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Transperineal MRI Fusion Prostate Biopsy

Image-guided targeted prostate biopsy through the perineum using MRI-ultrasound fusion.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Transperineal MRI Fusion Prostate Biopsy?

Transperineal MRI-fusion prostate biopsy is an advanced sampling technique that combines preoperative multiparametric MRI with real-time transrectal ultrasound to target suspicious prostate lesions through a perineal approach. Software fusion overlays MRI lesion contours onto live ultrasound, enabling precise sampling of PI-RADS 3-5 areas while obtaining standard systematic cores.

Compared with the traditional transrectal approach, the transperineal route avoids puncture of the rectal mucosa, reducing the risk of post-biopsy sepsis from below 1 percent versus 2-5 percent transrectal. It allows access to the apex and anterior prostate where significant tumors are often missed, and is now endorsed as the preferred biopsy approach by the European Association of Urology 2024 guidelines.

The procedure is performed under local, regional, or general anesthesia using a transperineal grid template or freehand stepper. Antibiotic prophylaxis can be limited or omitted. Reported csPCa detection rates exceed 50 percent in PI-RADS 4-5 lesions. Limitations include need for advanced imaging, specialized software, and longer learning curve.

Symptoms

Elevated PSA with normal DRE
PI-RADS 3, 4 or 5 lesion on mpMRI
Persistent PSA rise after negative biopsy
Prior atypical or HG-PIN findings
Active surveillance of low-risk cancer
Family history of prostate cancer
Need to sample anterior prostate

Risk Factors

Age over 50
Family history of prostate cancer
African ancestry
BRCA1/BRCA2 carrier status
Hereditary prostate cancer syndromes
Obesity
Previous negative transrectal biopsy

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • PSA above 4 ng/mL or above age-specific cutoff
  • Suspicious DRE finding
  • Suspicious mpMRI lesion
  • Rising PSA on active surveillance
  • Persistent suspicion despite prior biopsy

Treatment Methods

01
Multiparametric MRI before biopsy
02
MRI-ultrasound fusion software targeting
03
Transperineal template grid approach
04
Local or general anesthesia
05
Limited antibiotic prophylaxis
06
Combined targeted and systematic cores
07
Multidisciplinary uropathology review

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.