Trans Rectal Ultrasound (TRUS) Biopsy

What is a prostate biopsy?

A prostate biopsy is an examination that involves taking 10-18 small pieces of tissue from your prostate gland with a needle so that they can be examined under a microscope by a pathologist. It is performed by inserting a small ultrasound probe into the rectum (back passage), and using a special biopsy guide to target the biopsies and ensure the prostate is properly sampled.

Why do I need a biopsy?

The biopsy will have been recommended because your blood test has shown a high level of prostate specific antigen (PSA) or because Professor Vale has felt an abnormal lump on digital rectal examination.

A biopsy is normally recommended in this situation as either of these findings may be an indicator of prostate cancer.

Professor Vale will usually refer you to a specialist radiologist for the biopsy.

What should I expect before the procedure?

The procedure is usually performed under local anaesthetic and you will normally be admitted on the same day as the procedure. In this case, you may eat and drink as normal.

In the less common situation the procedure can be performed under general anaesthetic.

Please be sure to inform Professor Vale in advance of your surgery if you have any of the following:

  • an artificial heart valve
  • a coronary artery stent
  • a heart pacemaker or defibrillator
  • an artificial joint
  • an artificial blood vessel graft
  • a neurosurgical shunt
  • any other implanted foreign body
  • a regular prescription for Warfarin, Aspirin or Clopidogrel (Plavix®) (blood thinners)
  • a previous or current MRSA infection

What happens during the procedure?

At the start of the procedure you will receive an intravenous injection of a strong antibiotic. Occasionally, rather than an intravenous antibiotic, Professor Vale may have commenced you on an oral antibiotic prior to attending for biopsy. In that event, please let the radiologist performing the biopsy know this.

The radiologist performing this investigation will examine the prostate through the back passage before inserting the ultrasound probe. This probe is as wide as a man’s thumb and approximately 4 inches long. During the examination, which takes up to 20 minutes, you may feel some vibration from the motor within the probe.

In most cases it will be necessary to take samples (biopsies) of the prostate. Local anaesthetic is first injected around the prostate with a fine needle before the samples are taken; the taking of biopsies involves passing a needle through the centre of the probe which is activated by a spring-loaded device and makes an audible “crack”. Insertion of the needle causes mild discomfort, not dissimilar to a blood test needle.

If a series of samples need to be taken, the prostate may feel “bruised” by the end of the procedure. It is usually necessary to take between 10 and 18 samples.

What happens immediately after the procedure?

When no samples have been taken, there are no side-effects. If biopsy samples have been taken, blood in the urine is common for 2-3 days but this clears quickly if you increase your fluid intake. Bleeding may also occur from the back passage for a short period and in the semen for up to 6 weeks.

You will be instructed to take further oral antibiotics if biopsy samples have been taken and the radiologist will issue a prescription for this.

The average stay is less than 2 hours for biopsies under local anaesthetic and half a day for biopsies under general anaesthetic.

Are there any side-effects?

Common (greater than 1 in 10)

  • Blood in the urine
  • Blood in the semen – this may last for up to 6 weeks but is perfectly harmless and poses no problem for you or your sexual partner
  • Blood in the stools
  • Urinary infection (10% risk)
  • Sensation of discomfort from the prostate due to bruising
  • Haemorrhage (bleeding) causing an inability to pass urine (2% risk)

Occasional (between 1 in 10 and 1 in 50)

  • Blood infection (septicaemia) requiring hospitalisation (2% risk)
  • Haemorrhage (bleeding) requiring hospitalisation (1% risk)
  • Failure to detect a significant cancer of the prostate
  • The procedure may need to be repeated if the biopsies are inconclusive or your PSA level rises further at a later stage

Rare (less than 1 in 50)

  • Inability to pass urine (retention of urine)

What should I expect when I get home?

It is important that you:

  • take plenty of rest and avoid strenuous exercise/physically-demanding activities for the first 24 hours after the biopsies
  • drink twice as much fluid as you would normally for the first 48 hours after the biopsies
  • maintain regular bowel function
  • complete your 3-day course of antibiotics

Any discomfort in the prostate area can usually be relieved by simple painkillers.