If your doctor has recommended a prostate biopsy in São Paulo and you are looking for information before scheduling, this guide was designed to clarify each step of the process. Dr. Bruno Benigno, a urologic oncologist specialized in uro-oncology and robotic surgery, performs the procedure at Clínica Uro Onco, in Vila Clementino, using the most advanced techniques available: transperineal biopsy with MRI image fusion.

When is a prostate biopsy indicated?

The decision is made by the urologist based on a set of clinical data. It is always individualized — not every elevated PSA leads to a biopsy. The most common situations include:

Elevated or rising PSA — progressively increasing values on serial tests, regardless of the absolute value.
MRI with PI-RADS 4 or 5 — suspicious lesion identified on imaging.
Abnormal digital rectal exam — a nodule or focal hardening on physical examination.
Family history — first-degree relatives with prostate cancer, combined with other risk factors.
Repeat biopsy — patient with a previous negative biopsy and persistent clinical suspicion.

Types of prostate biopsy available in São Paulo

Transrectal Biopsy

Through the rectum, guided by ultrasound. The classic technique, most widely available.

Infection risk 2–5% Health insurance

Gold Standard

Transperineal + MRI Fusion

Through the perineum, with no contact with the rectal mucosa. Combines MRI with real-time ultrasound.

Lower infection risk +28% precision*

Cognitive Fusion

Mental MRI/ultrasound correlation. An intermediate alternative; depends on the operator’s experience.

Variable results

+28%

higher detection of clinically significant cancers with the transperineal fusion technique, compared with the classic transrectal approach (RR 1.28; p=0.03)

*Systematic review — European Urology Oncology (Rai et al., 2021)

The EAU 2024 guidelines recommend MRI-guided biopsy as the preferred approach when a lesion is visible on MRI. Dr. Bruno Benigno performs the transperineal image-fusion technique at leading referral hospitals in São Paulo.

How to prepare for a prostate biopsy

Preparation varies according to the technique used and the institution’s protocol. In general, you will need:

A correct medical order It must specify: the technique (transperineal or transrectal), image fusion and sedation/anesthesia.

Recent PSA Result required in order to perform the procedure.

Prior MRI Essential if the indication was PI-RADS 4 or 5.

8-hour fast Mandatory for procedures under intravenous sedation.

Anticoagulants Instructions to stop them according to protocol (usually 5–7 days before).

Adult companion Required on the day of the procedure.

What happens on the day of the prostate biopsy?

The procedure is performed in a hospital setting with full surgical infrastructure. With sedation combined with local anesthesia, the patient feels no pain during the procedure. It takes 30 to 45 minutes on average. The total time spent at the hospital is usually 2 to 3 hours.

Slight bleeding in the urine or stool during the first 48–72 hours.
Mild, temporary perineal discomfort.
Relative rest on the day of the procedure.

Warning signs: Contact us immediately if you have a fever above 37.8°C (100°F), severe difficulty urinating, heavy bleeding or worsening pain.

How to interpret the biopsy result

The report is issued by the pathologist and assessed by the urologist. The main scenarios include:

–

Negative

No neoplastic cells in the samples. This does not completely rule out cancer in areas that were not sampled. Ongoing clinical follow-up is necessary.

Positive — ISUP Grade Group

Replaces the classic Gleason grading. It stratifies the risk of progression into five groups (I to V). The higher the group, the more aggressive the tumor and the more intensive the recommended treatment.

Benign findings

Prostatitis, high-grade PIN or ASAP require specific follow-up with the urologist. They are not cancer, but some of these conditions may indicate an increased risk.

Patient Reviews

“I was very anxious about the biopsy, but the technique with sedation was excellent. I felt no pain at all, and Dr. Bruno’s team was extremely attentive from the first consultation to the result.”

Carlos M.

Review via Doctoralia

“Dr. Bruno gave me a lot of confidence when he explained the transperineal fusion technique. The procedure at the hospital was quick and safe, and the recovery at home was very smooth.”

Roberto S.

Review via Google

“I had my first consultation by telemedicine and then traveled to São Paulo only for the procedure. The clarity of the explanations and the professionalism of the entire Clínica Uro Onco team are admirable.”

Fernando A.

Review via Doctoralia

Frequently Asked Questions about Prostate Biopsy in São Paulo

With intravenous sedation combined with local anesthesia, the procedure is painless. The patient may feel slight pressure or discomfort, but the vast majority tolerate it well. At Clínica Uro Onco, all procedures are performed with an anesthesiologist present.

Coverage depends on the plan and the technique requested. Random transrectal biopsy is generally covered by health insurance plans in Brazil. Coverage for image-fusion biopsy varies — the ANS (Brazil’s national health insurance regulator) has issued a regulation expanding coverage for image-guided procedures. Our team will advise you on coverage when you schedule.

In general, the pathology result is available 7 to 14 business days after the procedure. Dr. Bruno Benigno holds a follow-up consultation to explain the report in detail and discuss the next steps.

Yes. A medical order is mandatory and must correctly specify the technique (transperineal or transrectal), the sedation/anesthesia and the relevant clinical data (PSA value, MRI findings). Dr. Bruno Benigno can also see you for an evaluation and issue the order.

Yes. The pre-biopsy evaluation — to confirm the indication, choose the most appropriate technique and explain the preparation — can be done by telemedicine with Dr. Bruno Benigno anywhere in Brazil. The biopsy itself requires you to be physically present in São Paulo.

In a transrectal biopsy, the needle passes through the rectal mucosa — where there is a high concentration of bacteria — increasing the risk of infection. In a transperineal biopsy, the needle is inserted through the skin of the perineum, without contact with the rectum, significantly reducing the risk of infection and allowing better access to all regions of the prostate. The transperineal image-fusion technique is the standard recommended by the EAU 2024 guidelines.

Prostate Biopsy in São Paulo: Clínica Uro Onco

Dr. Bruno Benigno performs transperineal image-fusion prostate biopsy at leading referral hospitals in São Paulo, with a dedicated anesthesia team and state-of-the-art equipment.

📍 Rua Borges Lagoa, 1070, Conjunto 131, Cobertura — Vila Clementino, São Paulo/SP

Scientific references

The information on this page is based on the guidelines and studies below, published in peer-reviewed medical journals.

Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-1777. PubMed · DOI 10.1056/NEJMoa1801993

PRECISION randomized trial: MRI before biopsy increased the detection of clinically significant cancer and reduced the diagnosis of insignificant tumors.

Ahmed HU, El-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815-822. PubMed · DOI 10.1016/S0140-6736(16)32401-1

PROMIS study: multiparametric MRI was more sensitive than ultrasound-guided transrectal biopsy and may avoid unnecessary biopsies.

Hu JC, Assel M, Allaf ME, et al. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted and Systematic Prostate Biopsy to Prevent Infectious Complications: The PREVENT Randomized Trial. Eur Urol. 2024;86(1):61-68. PubMed · DOI 10.1016/j.eururo.2023.12.015

PREVENT randomized trial comparing the transperineal and transrectal approaches in terms of infectious complications and cancer detection.

Cornford P, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer—2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2024;86(2):148-163. PubMed · DOI 10.1016/j.eururo.2024.03.027

European (EAU) 2024 guideline: recommends MRI before biopsy and the transperineal approach, given its lower risk of infection.

Wei JT, Barocas D, Carlsson S, et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy. J Urol. 2023;210(1):54-63. PubMed · DOI 10.1097/JU.0000000000003492

American (AUA/SUO) guideline on the indications for and technique of prostate biopsy.

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