Trans-rectal Ultrasound Guided Biopsy of the Prostate (TRUS-biopsy)

Why?

If your PSA is raised, or your prostate feels abnormal when examined by a urologist, you may need a biopsy of the prostate. This procedure allows tiny amounts of tissue from the prostate to be taken and examined under the microscope, to see what is causing the problem.

How?

Biopsy of the prostate is usually performed under local anaesthetic, but can be done under sedation or general anaesthetic if you wish. It is a minor procedure, but there are some rare, potentially serious complications that can occur. This will be discussed with you if you need a biopsy.

You will be given an antibiotic to take before the procedure, and one to take afterwards. Sometimes an additional antibiotic may be given to you into a vein in your arm.

You must tell your urologist:

• if you are taking any tablets that thin the blood warfarin, aspirin, clopidogrel (Plavix®) or any other blood thinner)
• if you have any allergies to antibiotics
• if you have any medical problems that make you prone to bleeding
• if you have any medical problems or take medicines that reduce your immunity
• if you have visited other countries in the last six months
• if you have an artificial heart valve
• if you have a coronary artery stent
• if you have a heart pacemaker or defibrillator
• if you have an artificial joint
• if you have an artificial blood vessel graft
• if you have a neurosurgical shunt

Local anaesthetic biopsy:

An ultrasound probe is inserted in the rectum to visualise the prostate, to measure its size, and to guide the biopsy needle. A very fine needle allows injection of local anaesthetic around the prostate to make it numb, and then 12 (sometimes more) small biopsies are taken with another needle. The process takes about 10 minutes, and you can leave the clinic or hospital soon after. You should not drive home, and you should rest for the remainder of the day. 

Sedation or general anaesthetic biopsy:

The procedure is the same as above, but will be done in an operating theatre. As for all day-case procedures, you should not drive for 24 hours, and another adult will need to take you home and stay with you for the rest of the day and overnight.

Potential side effects and complications

All procedures have the potential for side effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure. There are specific risks with this surgical procedure, and these will be discussed with you before your procedure. As a guide, these include:

Common side effects include:

• Blood in the urine; should be mild and resolve within a few days
• Blood in the semen, which can continue for up to 12 weeks
• A drip or two of blood from the back passage soon after the biopsy

Rare side effects (please contact your GP or urologist) include 

• Infection in the urine
• Difficulty or inability to pass urine
• Heavy bleeding from the back passage. This is very rare but needs immediate medical attention.
• Sepsis (infection spreading from the urine/prostate). Symptoms can include feeling very unwell, a high or swinging temperature, chills, shaking, a fast heartbeat) This is very rare but needs immediate medical attention. Please contact your GP or urologist immediately or go straight to your nearest emergency department.

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Disclaimer

This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your urologist. The information does not apply to all patients.

Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.