Transrectal Ultrasound Guided (Trus) Biopsy Of The Prostate
Cystoscopy :: Digital Rectal Examn :: Pathology
PSA :: Radiology :: Urodynamics :: TRUS
TRUS biopsy of the prostate is indicated to investigate whether prostate cancer is present. It is usually recommended for an elevated PSA blood test or an irregular feeling prostate.
A prescription for antibiotics is provided to cover the biopsy. Antibiotics are started the day prior to biopsy and continuing for one day afterwards. Although not critical, and more for your own comfort, you should try to open your bowels prior to the procedure. There is no need to fast for the test (that is, you may eat and drink as desired right up until the time of the test).
The process of TRUS biopsy takes around 10 minutes to perform. It involves a finger based examination of the prostate followed by insertion of an ultrasound probe into the rectum. Local anaesthetic is injected through the front wall of the rectum using a small needle to reduce sensation. This is often not felt. Prostatic measurements are taken however imaging alone is not accurate enough to distinguish the source of PSA elevation. A guide attached to the probe allows control of the biopsy device. When the biopsy device is activated it makes a clicking noise delivers a short lived “thud” in the rectal area. The biopsies have been likened to being flicked with a rubber band.
12 biopsy cores are taken on a “random” basis from the prostate. In reality these cores are directed using ultrasound imaging in a systematic fashion. These biopsies are designed to provide a representative sample however they do not remove the entire prostate.
Because the biopsies are taken through the rectal wall there is a small risk of either bleeding or infection. Antibiotics are given routinely to reduce the risk, starting the day prior to biopsy and continuing for one day afterwards. The risk of side effects significant enough to require admission to hospital is in the order of 1%. Blood thinners such as warfarin, clexane and clopidogrel should be stopped prior to the procedure however this process should be discussed first as alternative therapy may be required to avoid complications of stopping them. Aspirin at a moderate dose (300mg/day) is usually OK to continue for the biopsy. Other preparation such as bowel cleansers is unnecessary.
Following the biopsy, strenuous exercise is avoided for the first week. Pathological results generally take at least a week to become available as various staining tests need to be undertaken. A follow-up urology visit is routine to discuss the results of the biopsy and what these will mean in terms of either treatment or the need for future screening.