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Transrectal Ultrasound and Prostate Biopsy

Prostate cancer normally grows slowly until it becomes detectable by finger examination of the prostate - digital rectal examination (DRE) - or by an abnormal blood test reading of the prostate specific antigen (PSA) level.

The abnormality found at DRE or the elevation in PSA level may be due to a prostatic problem other than cancer, such as infection or non-cancerous prostatic enlargement.

Transrectal ultrasound (TRUS) examination involves the passage of a probe into the rectum which directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen. This allows accurate measurement of the size of your prostate. To determine whether an abnormal-looking area is indeed a tumour, biopsies (tissue samples) under local anaesthetic are obtained using a spring-loaded device that fires a thin needle into the prostate through the lining of the rectum. Although you will be aware of the biopsy procedure, there is rarely any significant pain. Normally, fourteen or more biopsies are obtained systematically from different locations within the prostate.

The tissue removed at biopsy is sent for histological diagnosis. The results should be available within a few days.

One should not take aspirin or clopidogrel (Plavix) or anti-inflammatory drugs for one week prior to the biopsy procedure, as these medications may increase the risk of bleeding. These medications can usually be restarted a day or two after your examination, unless urinary bleeding persists.

Antibiotic drugs are often prescribed to prevent infection after the biopsies. A urologist or ultrasound specialist will carry out the examination. The patient will be asked to lie on the side of the couch, after which the Urologist will examine the prostate with a finger. The ultrasound probe will then be introduced through the anus into the rectum to record images of the prostate before the biopsies are performed. The entire examination takes about 15 minutes.

Risks and Complications

There is a small risk of seeing blood in the urine, semen and in the back passage, although these are transient and often resolve within two weeks post biopsy. It is important that you drink a lot of water to flush out the small amount of blood from the prostate and guard against infection. When prophylactic antibiotics are taken properly for the prostate biopsies, infection is very unusual.