TRANSRECTAL PROSTATE BIOPSY (TRUS BIOPSY)
A TRUS biopsy of the prostate is a procedure where the prostate is tested for the presence of cancer. TRUS stands for “transrectal ultrasound”. The procedure is generally recommended for men who have a significant risk of having prostate cancer and are of an age group where treatment to cure the prostate cancer would be considered. In most cases, this means that the men will be between 40 and 75. Sometimes, older men are also recommended to undergo this test to see whether or not non-curative treatments, such as hormonal therapy, should be recommended. Most men who are recommended to undergo the test will have either a high prostate specific antigen (PSA) or an abnormal feeling prostate on rectal examination, or both.
The TRUS biopsy can be performed under local anaesthetic, sedation or general
anaesthetic. At Geelong Urology we normally favour performing the procedure
under sedation. This means that the men who have the procedure will normally
have no memory of undergoing this procedure and will not suffer any discomfort.
Therefore, the procedure is done in conjunction with an anaesthetist in a hospital
theatre. The procedure can be done under local anaesthetic, however in our
experience a small but significant number of men find it very uncomfortable.
The patient will be given a prescription for antibiotics to take for three doses.
The antibiotics are started the day before the procedure and continue until the
evening after the procedure. The anaesthetist may give further antibiotics at the time of the biopsy. Serious infection is quite rare if the antibiotics are taken. We have found that people who have traveled to Southeast Asia in six months prior to a biopsy can often have unusual bacteria present and this could increase the risk of infection. If you have been travelling to these regions and are about to undergo a TRUS biopsy, you should alert the staff at Geelong Urology.
WHAT DOES THE SURGERY INVOLVE?
Once the medication to cause sedation is given the procedure involves performing a digital examination followed by inserting the ultrasound probe into the rectum via the anus. The probe is a similar size to the finger. The ultrasound probe allows visualization of the prostate and the biopsies can then be taken using a special needle, which takes a small core of tissue. Normally 14 separate biopsies are taken. These are sent to the laboratory to be analysed for the presence of cancer by a specialist pathologist. The patient generally wakes up a couple of minutes after the procedure has been completed and will normally have no memory of the procedure-taking place. After an hour or so in recovery, the patient will be discharged home and a follow-up appointment for one or two weeks will be made to see your Doctor in his rooms to discuss the results.
WHAT CAN I EXPECT AFTER THE PROCEDURE?
The majority of patients have no problems at all but it is important that you understand what may happen.
Urethral bleeding – most men do pass a small amount of blood in the urine or leak blood from their penis after this procedure for up to 4-6 weeks.
Rectal bleeding – most men do pass a small amount of blood in the first 1-2 bowel motions post the procedure.
Haematospermia – blood in the semen or dark staining of the semen can persist for up to 3 months after the procedure. There is nothing to be concerned about and sexual activity can continue as normal.
WHAT ABOUT DIET?
Drink plenty of fluids (8-10 glasses or 2-3 litres)
Eat a diet high in fibre to prevent the need for straining when using your bowels
WHAT ABOUT EXERCISE/ACTIVITY?
Avoid strenuous activity, heavy lifting or engage in sports for the next day unless otherwise instructed by your doctor
Avoid driving a car, motorcycle or riding a bike for 24 hours after your procedure and do not walk home or travel alone by public transport
Sexual activity can resume as normal (see Haematospermia above)
WHAT ABOUT MEDICATIONS?
You can resume your usual medications
If your blood thinning medication was stopped, your Doctor will let you know when to recommence.
You can take 1-2 paracetamol every 4-6 hours for pain and discomfort (no more than 8 in a day)
WHAT ARE THE POSSIBLE COMPLICATIONS?
Infection (bladder or prostate) – can occur due to the fact that the needle must pass through the bowel wall into the prostate. Symptoms include difficulty urinating, burning on urination, frequent urination or fevers. If this occurs contact Geelong Urology, your GP or the Emergency Department.
Urinary retention – occasionally patients will have difficulty passing urine after the procedure. It may be due to temporary swelling of the prostate or blood clots. Symptoms consist of abdominal pain, poor flow or frequent small urination. This usually occurs in older men with larger prostates. If this happens go to your closest Emergency Department.
Sepsis – is a severe form of infection and is otherwise known as blood poisoning. This occurs in approximately 1 in 200 patients. Symptoms consist of fevers, chills, shaking, lethargy, warm skin, shortness of breath, rapid heartbeat, drowsiness and a general feeling of being unwell. If this occurs you need to seek immediate medical attention at an Emergency Department.
NOTIFY GEELONG UROLOGY or your GP if you experience any of the following:
The bleeding is accompanied by a fever or an increase in the discomfort when passing urine.
The bleeding is so heavy the urine looks like pure blood.
You have difficulty passing urine, can only pass small amounts the flow stops completely.
You experience symptoms such as fevers, chills, shaking, lethargy, warm skin, shortness of breath, rapid heartbeat, drowsiness or a general feeling of being unwell.
FOLLOW UP APPOINTMENT
Your follow up appointment is usually organised at the same time your procedure is booked. If an appointment time is not given to you on discharge from hospital, you will need to phone Geelong Urology to make an appointment.
If you have any queries please contact Geelong Urology on 03 5229 9105 during business hours OR leave a message on the After Hours Urology Paging Service 03 9387 1000