Prostate Cancer Diagnosis · University Urology, PC
Transperineal Prostate Biopsy in Knoxville, TN
An alternative to traditional transrectal biopsy that eliminates the rectal needle pass — significantly reducing infection risk and improving access to the anterior prostate and apex. Performed by four urologists at University of Tennessee Medical Center under general or local anesthesia.
Understanding Your Options
Two Approaches to Prostate Biopsy
University Urology physicians perform both transrectal and transperineal prostate biopsies. The right approach depends on your clinical picture, anatomy, prior biopsy history, and the goals of the procedure. Your urologist will recommend the most appropriate technique for your situation.
Transrectal Biopsy
- Pro: Technically straightforward, widely available, well-established technique with decades of data
- Pro: Can be performed with minimal or no anesthesia for most patients
- Pro: Familiar to most urologists and patients
- Consideration: Needle passes through rectum, carrying a small but real infection risk (1–5%)
- Consideration: Antibiotic prophylaxis typically required; resistant infections are a growing concern
- Consideration: Limited access to the anterior prostate and apex
Transperineal Biopsy
- Pro: Near-zero infection risk — needle bypasses the rectum entirely
- Pro: No bowel prep; typically no antibiotic prophylaxis needed
- Pro: Superior access to anterior prostate and apex where cancers are commonly missed
- Pro: Preferred for prior negative biopsy with persistent PSA elevation
- Consideration: Slightly higher reported discomfort than transrectal, though minimal and manageable — we offer Pronox (nitrous oxide) for in-office cases
- Consideration: Requires local or general anesthesia depending on patient preference and case complexity
Key Characteristics
What Makes Transperineal Biopsy Distinct
Understanding the practical differences helps you and your urologist choose the right approach for your specific situation.
Near-Zero Infection Risk
By bypassing the rectum entirely, infectious complications drop dramatically. Most patients require no antibiotic prophylaxis, reducing the risk of antibiotic-resistant infections — a growing concern with the transrectal approach.
Superior Sampling of the Entire Prostate
The transperineal route provides direct access to the anterior prostate and apex — regions that transrectal biopsy consistently undersamples. Cancers in these zones are more likely to be detected on the first biopsy.
MRI / Ultrasound Fusion Targeting
We combine systematic transperineal sampling with MRI/ultrasound fusion targeting of PI-RADS 3–5 lesions identified on multiparametric MRI. This allows us to biopsy the highest-risk regions with precision while still sampling the whole gland.
Outpatient — Home the Same Day
Whether performed under general or local anesthesia, transperineal biopsy is an outpatient procedure. Patients go home the same day and return to normal activity within 1–2 days in most cases.
Anesthesia Flexibility
We offer both general and local anesthesia depending on patient preference, anxiety level, and clinical factors. Your physician will discuss which option makes the most sense for your situation at consultation.
Foundation for Treatment Planning
Accurate biopsy pathology is the foundation of every treatment decision — including candidacy for focal therapy. A complete, well-sampled biopsy reduces the chance of understaging and guides the right treatment from the start.
Who Needs a Biopsy?
When Your Urologist May Recommend a Prostate Biopsy
A biopsy is not always the next step after an elevated PSA — but when it is indicated, we want to do it right the first time. The following findings typically prompt a biopsy discussion.
- Elevated or rising PSA — particularly PSA above age-adjusted norms, or a significant rise over time (PSA velocity)
- Abnormal digital rectal exam (DRE) — a nodule, asymmetry, or firmness palpated on exam
- Suspicious prostate MRI — PI-RADS 3, 4, or 5 lesion on multiparametric MRI, particularly in the anterior zone or apex
- Prior negative biopsy with persistent concern — continued PSA elevation or worsening MRI findings after a previous negative biopsy
- Active surveillance monitoring — confirmatory biopsy as part of a structured surveillance protocol for known low-risk cancer
- Family history or genetic risk — BRCA2, BRCA1, or Lynch syndrome mutation carriers with elevated baseline risk
A Note on MRI First
We strongly favor obtaining a multiparametric prostate MRI before biopsy whenever possible. MRI identifies suspicious lesions that can be targeted during the biopsy, improving detection of clinically significant cancer and reducing unnecessary sampling of benign tissue.
