Trans-Rectal Ultrasound (TRUS) Prostate with Biopsy

Your Prostate

Just below your bladder and in front of your rectum is a small, muscular gland called the prostate.  It wraps around the urethra, the tube that carries urine from your bladder.  Your prostate produces most of your semen.

At risk for cancer

If cells in the prostate change abnormally, cancer may form.  Cancer often appears in the outer area of the prostate (near the rectum) before spreading to the inner areas of the gland. Usually, there are no symptoms unless the growth begins to press on the urethra, which will cause you some pain.  Below are some examples from left to right of a normal prostate and open urethra, then you have a small tumor that still allows an open urethra.  The last image on the right shows large prostate tumor growth causing a narrowed urethra that will cause pain and effect the flow of urine.

Procedure Explanation

Why you need a prostate ultrasound biopsy

If a potential prostate problem is identified through a digital rectal exam or a PSA (Prostate-Specific Antigen) blood test, your doctor may suggest that you have a prostate ultrasound and biopsy.  This imaging technique, along with a biopsy, helps your physician discover cancer early, when it is more likely to be treatable.  Prostate ultrasound biopsies are usually done in our ultrasound department but they are also performed in our Ambulatory Surgery Center (ASC) under general anesthesia.  Prostate biopsies can be painful, so having it done on an outpatient basis in a surgery center can alleviate the pain when you are put to sleep.

What ultrasound reveals

Ultrasound uses high-frequency sound waves to create an image of the prostate gland. This can help your doctor identify abnormalities in the gland.

How ultrasound is performed

The ultrasound test is simple and will be performed at Urology Associates of Central California (UACC). The test takes about 15 minutes. To clear your rectum, you will be asked to use a Fleets Enema.  If a biopsy is performed, you will be given antibiotics both before and after the test to prevent infection.  One of our ultrasound sonographers will conduct the ultrasound portion of the exam, and your urologist will do the prostate biopsy.  In some instances your urologist may conduct the ultrasound portion of the test as well.

Creating the image

You will lie on your side or with your feet in stirrups. A tube-like probe barely bigger than a thumb is covered with a condom. Your doctor gently inserts the probe into your rectum.

The probe emits sound waves, creating an image of your prostate on a video screen. Your doctor views the image, looking at the size, shape, and structure of your prostate.

If a biopsy is needed

If your doctor finds suspicious areas in your prostate or if your PSA blood test is abnormal, a biopsy may be recommended. To do the biopsy, your doctor takes tissue samples from the suspicious areas of your prostate for examination. A biopsy is often performed during the ultrasound test.

Taking the prostate biopsy sample

• The small tip of the biopsy needle is inserted through your rectum into your prostate.
• One or more tissue samples are taken from the prostate (this is only slightly uncomfortable). Your tissue samples are then sent to a lab for pathology analysis.

After your biopsy

When the results of your biopsy are ready, your doctor will talk with you about the results, and any further exams or treatment that may be needed.

• You may notice some rectal bleeding or blood in your urine for a few days.
• You may see blood in your semen for 2-3 weeks.
• Ask your doctor if you should temporarily limit exercise or sexual intercourse after your biopsy.
• Call your doctor if you have a fever, excessive urinary or rectal bleeding, muscle aches, fatigue, or difficulty urinating.

Preventing future problems

Ultrasound alone is not a complete prostate exam; it is used to check abnormalities found by other tests. Even if your ultrasound shows no problems, continue to have regular prostate exams. The American Cancer Society recommends yearly digital rectal exams for men over age 40 and yearly PSA blood tests for men over age 50. If you are African American or have a family history of prostate cancer, you are at high risk.

Ultrasound Prostate Biopsy Preparation Instructions

You are scheduled for an ultrasound with possible biopsy of the prostate gland. Please follow these instructions:

• Two hours before the exam give yourself or have someone give you a Fleets Enema (Regular). You may purchase this at any pharmacy.
• The morning of the exam, take one of the antibiotic pills that you were given.
• The morning after the exam, take the second antibiotic pill that you were given.
• Your physician will give you instructions regarding your postoperative care.
• If you take aspirin products regularly, discontinue use 5-7 days prior to your procedure. If you take any blood thinners please remind your physician so that he may instruct you.

If you have any questions, please feel free to call our office at 559-321-2800.  If you are unable to keep this appointment, call us and we will reschedule your appointment for you.

Your biopsy specimen will be sent to a local hospital for analysis by a pathologist, and additional charges will be incurred for this service. The pathology facility will bill for these charges independent from Urology Associates of Central California.

Post-Operative Instructions

You have just had a transrectal prostate biopsy performed under ultrasound guidance. This is not a sterile procedure. However, it is a clean procedure. For this reason, it is extremely important that you take any antibiotics prescribed by your doctor until finished.

You should drink plenty of fluids following your biopsy.

Do not be alarmed if you notice…

1. Slight blood streaking of stools for possibly up to a week. You may even pass a small clot through the rectum before your first bowel movement.
2. Small amount of blood in your urine for up to a week following biopsy.
3. Small blood clots with initial urination for several days.
4. Blood in your ejaculate with sexual activity for up to two months.

Complications

Complications to the biopsy procedure occur in approximately 1% of patients. These are:

1. Bleeding:You may notice soft, bloody, frequent stools.
2. Fever: This can rapidly evolve into a serious problem, including shock if not treated immediately. Any temperature elevation at 100 degrees Fahrenheit or above is serious if it occurs within 2-3 days of your biopsy. Check your temperature with any hint of feeling ill, such as feeling flushed, weak, lethargic, having chills, etc.

If you have any questions or feel you are having a complication, call your doctor immediately at (559) 321-2800