Information for patients having a transrectal ultrasound scan and prostate biopsy
This page has been prepared using a leaflet from the Clinical Radiology Patients’ Liaison Group (CRPLG) of The Royal College of Radiologists.
The leaflet tells you about having a transrectal ultrasound scan and prostate biopsy. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor, but can act as a starting point for such discussions. If you have any questions about the procedure please ask the doctor who has referred you for the test or the department which is going to perform it.
The radiology department
The radiology department may also be called the X-ray or imaging department. It is the facility in the hospital where radiological examinations of patients are carried out, using a range of equipment, such as a CT (computed tomography) scanner, an ultrasound machine and an MRI (magnetic resonance imaging) scanner.
Radiologists are doctors specially trained to interpret the images and carry out more complex examinations. They are supported by radiographers who are highly trained professionals and carry out X-rays and other imaging procedures. Sonographers are radiographers who have trained further to specialise in the technique of ultrasound scanning. They carry out a great number of these examinations.
The prostate is a small gland associated with the male reproductive process, located at the base of the bladder. It tends to enlarge with age and can obstruct the outflow of urine. The gland is easily and accurately assessed by scanning, which provides the doctor with more information about the size and condition of the gland. Men do not always have symptoms from prostatic disease, but a blood test indicating an elevated PSA (prostate-specific antigen) may point to a hidden problem. A transrectal ultrasound scan and prostate biopsy will help to determine whether there is any serious disease within the prostate gland causing the abnormal blood test.
A tubular ultrasound probe is gently inserted into the rectum, giving an image of the prostate gland, for an accurate placement of the biopsy. This is taken with a spring-loaded biopsy needle. A trigger is pressed, the biopsy gun fires and a tiny piece of tissue is taken. Usually a number of biopsies are taken, which are later examined under a microscope by a pathologist.
The consultant in charge of your care and the radiologist doing the scan and biopsy. However, you will also have the opportunity for your opinion to be taken into account, and if, after discussion with your doctor, you do not want the procedure carried out, you can decide against it.
Normally no preparation is required. However, patients taking anticoagulants (blood-thinning treatment), such as aspirin, warfarin, clopidogrel or prasugrel may be asked to stop taking them for up to a week before the biopsy. Please make sure the department is aware if you taking any of these and tell the doctor if you are allergic to any antibiotics.
When you arrive
You should go to the reception desk in the department, after which you will be shown where to wait until collected by a member of staff.
The procedure for your examination will be explained to you. If you have to undress for the procedure, you will be shown to a private cubicle where you will be asked to put on the gown provided. You will be asked to place your clothes and personal items in a locker or a basket, which you will keep with you.
Can you bring a relative/friend?
Yes. When you attend the test, ideally you should be accompanied by someone to take you home.
Where will the biopsy take place?
Generally in a radiology department, possibly in the urology department.
This is done by a a radiologist or by an urologist.
What happens during the biopsy?
You will probably be given some antibiotics to protect you against infection.
You will be asked to lie on your left-hand side on a couch, with your knees drawn up. Local anaesthetic gel may be squeezed into the rectum and sometimes a local anaesthetic is injected around the prostate to make the procedure less uncomfortable.
An ultrasound probe is inserted into the rectum. While scanning the prostate gland, the doctor will take between eight and 12 small samples from the gland. The procedure is not normally painful. You will hear a loud click when each biopsy is taken, and may experience a sensation, which has been described by patients as a discomfort. Pain is occasionally experienced.
How long will it take?
The complete consultation takes about 30 minutes, but the biopsy procedure lasts around 15 minutes. Following this, you will be asked to remain in the department for about 30 minutes, or until you have passed urine.
After the procedure
Rest is advised for the remainder of the day, but you would normally be able to return to work the following day. You should avoid strenuous exercise for a couple of days.
Drink plenty of fluids over the next few days, but you may be asked to avoid alcohol.
You may shower or take a bath.
Sexual activity may be resumed after 48 hours. It is not unusual for blood to appear in the semen for a few days and exceptionally for several weeks. This does no harm to you or your partner
In case of complications you are advised to stay in the locality during the four days following the procedure.
Are there any after-effects?
Small amounts of blood from the rectum and in the urine is common for 24–48 hours, sometimes longer up to 3 weeks, and this is regarded as normal. If it becomes heavy or continues see your GP.
Rarely, heavy bleeding may occur at the time of biopsy, in which case you will be admitted to hospital until it settles.
Infection, while unusual, is the most common complication, usually occurring 24–48 hours later.
This is usually treated with antibiotics at home. Occasionally the infection can be severe enough to require hospital treatment with intravenous antibiotics. In exceptional cases, infection can be overwhelming. This is true of any infection, however caused, but there are rare reports of people having died as a result of infection thought to be due to the biopsy.
If you develop symptoms of infection, such as ‘flu-like’ symptoms, high temperature, shivering or become ill, please contact your GP or out-of-hours service immediately.
Should you have any concerns about your condition you must contact your GP or if appropriate, attend the A&E department at the hospital.
When will you get the results?
This is usually given at the next visit to clinic, unless some other arrangement has been made.
Some of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Other sources of information
For general information about radiology departments, visit The Royal College of Radiologists’ website: www.goingfora.com
For health advice or information you can call NHS Direct on 0845 45647 or visit the website: www.nhsdirect.nhs.uk
© The Royal College of Radiologists, December 2010.
Permission is granted to modify and/or reproduce this leaflet for purposes relating to the improvement of healthcare, provided that the source is acknowledged and that none of the material is used for commercial gain. The material may not be used for any other purpose without prior consent from The Royal College of Radiologists.
Please remember that this leaflet is intended as general information only. It is not definitive, and The Royal College of Radiologists cannot accept any legal liability arising from its use. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on the procedure or any concerns you may have with your doctor.
This leaflet has been prepared by the Clinical Radiology Patients’ Liaison Group (CRPLG) of The Royal College of Radiologists.
Approved by the Board of the Faculty of Clinical Radiology: 22 October 2010