Prostate Ultrasound and Prostate Biopsy
Transrectal Ultrasound (TRUS)
The Prostate
The prostate is a walnut-sized gland located beneath the bladder and in front of the rectum in men. The urethra (tube that transports urine and sperm out of the body) passes through the prostate to the bladder neck. Prostate tissue produces prostate specific antigen (PSA) and prostatic acid phosphatase, enzymes found in seminal fluid (the milky substance that combines with sperm to form semen).
Ultrasound
Ultrasound, or ultrasonography, involves using a special device (transducer) that reflects high-frequency sound waves off internal structures to create detailed images called sonograms. Transrectal ultrasound (TRUS), also called prostate ultrasound, provides images of the prostate and surrounding tissue and allows the physician to examine the gland for abnormalities (enlarged prostate [BPH], prostate cancer).
TRUS and prostate biopsy can be used to diagnose prostate cancer in patients with an abnormal digital rectal examination or elevated PSA level, to assess prostate volume, to detect inflammation of the prostate (prostatitis), and to help determine the cause of infertility such as blockages caused by prostatic cysts.
Procedure
Patients may be instructed to discontinue blood-thinning medications (e.g., aspirin, ibuprofen) for a week to 10 days prior to undergoing TRUS and prostate biopsy. An antibiotic, usually ciprofloxacin, may be prescribed prior to and for a couple of days following the procedure to help prevent infection. An enema or bowel prep is usually required to cleanse the bowel.
Transrectal ultrasound, which is performed with the patient lying on his side with his knees bent, involves using a small cylinder-shaped transducer, which is lubricated and inserted into the rectum, and a monitoring device. The transducer directs high-frequency sound waves into the body. As these sound waves are reflected back to the transducer, it records and transmits them to the monitoring device, which creates the images (sonograms).
In the presence of an abnormal PSA and/or if the results of TRUS are suspicious for prostate cancer, a prostate biopsy is performed. During a biopsy, transrectal ultrasound is used to help the physician properly place a needle to inject anesthetic to numb the prostate. A tiny 1.2 mm needle is projected through the tip of a probe inserted through the rectum along side the prostate. The biopsy needle is used to extract a tissue sample from several areas of the prostate. The entire procedure lasts 5 – 10 minutes.
The biopsy samples are sent to a pathologist (physician who identifies diseases by studying cells under a microscope) who analyzes the samples for the presence of prostate cancer. The pathologist examines the tissue samples. It takes about one week to get the results. You will be asked to return to the office in approximately 10 – 14 days to go over the results with your doctor.
Side Effects and Complications
Transrectal ultrasound usually is not associated with side effects or complications.
Following prostate biopsy, patients may experience
- blood in the urine (hematuria)
- blood in the semen (hematospermia)
- blood in the stool
- a dull ache in the perineum (area between the anus and the scrotum)
These side effects are usually minor and diminish within 1–2 weeks. Men may be advised to refrain from sexual intercourse for 3–5 days. If the patient develops a large number of blood clots, fever >101 or cannot urinate, the physician should be contacted immediately. Serious prostate infections and significant bleeding are rare.
Associated Urologists of Orange County
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