Consent and patient preparation

Patients deserve real figures, not vague reassurance. The main risks:

• Infection and sepsis: the serious one. Roughly 1-3% after TRUS, under 1% after TP.
• Bleeding: blood in the urine and in the semen are very common and settle. Rectal bleeding can occur after TRUS.
• Urinary retention, a vasovagal faint, and procedural discomfort.
• A false negative: a biopsy can miss cancer, which is why a suspicious MRI is not dismissed by negative cores.

The thing to warn about explicitly: blood in the semen can last several weeks and look alarming. If you say so beforehand, it is reassuring rather than frightening.

Why does route matter so much for infection? Because TRUS pushes the needle through the rectal wall, carrying gut bacteria into the gland and bloodstream.

So TRUS needs antibiotic prophylaxis. The problem is rising resistance, particularly to fluoroquinolones, so many units now use augmented or rectal-swab-guided prophylaxis.

TP avoids the rectum, so its infection risk is much lower and it often needs minimal or no antibiotics.

Always check the medication list before booking. The usual approach, balanced against the reason they are anticoagulated:

• Low-dose aspirin: often continued, the bleeding risk is low.
• Clopidogrel, DOACs, warfarin: usually managed or paused per local pathway, weighing the clot risk.

If someone has a high thrombotic risk, such as a recent stent, involve the relevant team rather than stopping blindly.

Pull it together into a clear conversation: the benefits (a diagnosis, a grade, a plan), the risks in numbers, the alternatives (including MRI-led monitoring), and clear safety-netting.

Practical checks: confirm there is no active urine infection, document the discussion, and make sure the patient knows exactly what to do if they become unwell.