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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:
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:
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:
Some discomfort in the area of the prostate as a result of the biopsies being taken.
Haematospermia. This means blood (or sometimes clots) in your sperm or ejaculate, and is extremely common after this type of procedure.
Haematuria (or blood in your urine). A common side-effect, it results from the fact that the urethra – the small canal transporting urine from your bladder to the penis – goes through the prostate and will therefore transport some blood into the urine.
Blood or clots when you first open your bowels, because the biopsies are taken through the rectum.
Infection. This is extremely rare, because of all the precautions taken. To help prevent this, your antibiotic cover may be continued for some days after the procedure. If you do get an infection, you will start feeling unwell as if you are getting the flu, often will have a fever, and sometimes may experience shivering. This will generally happen within 12–72 hours after the procedure. It is important that you notify your doctor immediately, or go to the nearest hospital emergency department.
Bleeding immediately after the procedure. Occasionally, some patients experience a small amount of bleeding from the rectum immediately after the procedure, sometimes when they are still on the procedure table. If this occurs, it will cease with gentle pressure, and is seldom of concern.
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.
Haematospermia (blood in the sperm) occurs in over 90% of patients having the procedure and this can persist for 2 or more weeks.
Haematuria (blood in urine) is very common (over 60% of patients).
Blood in the faeces is fairly common, but is usually mild.
Infection is very rare (less than 1% of patients overall), but this can be severe if untreated.
Internal haemorrhage. This is exceedingly uncommon (less than 0.01% of patients), but if severe may require surgery
Rarely, urine retention can occur. If the prostate is very enlarged to start with, and bleeding occurs within the prostate as a result of having the biopsy, this relatively small amount of bleeding may be enough to cause a blockage of the urethra – the canal that transports urine out of the bladder and passes through the prostate. This can then lead to retention, which is the temporary inability to pass urine. This is relieved by the passage of a catheter, a sterile rubber tube, which is inserted into the urethra to relieve the blockage.
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.
Trans-rectal Ultrasound Guided Prostate Biopsy:
Prostate Biopsy Procedure, Effects, Uses, Complications, and More:
Prostate Biopsy Procedure:
Page last modified on 26/9/2016.
RANZCR® is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any of them.
RANZCR® intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
RANZCR® recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, RANZCR®, its Board, officers and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests.