Transperineal Targeted Prostate Biopsy in Da Nang – Zero Sepsis Cancer Diagnosis and ISUP Gleason Grading With Dr. Dang Phuoc Dat

When an elevated PSA blood test and a 3.0 Tesla Multiparametric Prostate MRI (mpMRI) reveal a suspicious PI-RADS 4 or PI-RADS 5 lesion, tissue biopsy is the definitive next step to confirm or rule out prostate cancer. For international patients and expats in Vietnam, choosing how that biopsy is performed makes a decisive difference in diagnostic accuracy, comfort, and infection safety.

1. Why the EAU 2026 Guidelines Prioritize Transperineal (TP) Over Transrectal (TRUS) Biopsy

Historically, prostate biopsies were performed via the transrectal route—advancing a biopsy needle 12 times directly through the rectal wall into the prostate. Even with prophylactic oral antibiotics, transrectal biopsy carries a 2% to 5% risk of febrile urinary tract infection and life-threatening urosepsis caused by antibiotic-resistant rectal bacteria entering the richly vascularized prostate, alongside a 15–20% risk of rectal bleeding [1, 3].

In contrast, Transperineal (TP) Prostate Biopsy is a clean, percutaneous procedure. While the ultrasound transducer remains gently positioned in the rectum for real-time biplane imaging, the biopsy needle never enters the bowel. Instead, it passes through two tiny pinhole access points in the disinfected perineal skin, traveling longitudinally along the anatomical axis of the prostate [1, 3]:

• Near-Zero Infection & Sepsis Risk (< 0.1%): Because rectal fecal flora is completely bypassed, post-biopsy sepsis is virtually eliminated [3].
• Unmatched Access to the Anterior & Apical Prostate: Up to 25% of clinically significant prostate cancers—especially in men with a rising PSA after a previous negative transrectal biopsy—are located in the anterior fibromuscular stroma or extreme apex. The coaxial path of transperineal biopsy samples these anterior and apical zones directly [1, 2].

2. Clinical Comparison Table: Transperineal Targeted Biopsy vs. Transrectal Biopsy

To help international patients understand why major urological centers worldwide have transitioned to the transperineal approach, Dr. Dang Phuoc Dat summarizes the clinical evidence below [1, 2, 3]:

3. Understanding Your Pathology Report: Gleason Score & ISUP Grade Groups (1 to 5)

Not every prostate cancer requires immediate surgery or radiation. Modern pathology classifies prostate adenocarcinoma into five ISUP Grade Groups based on architectural Gleason patterns [1, 4]:

• ISUP Grade Group 1 (Gleason Score 3+3 = 6): Indolent, well-differentiated glands that almost never metastasize. In accordance with EAU 2026 Guidelines, Grade Group 1 is best managed with Active Surveillance—preserving 100% of urinary continence and erectile function while tracking PSA and repeat mpMRI [1].
• ISUP Grade Group 2 (Gleason Score 3+4 = 7): Favorable intermediate-risk disease (predominantly pattern 3 with a minor percentage of pattern 4). Managed with either tailored Active Surveillance (if low volume without cribriform pathology) or curative therapy.
• ISUP Grade Group 3 (Gleason 4+3 = 7) & Grade Groups 4–5 (Gleason 8–10): Clinically significant, aggressive prostate cancer requiring staging imaging and definitive curative intervention [1, 4].

4. Frequently Asked Questions (FAQ)

Is a transperineal prostate biopsy painful, and when can I go home?

With targeted ultrasound-guided perineal/periprostatic nerve block (or brief 15-minute twilight IV sedation), patients experience virtually no pain during the procedure. You recover comfortably in our day-ward and return home the same afternoon once you have urinated smoothly.

Why is there dark brown or rust-colored blood in my semen weeks after the biopsy?

Mild blood in the semen (hematospermia) occurs in 50–80% of men after prostate biopsy and can persist as a dark brownish tint for 4 to 6 weeks. This represents old residual blood clearing naturally from the prostatic ducts and is completely harmless to both you and your partner.

How soon are pathology results available at Family Hospital Da Nang?

Comprehensive histopathological analysis—including core-by-core Gleason scoring, percentage of tumor involvement, presence of perineural or cribriform invasion, and immunohistochemistry when indicated—is typically finalized within 3 to 5 business days, followed by a detailed English/Vietnamese consultation with Dr. Dang Phuoc Dat.

References (Vancouver Style)

1. Cornford P, Tilki D, van den Bergh RCN, Briers E, Eberli D, De Meerleer G, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Arnhem: European Association of Urology Guidelines Office; 2026.
2. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-1777.
3. Jacewicz M, Günzel K, Rud E, Sandbæk G, Magheli A, Busch J, et al. Antibiotic prophylaxis versus no antibiotic prophylaxis in transperineal prostate biopsies (NORAPP): a randomised, open-label, non-inferiority trial. Lancet Infect Dis. 2022;22(10):1465-1471.
4. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2016;40(2):244-252.