Trans-rectal ultrasound and prostate biopsy

Welcome

At Mater Hospital Brisbane, we understand that being hospitalised can be a very stressful experience. In keeping with our Mission to offer compassionate, quality care that promotes dignity whilst responding to patients' needs, this booklet aims to alleviate some of your concerns. It explains the general day to day events that may occur during your visit and the things to expect when you are discharged from the hospital.

It is, however, only a guideline as each person may require differing treatments.

If you have any questions about your treatment please speak to your doctor or nurse.

Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.

Trans-rectal ultrasound and prostate biopsy (TRUS)

What is a prostate biopsy and trans-rectal ultrasound (TRUS)?

This biopsy is where small samples of tissue are taken from your prostate gland, using an ultrasound device. A small ultrasound probe is inserted rectally, identifying your prostate gland (in front of your rectum). This is called trans-rectal ultrasound, or TRUS. The TRUS helps to guide your doctor in performing the biopsy.

The ultrasound test feels similar to a prostatic examination performed by your urologist. It is usually performed under a local anaesthetic with sedation. A small needle passes through the ultrasound probe and samples a small amount of your prostate tissue. Usually 12 needles samples are taken. The whole procedure takes about 15 minutes. Be aware that the biopsy needle does make quite a loud clicking noise associated with its firing mechanism.

Why do I need a prostate biopsy?

You may have been advised to have a prostate biopsy for the following reasons:

• your doctor found a lump or abnormality during digital rectal examination
• you have had a blood test showing a high level of PSA (prostate specific antigen). PSA is a protein that is released into your blood from your prostate gland. High levels of PSA may indicate cancer.

Having a prostate biopsy is currently the only method available to make a diagnosis of your symptoms.

The biopsy may find out whether any of your prostate cells have become cancerous. It can also diagnose other conditions such as:

• Benign prostatic hyperplasia—enlargement of the prostate
• Prostatitis—inflammation of the prostate usually caused by bacterial infection
• Prostatic intraepithelial neoplasia (PIN)—a change in the cells of your prostate.

Potential complications

The majority of patients have no problems at all but it is important that you understand what may happen.

1. Urethral bleeding is expected—most men do pass a small amount of blood in their urine or leak blood from the penis after the procedure.
2. Rectal bleeding is expected—most men do pass a small amount of blood in the first one or two bowel motions after the procedure.
3. Hematospermia is expected—blood in the semen or dark staining of the semen can persist for up to three months after the procedure. There is nothing to be concerned about and sexual activity can continue as normal.
4. Infection of the urine or prostate can occur after the procedure and cause symptoms of difficulty urinating, burning or urination, frequent urination or fevers.
5. Sepsis is a severe form of infection and is otherwise known as blood poisoning. This occurs in approximately one in 200 patients. The symptoms consist of fevers, chills, shaking, lethargy, warm skin, shortness of breath, rapid heart beat, drowsiness and a general feeling of being unwell. If this occurs, seek medical attention.
6. Occasionally patients will have difficulty passing urine after the procedure. This is called urinary retention. The symptoms consist of abdominal pain, poor flow or frequent urination. This usually happens in older men or men with extremely large prostates. If this happens, go immediately to your nearest emergency department where medical staff may insert a catheter into your bladder.
7. Sometimes if the prostate cancer is small the needle biopsy of the prostate may miss the cancer and cause a 'failure to diagnose'. Even if your biopsy is negative, close follow-up is required.
8. Patients rarely have difficulties in gaining erection after a prostate biopsy.

For your information

It is normal for you to expect to be going home on the same day as your procedure.

Your arrival time is NOT your procedure time. Admission and appropriate preparation need to be undertaken prior to your procedure, before an approximate time of your procedure can be given. Please also be aware that there can be waiting times due to emergencies and unforeseen delays. You will be in the unit for approximately three to four hours.

Prior to your procedure

• Please confirm your booking five days prior to procedure by phoning 07 3163 8444 and select option 2, between 8.30 am and 4 pm, Monday to Friday.
• Discuss with your doctor or nurse:
  • which medications you will need to stop prior to your procedure (e.g. aspirin, iron, diabetic medications, herbal medications, fish oils, anti-inflammatory medications etc.). It is important that you mention all medications you take in case special precautions are required
  • if you have ever had any bleeding problems
  • if you have an artificial heart valve
  • having a PSA and MSU within four weeks of your procedure.
• Arrange for someone to take or accompany you home. Please bring their contact details with you to hospital. It is also a requirement that you have someone care for you for 24 hours after your procedure.
• Follow-up appointment:
  • Outpatient clinic/Brisbane regions: your follow-up appointment should have been made for you at the time of your visit in the specialist clinic
  • Cairns/Toowoomba region: the outreach team will call you after your surgery. It is important for you to know that you can call the outreach team at any time if you have any queries or problems by phoning 07 3163 3490.
  • Antibiotics—commence your antibiotics as prescribed by your doctor. If you do not have a script please contact either the urology nurse or the outreach team by phoning 07 3163 3490.
• You will be provided with an enema to use the morning of your procedure to prepare your bowel. Please follow your doctor's instructions regarding this.

On the day of your procedure

• Bring your Medicare card with you.
• Bring your completed registration form with you.
• Bring your medications to hospital that you may need to take after your procedure (e.g. diabetic medications, anti-inflammatory medications etc).
• Please do not bring any valuables or wear any jewellery when you come to hospital.
• On arrival to Mater Hospital Brisbane, please report to the admission desk on level 5, Day Procedure Unit.
• It is important for you to shower and dress into clean clothes prior to coming into hospital.
• It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. Please follow instructions provided by your doctor or nurse.
• Read this booklet and bring it with you to hospital.

After your procedure

You will be transferred from the procedure room to recovery where your observations will be monitored. When you are feeling more awake you will be given a light meal prior to going home.

The biopsies will be analysed in the laboratory and the results will be discussed with you at your pre-booked follow-up appointment.

You may resume your normal daily routine including working the day after your procedure unless otherwise instructed.

Resume normal eating habits unless otherwise instructed.

For at least 24 hours after your procedure you should not:

• drive a car, motorcycle or ride a bicycle
• drink any alcohol
• make any important decisions or sign important papers
• walk home
• use hazardous machinery including the stove
• engage in sports or heavy lifting
• travel alone by public transport (bus, train or plane).

Contact us

Please contact either you general Practitioner (GP); Mater Hospital Brisbane Procedure Unit on 07 3163 8324; or Mater Hospital Brisbane Emergency Department on 07 3163 8111 immediately if you experience any of the following after discharge:

• fever, chills, shaking, lethargy, shortness of breath, rapid heart beat
• increasing drowsiness
• general feeling of being unwell
• difficulty in passing urine or unable to pass urine
• excessive bleeding.

Mater Hospital Brisbane

Raymond Terrace, South Brisbane Q 4101

Telephone: 07 3163 8111

Acknowledgments

Staff of Mater Hospital Brisbane, South Brisbane

© 2010 Mater Misericordiae Ltd. ACN 096 708 922.

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