike with a “targeted” biopsy.

Transperineal 3D fusion targeted biopsy

In the medium term, the benefits of transperineal fusion biopsies should be sufficient for it to become a new benchmark in prostate cancer diagnosis:

  • Ultra-precise targeting of potentially cancerous tissue (Ideal for active surveillance)
  • Reduced number of samples required
  • 3D mapping of the prostate
  • Can be performed in an outpatient setting under local anaesthetic
  • Diminished side effects
  • Lower risks associated with the anaesthesia
  • Reduced risk of infection (the needle no longer passes through the rectum)

KOELIS Trinity®, developed by KOELIS®, is to this day the most advanced medical MRI-Ultrasound fusion system for transperineal targeted biopsies under local anaesthetic. KOELIS Trinity® is the only fusion biopsy system that’s equipped with Organ-Based Tracking Fusion® (OBT Fusion®), a patented KOELIS® innovation that works in tandem with elastic fusion technology. Unlike other technologies that track the movement of the probe (robotic technology or electromagnetic sensors), OBT Fusion® tracks the shifting prostate and automatically compensates for these movements therefore maximizing the accuracy of the procedure.

Transrectal vs Transperineal Biopsy

Transrectal Transperineal
Anaesthetic Local Local Anesthesia General Anesthesia
Hospital stay Outpatient Outpatient Day Case
Discomfort during procedure Moderate Very moderate None
Infection risk Low Very Low Very low

Source:Transperineal vs transrectal biopsy in MRI targeting – Grummet et al. Transl Androl Urol– June 20177

Side Effects and Complications

The following side effects can be associated with transperineal biopsies:

  • Pain and discomfort around the sampled area
  • Difficulty urinating
  • Bleeding of the prostate – Presence of blood in urine/sperm
  • Side effects due to general anaesthetic
  • Risk of infection due to the passage of needles via the rectum (2 to 4%)

Recovery remains fast after such medical exam.

KOELIS® technology for transperineal biopsy

For over a decade KOELIS® has been assisting urologists and radiologists from around the world in their routine clinical practice providing the latest technology for a patient-focused solution against prostate cancer.

In order to bring personalized answers to every patient in the respect of their quality of life, we’ve developed a comprehensive tool: KOELIS Trinity® Perine, the first 3D image-based cartographer created to help clinicians to optimize their intervention thanks to the precise planning and live guidance. This system allows physicians to perform targeted transperineal MRI/US fusion guided biopsies under local or general anesthesia. KOELIS Trinity® Perine is the new standard accurate, effective and easy to perform for outpatient transperineal prostate biopsies.

« KOELIS® provides the best quality of prostate care to patients while optimizing the workplace for doctors, nurses, and the overall healthcare industry. »

It is equipped with our exclusive Organ-Based Tracking Fusion® technology which guarantees the accuracy of the biopsy. This technique brings an increased quality control over biopsy localizations. A precise, individual prostate biopsy mapping is a value for the accurate diagnosis and the further management of each patient.

To locate a clinic equipped with our solutions: Discover our interactive map.

Last updated on April 26th 2019

  • Transperineal vs transrectal biopsy in MRI targeting – Grummet et al. Transl Androl Urol– June 2017