Transrectal ultrasound-guided prostate biopsy

Published by Bupa's Health Information Team, February 2011.

This factsheet is for men who are having a transrectal ultrasound-guided prostate biopsy, or who would like information about it.

Transrectal ultrasound-guided prostate biopsy is a procedure that can help diagnose prostate cancer. A sample of prostate tissue is removed and sent to a laboratory for testing.

You will meet the doctor carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About transrectal ultrasound-guided prostate biopsy

A transrectal ultrasound-guided prostate biopsy is a procedure that takes small samples of tissue from your prostate gland. Your doctor may recommend that you have a prostate biopsy to check for cancer if tests show that you have a raised level of prostate-specific antigen (PSA) in your blood or an enlarged prostate gland.

Your prostate is about the size of a walnut and lies at the base of your bladder. The back of your prostate presses against your rectum (back passage) and the front of your prostate surrounds your urethra (the tube that carries urine from your bladder and out through your penis). Any change in the size or shape of your prostate can narrow your urethra, making it difficult for you to pass urine.

The prostate gland and surrounding structures

Preparing for your transrectal ultrasound-guided prostate biopsy

Transrectal ultrasound-guided prostate biopsy is routinely done in hospital as a day-case procedure. This means you have the procedure and go home the same day.

You will be given a local anaesthetic to ease any discomfort you may feel. Local anaesthesia completely blocks pain in your rectal area and you will stay awake during the procedure.

Usually you can eat or drink as normal before having a prostate biopsy. If you take medicines to prevent blood clots (anticoagulants) such as warfarin, aspirin or clopidogrel, you will be asked to stop taking them before the procedure. If you’re unsure about taking your medication, please contact the hospital.

You will be given antibiotics before the biopsy to help prevent infection.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a transrectal ultrasound-guided prostate biopsy

The procedure usually takes 10 to 15 minutes.

You will be asked to change into a hospital gown that opens at the back. You will need to lie down on your left side with your back to your doctor.

Your doctor will carefully pass a lubricated ultrasound sensor into your rectum. The sensor may feel uncomfortable but shouldn't be painful. Images of your prostate will be displayed on a monitor.

Your doctor will use these ultrasound images to look at your prostate. They will also help to guide him or her in taking biopsies of your prostate through the wall of your rectum.

Your doctor will pass a special port that contains biopsy needles down the shaft of the ultrasound sensor. The needles are used to collect about 10 to 12 samples of prostate tissue. The procedure is very quick but you may feel a short, sharp sensation each time a needle is inserted. Your tissue samples will then be sent to a laboratory for testing.

What to expect afterwards

You will usually need to stay at the hospital for at least 30 minutes after your biopsy to make sure you have made a good recovery. You will be asked to pass urine before you go home. You will be given a course of antibiotics to take and a date for a follow-up appointment.

You can drive home if you wish, but you may feel a little uncomfortable and prefer to have someone else take you.

Your results will be ready a few days later and will usually be sent in a report to the doctor who requested your biopsy. He or she will review the results and discuss them with you at your follow-up appointment.

Recovering from a transrectal ultrasound-guided prostate biopsy

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Take it easy for the rest of the day. Try to drink plenty of fluids to help flush out any possible infection. It's common to have some blood in your urine, stools and semen for several weeks afterwards.

It's important that you complete your course of antibiotics to try to prevent infection. However, you may still develop one so it’s important to contact your GP if you have:

• severe pain or pain that lasts for more than 48 hours
• difficulty in passing urine
• burning sensation on passing urine or if your urine starts to smell
• increasing blood in urine
• high temperature

What are the risks?

As with every procedure, there are some risks associated with transrectal ultrasound-guided prostate biopsy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure.

Common side-effects of prostate biopsy include:

• slight discomfort in rectal area
• blood-stained urine or faeces - this can last up to a week or two
• blood-stained or discoloured semen - this may last for six weeks
• difficulty in passing urine - this usually improves quickly

Complications

This is when problems occur during or after the procedure. Most men are not affected. Complications include:

• your biopsy needing to be repeated because the samples are of poor quality
  
• a urinary or bowel infection – these are very rare and are caused when the biopsy needles pierce your rectal wall and bacteria from your bowel cause an infection

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.