Transrectal Prostate Biopsy
A Transrectal Ultrasound Guided Biopsy of the Prostate (TRUS biopsy) involves taking multiple small tissue samples from the prostate for evaluation by a pathologist) to exclude the presence of prostate cancer. Prostate biopsies are not perfect in their ability to detect prostate cancer. However, at this point in time there is no other method to differentiate benign tissue from malignant tissue in a patient with a suspicious PSA (prostate specific antigen) or digital rectal examination.
We take samples that reflect each of the different zones of the prostate as well as the size of your prostate. In other words, we might take a few extra samples from a larger gland. Despite the fact that multiple (usually 10 or more) samples are taken, a prostate biopsy may still miss cancer. For that reason, the procedure may need to be repeated depending on the future PSA or digital rectal examination findings.
Please refer to the detailed information provided by the rooms. This is also available on the website.You will most probably be asked to stop any blood thinning medication for 5-7 days before the procedure. These include Aspirin, Warfarin and Plavix.You will be prescribed antibiotic tablets. These must be started on the day before the procedure and continued until the course is completed.
The actual procedure typically takes 5-15 minutes. You will be placed lying down on your left side on an examining table. A dose of intravenous antibiotic will then be administered. You will then be given a light general anaesthetic. Alternatively, the procedure may be performed under local anaesthetic. These options will be discussed with you in the office. Your prostate will then be examined and an antiseptic solution is placed inside your rectum. An ultrasound probe will be gently placed in your rectum. Once the ultrasound is in the rectum, biopsies will be taken.
After the procedure, you might feel a bit sore in the rectal or anal area for a few hours. We rarely hear of problems beyond that, although patients with hemorrhoids might have discomfort a bit longer. It is very common to see some blood from the rectum, on the stool with the next bowel movement, or on the toilet paper especially that day and rarely the next day. Again, this is more common in patients with hemorrhoids. A small amount of blood in the urine or some discolouration of the urine may also be seen. You may commonly see blood in your semen (ejaculation) for several days to weeks. This is called haematospermia. It might be red or just discolour your semen brown.
You have no restrictions after the biopsy other than to take it easy that day. Remember to take all of the prescribed antibiotics.
The results of the biopsy will be discussed in detail during your post-procedure consultation
Possible Complications of the Procedure
The vast majority of patients will not experience any problem after a prostate biopsy. However, any procedure, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. These may include, but are not limited to:
- Excessive Bleeding from the Anus
It is uncommon to require any treatment, and the majority of the time the bleeding stops on its own. This is far more common in patients with hemorrhoids.
- Blood Clots in the Urine
The needle can enter the middle of the prostate where the urethra or the neck of the bladder are located and cause blood in the urine. If the bleeding is significant, it can cause clots that can block the urine flow. A catheter may need to be inserted to flush out the clots.
- Urinary Retention
Even in the absence of bleeding, the prostate can become swollen from the biopsy or secondary to infection. This can lead to difficulty passing urine, or an inability to pass urine altogether. In this instance, a catheter will be placed. Usually, the problem resolves with time after the swelling goes down. Sometimes, medications are given that may help to open the prostate channel. Patients at greater risk are those who already have difficulty urinating before a procedure due to BPH (Benign Prostatic Hyperplasia). Occasionally a formal prostate procedure such as a transurethral prostate resection may be needed to relieve the obstruction and allow normal urination.
- Urinary Tract Infection or Urosepsis (Bloodstream Infection)
Although we give you antibiotics, before, during and after the procedure it is possible for you to get an infection. It may be a simple bladder infection that presents with symptoms of burning urination, urinary frequency and a strong urge to urinate. This will usually resolve with a few days of antibiotics. If the infection enters the bloodstream, you might feel very ill. This type of infection can present with both urinary symptoms and any combination of the following: fevers, shaking chills, weakness or dizziness, nausea and vomiting.
It is very important that if you experience any of these symptoms, you must attend your nearest public hospital emergency department and inform them that you have had a prostate biopsy. They can contact Dr Sved through the switch board at RPA Hospital on 9515 6111 for any instructions. You may require a short hospitalisation for intravenous antibiotics, fluids, and observation. This scenario is more common in diabetics, patients on long-term steroids, or in patients with disorders of the immune system.
Please contact the office within 3 days of discharge. You should make an appointment to see Dr Sved as directed in the hospital. You may see him in his offices at RPA, Bankstown or Strathfield Private Hospital. Do not hesitate to call at any time if you have any concerns.