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Gpcare.org.uk

Information about the GP Care Trans-rectal Ultrasound and Biopsy

Why might I need to have a trans-rectal ultrasound and prostate biopsy?
If the prostate gland is enlarged it can make it difficult to pass urine. You may need a
trans-rectal ultrasound to let your consultant see any enlargement and it may provide
further information as to the cause.
The main types of prostate problem are benign prostatic hyperplasia (BHP),
prostatitis or prostate cancer. Your GP will probably have taken a blood test (Prostate
Specific Antigen) (PSA) and done a digital rectal examination (DRE) of your prostate
prior to referring you to the GP Care Community Urology Service.
If your PSA is elevated or the rectal examination is abnormal you may need the biopsy
to work out what is going on within the prostate.
The TRUS biopsies (samples taken), the PSA and DRE are the tests required to make a
diagnosis. The results will help your consultant to decide what should happen next and
the most appropriate treatment for your particular symptoms. These tests are the only
way to obtain these results. No other test is available.
Occasionally the diagnosis is not made on the first set of biopsies and some patients
may need to undergo further biopsies in the future.
What do I need to do before I come in?
If you are taking warfarin, aspirin, asasantin or any other blood-thinning
medication, it may be necessary to stop taking them. Please telephone the GP
Care Admin team on 0845 625 2102.

Your GP will have prescribed a short course of the antibiotic Ciprofloxacin. You will need
to take two of 500mg of the tablets one hour before your appointment, and to finish
the course as instructed over the following days. Please bring these tablets with you to
the appointment.
You will also need to bring a urine sample with you to the clinic. You only need to bring
about 20mls (4 teaspoons) of urine that you produced first thing in the morning of the day of
your appointment. The container should be a clean and have a tight fitting lid. You can ask
for a urine sample bottle from your own GP surgery. Please give the sample to the nurse.
No other special preparation is required. You may eat or drink normally and you do not
need to bring anything else with you to your appointment.
Please avoid drinking alcohol while taking your course of antibiotics
It is advisable that a friend or relative comes with you to the clinic and drives you home
afterwards.

What happens when I arrive?
Please report to the reception desk and tell the receptionist that you have arrived for the
GP Care Community Urology Clinic. They will be expecting you and will ask you to sit
where they can see you. They will inform the Community Urology Clinic staff of your
arrival.
A Nurse will come to collect you and take you to the investigation room where the doctor
will explain what will happen and answer any questions.
What does a scan consist of?
The scan uses high frequency sound waves to produce a picture of the prostate gland.
You will be asked to remove your trousers and pants and lie on your side. Lubricating
jelly will be applied to your anal area to help keep you comfortable.
You will be given an injection of local anaesthetic into several areas of the prostate.
As you can see from the diagram below a probe will be inserted into your rectum. You
may find this uncomfortable and some men do find it painful. You may feel like you are
about to pass a bowel motion. Please be assured that this is just a sensation and is a
normal reaction.

Side view of a TRUS and biopsy

The doctor is able to see the prostate gland on a screen and measure its size. Shortly afterwards a number of small samples (biopsies) will be removed from the prostate using special needles. You will hear a loud clicking noise as samples are taken. The taking of samples, again, can be uncomfortable. Deep breathing and trying to relax can often help. Any sample that is taken will be sent to a laboratory to be analysed. The results are normally available in two weeks.
How long will the procedure take?
It will take around 10-12 minutes to carry out the procedure and the doctor will explain
what is happening throughout.
What are the risks in having this procedure?
It is common for men to notice blood in their urine for a while, blood on wiping their
bottom for a few days and blood in their semen for several weeks. This is all normal and
should settle down
Some men experience discomfort associated with bruising in the area. There is a 10%
risk of urinary infection following the procedure and a 2% risk of haemorrhage (bleeding)
which could result in the inability to pass urine.
There is a 2% risk of infection and a 1% risk of haemorrhage (bleeding) which may
require hospitalisation.
Will there be any after effects?

You will be asked to finish the course of antibiotics. This helps to prevent infection.
It is not uncommon to experience bleeding.
If you are concerned by the degree of bleeding or you develop symptoms of a fever
(sweating, shivering or feeling cold then you should consult your GP immediately.
What will happen afterwards?
Your biopsies will be analysed and the results will then be reviewed at a multi-
disciplinary team meeting (MDT). This process can take up to 10 -14 days.
You will then be contacted and offered an outpatients appointment at the hospital to
discuss your biopsy results.
You can use this space to write down any questions that you may want to ask the doctor
at your appointment.

Source: http://www.gpcare.org.uk/cms/document/GP_Care_Leaflet_TRUS_Bx.pdf

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