Prostate Biopsy FAQ

Trans-Rectal Ultrasound (TRUS) & Prostate Biopsy FAQ


 1Why might I need to have a trans-rectal ultrasound?

The most common reason is for an elevated PSA test (prostate blood test), the ultrasound is done in conjunction with biopsies of the prostate to determine the cause of this elevated PSA test.

Also if the prostate gland is enlarged it can make it difficult to pass urine. You may need a trans-rectal ultrasound to let your consultant see any enlargement and it may provide further information as to the cause.

The main types of prostate problem are benign prostatic hyperplasia (BHP), prostatitis or prostate cancer. Your GP will probably have taken a blood test (Prostate Specific Antigen) (PSA) and done a digital rectal examination (DRE) of your prostate prior to referring you to our Urology service.

The TRUS biopsies (samples taken), the PSA and DRE are the tests required to make a diagnosis. The results will help your consultant to decide what should happen next and the most appropriate treatment for your particular symptoms. These tests are the only way to obtain these results. No other test is available.

 2What do I need to do before I come in?

There is little preparation needed

If you are taking warfarin, high dose aspirin, asasantin, clopidogrel or any other blood-thinning medication, it may be necessary to stop taking them.
It is ok to do the biopsies if you are taking the low dose or 75mg of Aspirin.
Please tell the doctor about any allergies, especially to antibiotics.

No other special preparation is required. You may eat or drink normally and you do not need to bring anything else with you to your appointment. However it is advisable that someone comes with you to the clinic and drives you home afterwards.

 3Will I need to take antibiotics?

Yes. You will have been prescribed a short course of antibiotics. You will need to take the first two tablets one hour before your appointment, and to finish the course as instructed over the following days. Please bring these tablets with you to the appointment

 4What happens when I arrive?

Please tell the receptionist that you have arrived for the TRUS clinic. They will inform the Urology Clinic staff of your arrival. A Nurse will come to collect you and take you to the investigation room where the doctor will explain what will happen and answer any questions, and ask you to sign the consent form.

Your urine will be tested to rule out infection. If there is any evidence of a urine infection then the procedure will be postponed until it has been treated.

 5What does a scan consist of?

The scan uses high frequency sound waves to produce a picture of the prostate gland.

You will be positioned on the couch with the help of the nurse, you can leave your shoes on but will be asked to remove your trousers and pants down to your knees. You will need to lie on your left side with your knees up to your tummy(foetal position). Lubricating jelly will be applied to your anal area to help keep you comfortable and the prostate will be examined. The Ultrasound probe is then inserted into the rectum to scan the prostate gland

You will be given an injection of local anaesthetic into several areas of the prostate.

As you can see from the diagram below a probe will be inserted into your rectum. You may find this uncomfortable and some men do find it painful. You may feel like you are about to pass a bowel motion. Please be assured that this is just a sensation and is a normal reaction.

Side view of TRUS and biopsy

The doctor is able to see the prostate gland on a screen and measure its size. Shortly afterwards a number of small samples (around 12 biopsies) will be removed from the prostate using special needles. You will hear a loud clicking noise as samples are taken. The taking of samples, again, can be uncomfortable. Deep breathing and trying to relax can often help.

Any sample that is taken will be sent to a laboratory to be analysed. The results are normally available in two weeks.



 6How long will the procedure take?

The consultation takes 30 minutes with the actual procedure lasting around 10-12 minutes, the doctor will explain what is happening throughout.

 7Who will be doing the procedure?

A qualified Urologist or Radiologist will be doing the procedure.

8Are there any side effects from the treatment that I need to know about?

Yes

Most side effects are minor and self limiting, more major side effects are rarer although this is weighed up against not doing the procedure and risking missing a more serious condition.

Common:

  • Blood in urine
  • Blood in semen
  • Bruising in perineal area
  • Urinary infection (5 -10% risk)
  • Haemorrhage causing inability to pass urine (2% risk)

Occasional:

  • Sepsis requiring hospitalisation (2% risk)
  • Haemorrhage requiring hospitalisation (1% risk)
  • Failure to detect a significant cancer of the prostate
  • Repeat of the procedure should biopsy results be inconclusive
  • Urinary retention
  • Need for rebiopsy(10-15%)


9Will there be any after effects?

Although the test does not require a general anaesthetic, most men find it reassuring if a friend or relative accompanies them and is available to take them home.

You will be asked to finish the course of antibiotics. This helps to prevent infection. DO NOT drink alcohol while taking them. We also ask you to wait to pass urine before you go home, as occasionally some men find it difficult to void. It is also not uncommon to experience bleeding. You may notice blood in your urine for a few days, blood on wiping your bottom for a day or two and blood in the semen for several weeks. This is all normal and should settle down.

If you are concerned by the degree of bleeding or you develop symptoms of a fever (sweating, shivering or feeling cold then you should consult your GP immediately.

 10What will happen afterwards?

An appointment will be made 1-2 weeks after the biopsy and at that point we will go over these results with you. f your biopsy results are positive discussions regarding appropriate treatments will start at this clinic.If your biopsy results are negative your GP will be asked to organise further tests and monitor your condition and may refer you back to the if appropriate.


11Who should I call if there are any problems?

If you do have any concern or worries after the procedure contact your G.P., hospital where it was performed or attend your local A&E department. If you do need to see a Doctor please take this leaflet with you.