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Transrectal ultrasound-guided prostate biopsy

Transrectal ultrasound-guided prostate biopsy is a procedure that is used to help diagnose prostate cancer. Samples of your prostate tissue are 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 in which small samples of tissue are taken from your 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).

Your doctor may recommend that you have a prostate biopsy to check for cancer if other tests show that you have a raised level of prostate-specific antigen (PSA) in your blood. PSA is a protein made by your prostate gland and having a raised PSA level can be a sign of prostate cancer or other conditions including inflammation of your prostate. Your doctor may also recommend you having a prostate biopsy because you have an enlarged prostate gland.

Illustration showing the prostate gland and surrounding structures

What are the alternatives to transrectal ultrasound-guided prostate biopsy?

An alternative to transrectal ultrasound-guided prostate biopsy is a transperineal prostate biopsy. This is carried out under general or spinal anaesthesia. In this procedure, your doctor will insert biopsy needles through the skin of the area between your testicles and rectum (your perineum). This is carried out under ultrasound guidance, using an ultrasound probe inserted into your rectum.

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. This will completely block 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, these could increase your risk of bleeding after the procedure. You may be asked to stop taking them before having your biopsy, but you will need to discuss the risks and benefits of this with your doctor carrying out the biopsy and the doctor who prescribed you the anticoagulant. If you’re unsure about taking any of your medicines, please contact the hospital.

It’s not recommended to have an enema (where liquid is injected into your rectum to empty your bowel) before the biopsy because no benefit has been found in having one. However, you will be given antibiotics before the biopsy to help prevent an infection. You may also be prescribed antibiotics to take for a few days after the procedure. It’s important that you complete any course of antibiotics you’re prescribed. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain relief you might need. 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 and your knees drawn up towards your chest.

Your doctor will carefully pass a lubricated ultrasound sensor through your anus and into your rectum. The sensor will be covered with a condom, therefore, let your doctor know beforehand if you’re allergic to latex so that a suitable alternative can be used. 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 while 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 biopsy port has a trigger that will make a loud noise each time it’s fired, so you need to be prepared for this. Try to keep still during the procedure as this will help to ensure you won’t need a repeat procedure later. You may find having the biopsies taken is slightly uncomfortable or painful. After the procedure, your tissue samples will 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.

It’s recommended that you arrange for someone to drive you home because you may be feeling a little uncomfortable after your procedure, which could distract you from driving.

Your results will be ready within about two weeks 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 enough fluids to help flush out any possible infection. It's common to have some blood in your urine, faeces 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
  • a burning sensation on passing urine or if your urine starts to smell
  • increasing amounts of blood in your urine or faeces
  • a 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:

  • some pain in your 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

Complications

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

  • Your biopsy may need to be repeated because the samples are of poor quality or because your PSA levels continue to rise even though your initial biopsy shows no cancer. As many as two in 10 men will have prostate cancer that is missed in their first biopsy.
  • An infection. This may be caused when the biopsy needles pierce your rectal wall and bacteria from your bowel get into your urethra or bloodstream. Your doctor will prescribe you antibiotics to treat the infection.
  • Difficulty in passing urine. This can happen because of a blockage in your urethra caused by a blood clot or because your prostate is swollen. If you have difficulty passing urine after your biopsy, you will need to urgently go to hospital for treatment.

 

Produced by Louise Abbott, Bupa Health Information Team, January 2013.

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

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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