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Dr Alain Laviopierre
Prof Robert Gibson
Date last modified: October 28, 2015
An ultrasound guided prostate biopsy is a procedure where a special needle is inserted into the prostate gland to take a small sample of tissue from the gland. The sample is then sent to a laboratory for testing, to determine the presence or absence of prostate cancer.
Your doctor would refer you to have this procedure, usually for one of three reasons:
Preparation for an ultrasound guided prostate biopsy includes:
Blood thinning medications will need to be stopped for a period of days, or your normal dose reduced, before this procedure is carried out. It is very important that you do not stop any of these medications or change the dose without consulting both the hospital radiology clinic or department and your own doctor. They will give you specific instructions about when to stop and restart the medication. These drugs are usually prescribed to prevent stroke or heart attack, so it is very important that you do not stop taking them without being instructed to do so by your doctor or the radiology practice or both. Aspirin is usually not stopped.
A blood test may be required to check your blood clotting on the day of the procedure.
The urologist, medical oncologist or radiation oncologist (specialist doctors) who referred you for the biopsy procedure will discuss and arrange your appropriate preparation with you.
If you suffer from any heart valve condition or have an artificial heart valve or similar device, you must inform the radiologist (specialist doctor) carrying out the biopsy before having the procedure so that you can be given additional antibiotic cover.
Often, an intramuscular injection (an injection into a muscle) of an antibiotic called Gentamicin is given to further reduce the likelihood of infection.
During the procedure, you will be asked to lie on your left side, with your legs bent up.
The radiologist will first carry out a DRE with a gloved finger.
An ultrasound probe, which is about the thickness of a thumb, will then be inserted into your rectum. The probe is sterilised, covered with two condoms to ensure protection from any infection or contamination, and a lubricant to help it glide easily into your rectum.
Sometimes an injection of local anaesthetic or sedative may be given into the area of your rectum to minimise discomfort during the procedure.
Often the procedure is carried out after you have been given a light general anaesthetic, which means you will be asleep or sedated during the procedure.
After having examined your prostate with the ultrasound, the radiologist will then take biopsies. To take the biopsies, a very fine needle is guided, using pictures or images the radiologist can see on the ultrasound screen, through the wall of your rectum into the prostate and a sample of tissue is taken. The sample is sent to a pathology laboratory for analysis by another specialist doctor called a pathologist.
This biopsy sampling is repeated several times to ensure that any visible abnormal area is adequately sampled, and that as much of the prostate gland as is necessary is also sampled. Usually, between six and 14 individual samples will be taken and sent for analysis.
When this is over, the probe is removed and, if you have had a general anaesthetic, you are woken up. You are then given a small pad to wear around your bottom in case of any bleeding, and you will be kept under observation for a while until you can urinate. When the doctor or nurse is happy with your condition, you are allowed to leave – provided someone can take you home.
NOTE: The ultrasound guided prostate biopsy can sometimes be carried out through the perineum (the area of skin between the base of the penis and the rectum). This is called a trans-perineal approach. A local anaesthetic is injected into the perineum to numb the area before the biopsy. The ultrasound probe is inserted into the rectum to guide the biopsy, but the samples from the prostate are taken through the skin with a prostate needle.
This approach is used if:
- it is the radiologist’s preferred method;
- a possible cancer is suspected at the front of the prostate gland, the part furthest away from the rectum; or
- you do not have a rectum.
The radiologist can advise you before the procedure whether a trans-rectal or trans-perineal approach is being used.
The after effects of an ultrasound guided prostate biopsy include:
If you have had a light general anaesthetic or sedation, you will usually have a feeling of mild ‘wooliness’ in the head for a day or so.
The ultrasound and biopsy procedure itself takes approximately 30 minutes.
The procedure together with preparation such the blood test, enema, injection of antibiotics, and observation time afterwards will take a couple of hours. If rectal bleeding occurs immediately after the procedure (a rare occurrence), you may be kept a little longer for observation until the radiologist or nurse feels that it is safe for you to go home.
For the risks of an ultrasound guided biopsy, please also refer to the section on after effects.
The main benefit of an ultrasound guided prostate biopsy is that it helps accurately diagnose the presence or otherwise of cancer in the prostate.
If cancer is found, it helps diagnose the extent of the cancer and the appropriate treatment can then be undertaken.
The ultrasound guided prostate biopsy is carried out by a radiologist or urologist (specialist doctors), assisted by a sonographer (a trained technologist who helps to prepare and operate the ultrasound equipment), and often a nurse who helps look after the patient.
An anaesthetist will be present if the procedure is carried out using an anaesthetic.
An ultrasound guided prostate biopsy is carried out either in a hospital as an outpatient procedure or in a day procedure centre. It can also be carried out in a radiology clinic.
The pathology result generally takes a few days to be available to your doctor.
The time it takes your doctor to receive a written report on the test or procedure will vary depending on:
Please feel free to ask the private practice, clinic, or hospital when the written report will be provided to your doctor.
It is important that you discuss the results with your doctor, either in person or on the telephone, so that they can explain what the results mean for you.