Transrectal Prostate Biopsy
What is prostate gland?
The prostate is a small gland, found only in men, which is about the size of a walnut and lies at the base of the bladder. The tube draining urine from the bladder is called the urethra and passes through the prostate gland.
Why do I need this procedure?
An abnormal prostate-specific antigen (PSA) level or an abnormal digital rectalcexamination may indicate the presence of prostate cancer. Your Urologist hascrecommended that you undergo a Transrectal ultrasound (TRUS) guided prostate biopsy to help determine if there is cancer in your prostate.
Any instructions before the biopsy?
Urine culture report will be required. Come to hospital as per the appointment. It will be a day-care procedure if no complications.
You can take bath at home and can have normal breakfast on the day of biopsy.
If your urine culture is positive, you will be given an antibiotic 2 days prior to procedure based on sensitivity. If urine culture shows no growth, you will be given tab. Ciprofloxacin 500mg two tablets (total 1gm) to take 2 hours prior to the biopsy in order to reduce the risk of infection due to the procedure. Please inform us if you are allergic to Ciprofloxacin.
If you are on some blood thinning drugs (like clopidogrel), it should be stopped 7 days prior to the procedure after consulting your urologist.
You will be administered an enema (Rectal) at admission, to clear stools.
What is done during the biopsy?
The procedure itself will take around 20-30 minutes. You will be asked to lie on your left hand side on the bed in ultrasound room. The doctor performing the procedure will then insert an ultrasound probe, about the width of 2 fingers, into the rectum to obtain images of the prostate, which sits immediately in front of the rectum.
Local anaesthetic gel is used to make the procedure more comfortable and most men only feel mild discomfort/mild pain. Small biopsy samples (usually 12) are then taken from the prostate using a biopsy needle, which makes a loud click each time a sample is taken. The samples are then sent to the laboratory for analysis.
What is to be expected after the biopsy?
We will ask you to stay in the ward for 4-5 hours till you pass urine twice. It is not required, but we recommend that you have a responsible adult to take you home after your procedure.
Up to 15% of men feel slight pain after the biopsy, which usually settles with simple pain relief such as Tab. Paracetamol.
Do not engage in any sexual activity for 3 days after your procedure.
For the next 5 days after your procedure, do not do any sports, work out in a gym, ride a bicycle, or lift any objects heavier than 10 kg.
Are there any risks of prostate biopsy?
Overall, prostate biopsy is a safe procedure but it is important to be aware of the risks.
Despite precautions, up to 5% of men will develop an infection after the biopsy, requiring more antibiotics and extended hospital stay.
Upto 15% of men notice some blood in their urine, upto 20% notice some blood in stools and about 38% notice blood in their semen. This bleeding is usually minor but can go on for up to a week. Bleeding is slightly more likely if you are/were taking warfarin/ clopidogrel tablets.
Some of them who already had poor urinary flow and high residual urine volume before the biopsy, may not be able to pass urine and go for urinary retention, in which case , may require placement of temporary catheter in the urinary passage to drain urine.
When do I consult Urologist after discharge?
You need to see Urologsit with appointment to discuss about the biopsy report which will be ready in a weeks’ time.
What do I do, if there is any emergency?
After discharge, if you experience fever, chills, fatigue, difficulty urinating, or if the bleeding gets worse, please contact Urologist in the hospital immediately.
- Prostate cancer update. EAU guidelines 2015, Page 23.
- Campbell Urology 10th edition.