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Transrectal ultrasound-guided prostate biopsy

Published by Bupa's health information team, November 2008.

This factsheet is for men who are planning to have a transrectal ultrasound-guided prostate biopsy, or who would like information about it.

The prostate is a gland that produces the liquid part of semen. Transrectal ultrasound-guided prostate biopsy can help diagnose prostate cancer. A sample of prostate tissue is removed and sent to a laboratory for testing.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About the prostate
Preparing for your prostate biopsy
About the procedure
What to expect afterwards
Recovering from a prostate biopsy
What are the risks?
Further information
Questions and answers
Related topics
Sources

About the prostate

The prostate is about the size of a walnut and lies at the base of your bladder. The back of the prostate presses against the rectum and the front of the prostate surrounds the tube that carries urine from your bladder and out through your penis (urethra). Any change in the size or shape of the prostate can narrow the urethra, making it difficult for you to pass urine.

Your doctor can easily check the size of your prostate by doing a digital rectal examination (DRE). This is done by inserting a gloved finger into your rectum to feel the prostate through the wall of your rectum.

Illustration showing the prostate gland and surrounding structures
The prostate gland and surrounding structures

Your doctor may recommend a prostate biopsy to check for cancer if a DRE or a prostate-specific antigen (PSA) test shows you have an enlarged prostate.

Preparing for your prostate biopsy

Transrectal ultrasound-guided prostate biopsy is routinely done in hospital as an out-patient or day case. This means you have the procedure and go home the same day.

The procedure is usually done by passing fine needles through the wall of your rectum (transrectal prostate biopsy). Ultrasound is used to guide the needles into the prostate gland. A local anaesthetic isn't necessary but may be used to ease any discomfort. Local anaesthesia completely blocks feeling in the rectal area and you will stay awake during the procedure.

Sometimes a prostate biopsy is done through the urethra, or the area between the anus and scrotum (the perineum). These methods are less common and require anaesthesia. Your surgeon will advise which method is suitable for you.

Usually you can eat or drink as normal before having a prostate biopsy. If you normally take medication (eg tablets for blood pressure), continue to take this as usual, unless your surgeon specifically tells you not to. If you are unsure about taking your medication, please contact the hospital.

At the hospital, you may be asked some questions about your health, past surgery, allergies and any medicines you are taking. Your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will explain the procedure and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You will usually be given antibiotics before the biopsy to help prevent infection.

About the procedure

The procedure usually takes 10 to 15 minutes.

You will be asked to change into a hospital gown which opens at the back. You will need to lie down on your left side with your back to your surgeon.

Ultrasound is used to view the prostate and guide the biopsy needles. Your surgeon will carefully pass a lubricated ultrasound sensor into your rectum. The sensor will feel uncomfortable but shouldn't be painful. Images of your prostate are displayed on a monitor.

Your surgeon will pass a special port holding the biopsy needles down the shaft of the ultrasound sensor. The needles are passed through the rectal wall into the prostate gland. The needles are used to collect at least six samples of prostate tissue. The procedure is very quick but you may feel a sharp stinging sensation. The tissue samples are sent to a laboratory for testing.

What to expect afterwards

You will be asked to pass urine before you go home. You may be given a course of antibiotics to take with you and a date for a follow-up appointment.

You can drive home if you wish, but you may feel a little uncomfortable and may prefer to have someone drive you home.

Results

Your results will be ready several days later and will usually be sent in a report to the doctor who requested your biopsy. Your doctor will review the results and discuss them with you at your follow-up appointment.

Recovering from a prostate biopsy

If you are prescribed antibiotics, it's important that you complete the course. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Take it easy for the rest of the day. Try to drink plenty of fluids to help flush out any possible infection. It's normal to have some blood in your urine, stool and semen for a few days.

Contact your GP if you have any of the following symptoms, as you may have developed an infection:

severe pain or pain that lasts for more than 48 hours
difficulty in passing urine
burning sensation on passing urine or if your urine starts to smell
increasing blood in urine
high temperature

What are the risks?

Transrectal ultrasound-guided prostate biopsy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure.

Common side-effects of prostate biopsy include:

slight discomfort in rectal area
blood-stained urine or faeces - this can last up to a week or two
blood-stained or discoloured semen - this may last for six weeks
difficulty in passing urine - this usually improves quickly

Complications

This is when problems occur during or after the operation. Most men are not affected. Your surgeon will be experienced at performing prostate biopsies, but even so, a few are not successfully completed and may need to be repeated.

Other complications of prostate biopsy are uncommon but can include urinary or bowel infection. The biopsy needles pierce the rectal wall and bacteria from the bowel may cause an infection - but this is very rare. You will be given antibiotics before the biopsy to reduce your risk of infection.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Further information

The Prostate Cancer charity
0800 074 8383
www.prostate-cancer.org.uk