If you have not had a prostate MRI and biopsy is being considered, ask us about sequencing your workup appropriately before proceeding.
Anesthesia Options
General or Local Anesthesia — Your Choice
We provide flexibility in how your biopsy is performed. In-office transperineal biopsy is available with local anesthesia and Pronox (nitrous oxide) for comfort. For patients who prefer to be fully asleep, or for more complex cases, the procedure can be performed under general anesthesia in an outpatient surgery suite. Your urologist will discuss which option best fits your situation.
Fully Asleep
You will be completely unconscious for the procedure. General anesthesia is a good option for patients who prefer to have no awareness of the procedure, have significant anxiety, or require a more extensive sampling protocol.
- No awareness or discomfort during the procedure
- Ideal for more extensive or complex biopsy plans
- Requires a driver home — same-day discharge
- Short recovery — mild grogginess for a few hours
In-Office — Awake but Comfortable
Local anesthetic numbs the perineal area, and we offer Pronox (nitrous oxide) for additional comfort and anxiety relief. This option allows the procedure to be performed in our office without the need for an operating room or general anesthesia. Most patients tolerate this very well.
- Performed in-office — no surgery center required
- Pronox (nitrous oxide) available for comfort and anxiety relief
- No driver required in most cases
- Avoids risks and recovery of general anesthesia
- Suitable for most standard biopsy protocols
Your physician will discuss anesthesia options at your pre-procedure consultation and help you decide what makes the most sense for your clinical situation and personal preferences.
What to Expect
Step by Step: Your Biopsy Experience
Understanding what to expect before, during, and after helps reduce anxiety and ensures a smooth experience.
Consultation & Planning
Your urologist reviews your PSA history, MRI findings, and clinical picture. You’ll discuss the biopsy plan, anesthesia preference, and what pathology results will guide next. Bring outside MRI images if available.
Preparation
Unlike transrectal biopsy, a bowel prep is not required. Most patients do not need antibiotic prophylaxis. Fasting instructions apply if you are receiving general anesthesia. Your team will give you specific preparation instructions at your pre-procedure visit.
The Procedure
Ultrasound guidance is used throughout. Systematic cores sample the entire gland, and MRI-targeted cores are taken from any suspicious lesions identified on prior imaging. The procedure typically takes 20–35 minutes. You will go home the same day.
Recovery
Most patients return to normal activity within 1–2 days. Some blood in the urine or semen for a few days is normal and expected. Serious complications — including infection — are rare with the transperineal approach.
Results & Next Steps
Pathology results are typically available within 5–7 business days. Your physician will review findings with you and discuss next steps — whether that is active surveillance, treatment planning, or additional workup including molecular testing or staging imaging.
Our Providers
Four Urologists Performing Transperineal Biopsy
All transperineal biopsies are performed at the University of Tennessee Medical Center in Knoxville. With four physicians offering this procedure, scheduling is flexible.
Dr. Jonathan Angelle, MD
Urologic Oncology · Robotic Surgery
Full Profile →Dr. James M. Bienvenu, MD
Urologic Oncology · Focal Therapy Specialist
Full Profile →Dr. Eric C. Riedinger, MD
Endourology · Advanced Prostate Procedures
Full Profile →Dr. Wesley M. White, MD
Urologic Oncology · Department Chair
Full Profile →Frequently Asked Questions
Common Questions About Transperineal Biopsy
Ready to Schedule Your Prostate Biopsy?
Four physicians. Flexible anesthesia options. Outpatient at UTMC. Message us or call to get started.
Preparation Instructions
Preparing for Your Procedure
Before your transperineal prostate biopsy, review your preparation instructions. No bowel prep is required. A driver is required. You will receive an antibiotic prescription prior to the procedure.