Transrectal ultrasound-guided (TRUS) biopsy of the prostate is the technique by which the prostate is sampled for pathologic analysis to determine the presence (or not) of prostate cancer.
Who might require a TRUS biopsy?
Men in whom there is a suspicion of prostate cancer are usually offered the opportunity for prostate biopsy. This usually occurs in one of the following circumstances:
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An elevated PSA level.
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Abnormal feeling prostate on rectal examination.
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A suspicious area on a prostate MRI scan.
What happens during the procedure?
Most men will have a light anaesthetic for this procedure in this practice. This allows the biopsy to be performed in a completely pain-free manner, and as there is no discomfort the patient does not move - allowing more accurate biopsies to be performed.
An ultrasound probe is inserted into the rectum allowing the prostate to be imaged. A special biopsy instrument is used to take small “sealed” cores of prostate tissue that are the sent to the Pathologist for analysis. A standard pattern of 12-16 cores is performed, with extra cores often being taken from areas of suspicion as seen on an MRI scan.
A cystoscopy (telescope inspection of the prostate and bladder) is often performed at the same time.
A few important points
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You should inform the doctor if you are taking any anti-coagulants – as these should be stopped before the procedure. Read about Preparing for Surgery.
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It is possible small tumours can be missed by the biopsy pattern.
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Prostate MRI prior to biopsy would seem to decrease this chance on present evidence.
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The doctor will discuss the risk of infection with you – and the importance of taking the prescribed antibiotics.
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You should inform the doctor if you have been travelling in Asia in the previous 3 months. The choice of antibiotic cover may need to be varied if so.
After the procedure
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You will be allowed home a few hours after your biopsy - once you have recovered from your anaesthetic and successfully passed urine.
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It is important to take the prescribed antibiotic tablets for a few days after the biopsy.
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For a few weeks after the biopsy, you may notice small amounts of blood in your urine, semen and/or bowel motions. This is quite normal, and usually settles without any incidence.
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Infections occasionally occur as a consequence of the biopsy. If you feel a burning sensation on passing urine, notice that your urine is cloudy or smelly, or you develop a temperature, have shaking attacks and feel generally unwell, contact your GP or urologist. He will probably prescribe more antibiotics or, very occasionally, admit you to hospital for treatment using an intravenous drip.
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An appointment will have been made with your Urologist to discuss the results of you biopsy – so take a careful note as to its time.
Are there any possible side effects?
Most procedures are straightforward. Although the complications listed below are well recognised, most patients do not suffer any problems.
Relatively Common
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Blood in your urine.
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Blood in your semen for up to 6 weeks; this poses no problem for you or your sexual partner.
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Blood in your stool.
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Discomfort from the prostate area.
Occasional
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Urinary tract infection.
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Blood infection (septicaemia) needing hospital admission (< 2% risk).
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Haemorrhage (bleeding) needing admission (<1% risk).
Rare
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Urinary retention – inability to pass urine requiring a temporary catheter to be inserted into the bladder.