Transrectal Ultrasound-Guided Prostate Biopsy
A prostate biopsy is taking multiple small tissue samples from the prostate for evaluation by a pathologist (doctors who examine tissue under the microscope). We use ultrasound technology to accurately guide our biopsy needle. Prostate biopsies are not perfect in their ability to detect prostate cancer. At this point in time, however, 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. It is possible that a very small (microscopic) area of cancer could be missed. 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.
The procedure cannot be done if you are currently on, or have recently taken any medication that may interfere with your ability to clot your blood ("blood thinners"). We will have reviewed all of your current medications with you during the consultation, but please tell us if anything has changed since your previous visit. The most common of these medications are aspirin and all related pain reliever or anti-inflammatory compounds (whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past 10 days. If you new medication is not on the list, mention it anyway so that we may ensure it is not a blood thinner.
You do not have to fast in order to have a prostate biopsy. It is recommended that you eat a very light breakfast (if your biopsy is in the morning) or a very light lunch (if your biopsy is in the afternoon). Try, however, to eat at least one hour before the biopsy. If you are diabetic, make sure you do not miss your regular meal.
You may be asked to take enemas. The first enema is usually administered one hour before bed the night before your biopsy; and the second should be administered 1-2 hours before you leave for your appointment with our office. Each physician has their own regimen, and they will let you know about the number of enemas and the times that they should be administered.
You will be given antibiotic tablets as well. They should be taken as directed by your urologist.
If possible, have a friend or family member come with you that day to keep you company and drive you home. While it is not absolutely necessary, we would prefer that you have someone accompany you. In some cases, a patient can unexpectedly feel light-headed or uncomfortable after any procedure. If you do not have anyone available, we may ask that you relax for awhile in our waiting room after the procedure until we feel it is appropriate for you to leave.
To review the basics of what we discussed in the office: The actual procedure typically takes10-15 minutes. You will be placed lying down on your side on an examining table. Some urologists may use numbing medicine. It can be given by an injection around the nerves adjacent to the prostate or sometimes as a jelly pushed into the rectum. An ultrasound probe will be gently placed in your rectum. Although it is slightly uncomfortable, very few patients believe it is painful. We will then take the biopsies with a small needle. You will hear a click or snap sound for each biopsy and feel a little pinch. Again, while most admit it is uncomfortable, very few claim that it is actually painful. The amount of biopsy cores taken will depend on the decision of your urologist, your anatomy, and possibly on whether you have had a prostate biopsy done in the past.
After the procedure, you might feel a bit sore in
the rectal or anal areas 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 discoloration of the urine
is rarely seen but not impossible. You may commonly see
blood in your semen (ejaculation) for a few days and
sometimes up to 4-6 weeks. It might be red or just discolor
your semen brown.
You have no restrictions after the biopsy other than to take it easy that day. If possible, have a friend drive you home.
Expectations of Outcome
After the biopsy, the specimens are sent to a pathology laboratory for evaluation by a trained pathologist. We cannot give you any accurate information from the ultrasound appearance of the prostate or from the look of the tiny specimens that we remove with the needle. We understand that you are anxious to have the results and can only ask for your patience. We will call you as soon as they are available to us. It usually takes one week to get the results.
Possible Complications of the Procedure
ALL procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned. It is important that every patient be made aware of all possible outcomes which 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. In this instance, a catheter will be placed and your doctor will discuss the next step. 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 the procedure due to BPH (Benign Prostatic Hyperplasia).
- Urinary Tract Infection or Urosepsis: Although we give you antibiotics, 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 may feel very ill. This type of infection often presents with the urinary symptoms and any combination of the following: fevers, shaking chills, weakness or dizziness, nausea and vomiting. You may need a short hospitalization for intravenous antibiotics, fluids, and observation. This is more common in diabetics, patients on long-term steroids, or patients with any disorder of the immune system. Lastly, an abscess of the prostate, while quite rare, can develop. This is an infectious cavity that may respond to antibiotics alone or need surgical (needle) drainage. It can begin with urinary symptoms but also progress to the symptoms of bloodstream infections. Urinary retention is possible with an abscess.
If you have symptoms of any of the above, especially those of infection, you must contact us immediately or go to the nearest emergency room.
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.
Delta Medix, P.C.