Prostatic ultrasound ± guided biopsies
Summary: This procedure involves using an ultrasound probe, inserted via the back passage, to scan & biopsy the prostate
Contents:
- What does the procedure involve?
- What are the alternatives to this procedure?
- What should I expect before the procedure?
- What happens during the procedure?
- What happens immediately after the procedure?
- What should I expect when I get home?
- What else should I look out for?
- Are there any other important points?
- Is there any research being carried out in this field?
- Who can I contact for more help or information?
- Can I obtain a printed version of this information?
- Side effects & risks
What does the procedure involve?
This procedure involves using an ultrasound probe, inserted via the back passage, to scan the prostate. If biopsies are needed, a needle is inserted into the prostate and tissue samples (normally between 10 and 15) are taken.
What are the alternatives to this procedure?
Observation with repeat blood tests but without biopsies.
What should I expect before the procedure?
Prostatic ultrasound is usually performed under local anaesthetic and you will normally be admitted on the same day as the procedure. In this case, you may eat and drink as normal before your appointment and may have lunch on the same day.
If the procedure is to be performed under general anaesthetic, you will receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. In this event, you will be seen after admission by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse.
If you are taking Warfarin you must inform the clinic staff so that you are advised when to stop your Warfarin prior to the procedure. Usually you are asked to withold Warfarin for 3 days. A blood test, INR, will be performed prior to your biopsy. If you are taking Aspirin, you do not need to stop these. If you are taking Clopidogrel, you mst inform the doctor in the clinic because the beiopsy may need to be postponed or alternative arrangements made..
After checking for alllergies, you will normally be given an antibiotic tablet (Ciprofloxacin 500mg) to prevent infection in the prostate, the urine or the bloodstream.
Please be sure to inform your Urologist in advance of your surgery if you have any of the following:
- an artificial heart valve
- a coronary artery stent
- a heart pacemaker or defibrillator
- an artificial joint
- an artificial blood vessel graft
- a neurosurgical shunt
- any other implanted foreign body
- a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
- a previous or current MRSA infection
- high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)
What happens during the procedure?
If the procedure is to be carried out under local anaesthetic, you will be changed into a gown and then asked to lie on a couch on your left side with your knees drawn up to your chest. The doctor will examine the prostate through the back passage (anus) before inserting the ultrasound probe (see below). This probe is as wide as a man’s thumb and approximately 4 inches long. During the examination, which takes up to 20 minutes, you may feel some vibration from the motor within the probe.
In most cases it will be necessary to take samples (biopsies) of the prostate. Local anaesthetic is first injected around the prostate with a fine needle before the samples are taken; the taking of biopsies involves passing a needle through the centre of the probe which is activated by a spring-loaded device and makes an audible “crack”. Insertion of the needle causes mild discomfort, not dissimilar to a blood test needle. If a series of samples need to be taken, the prostate may feel “bruised” by the end of the procedure. It is usually necessary to take between 10 and 18 samples.
What happens immediately after the procedure?
When no samples have been taken, there are no side-effects. If biopsy samples have been taken, blood in the urine is common for 2-3 days but this clears quickly of you increase your fluid intake. Bleeding may also occur from the back passage for a short period and in the semen for up to 6 weeks.
You will be given antibiotics to take home for a 3-day period if biopsy samples have been taken.
The average hospital stay is less than 1 day under local anaesthetic and 1 day for ultrasound under general anaesthetic.
What should I expect when I get home?
It is important that you:
- sit quietly at home for the first 48 hours after the biopsies
- drink twice as much fluid as you would normally for the first 48 hours after the biopsies
- maintain regular bowel function
- avoid physically-demanding activities
- complete your 5-day course of antibiotics
Any discomfort in the prostate area can usually be relieved by simple painkillers.
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
What else should I look out for?
If you experience a fever, shivering or develop symptoms of cystitis (frequency and burning on passing urine), you should contact your GP. If there is a lot of bleeding in the urine or from the back passage, especially with clots of blood, you should contact the Urology Department.
If you develop a fever outside surgery opening hours, you must telephone the emergency number at your GP surgery so that a doctor can assess your condition.
Are there any other important points?
You will receive an appointment for discussion of the biopsy results at the time of your examination.
It will be at approximately 14 days before the pathology results on the tissue removed are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion. We sometimes need to order additional tests as a result of the discussion at this meeting and, as a result, you may receive appointments for a bone scintigram, CT scan or MRI scan before you are seen again in outpatients.
Is there any research being carried out in this field?
There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly Audit & Clinical Governance meeting.
However, a national study of screening for prostate cancer (ProTECT) is currently in progress to assess the diagnosis of prostate cancer in men with no symptoms.
Who can I contact for more help or information?
Oncology Nurses
- Bladder cancer Nurse Practitioner (cystectomy patients) -
01223 586748 - Bladder cancer Nurse Practitioner (haematuria, chemotherapy & BCG) - 01223 274608
- Prostate cancer Nurse Practitioner - 01223 216574
- Uro-Oncology Clinical Nurse Specialist (kidney patients) - 01223 257167
Non-Oncology Nurses
- Urology Nurse Practitioner (incontinence, urodynamics, catheter patients) - 01223 274608 or 586748
Patient Advice & Liaison Centre (PALS)
- Telephone +44 (0)1223 216756 or 257257
- PatientLine *801 (from patient bedside telephones only)
- E mail PALS
- PALS, Box No 53, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
Chaplaincy and Multi-Faith Community
- Telephone +44 (0)1223 217769
- E mail the chaplain
- The Chaplaincy, Box No 105, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
MINICOM System ("type" system for the hard of hearing)
- Telephone +44 (0)1223 274604
Access Office (travel, parking & security information)
- Telephone +44 (0)1223 586969
Can I obtain a printed version of this information?
Yes. You can print this Infosheet by using the print option on your browser or by clicking the "Print Infosheet" button at the top of this page.
If you wish to obtain the formal, printed version from Addenbrooke's or Hinchingbrooke, please contact your Consultant or Specialist Nurse.
To obtain this information in other languages, large print or audio format, e-mail Patient Information at Addenbrooke’s or telephone +44(0)1223 216032.
common Side-effects (greater than 1 in 10)
- Blood in the urine
- Blood in the semen – this may last for up to 6 weeks but is perfectly harmless and poses no problem for you or your sexual partner
- Blood in the stools
- Urinary infection (10% risk)
- Sensation of discomfort from the prostate due to bruising
- Haemorrhage (bleeding) causing an inability to pass urine (2% risk)
occasional Side-effects (between 1 in 10 and 1 in 50)
- Blood infection (septicaemia) requiring hospitalisation (2% risk)
- Haemorrhage (bleeding) requiring hospitalisation (1% risk)
- Failure to detect a significant cancer of the prostate
- The procedure may need to be repeated If the biopsies are inconclusive or your PSA level rises further at a later stage
rare Side-effects (less than 1 in 50)
- Inability to pass urine (retention of urine)
Hospital-acquired infection (overall risk for Addenbrooke’s Urology)
- Colonisation with MRSA - 0.14% (1 in 700)
- Clostridium difficile bowel infection - 0.04% (1 in 2500)
- MRSA bloodstream infection - 0.08% (1 in 1250)
(These rates may be greater in high-risk patients e.g. with long-term drainage tubes, after removal of the bladder for cancer, after previous infections, after prolonged hospitalisation or after multiple admissions)
