TRUS (Trans-Rectal Ultra Sound) Guided Biopsy
The urologist may decide to repeat some of the tests that you were given by your GP. After examining you, they may be able to reassure you and your GP that there is nothing to worry about, or offer you another PSA test in the near future to check that your PSA is not rising. However, if they are still concerned that you may have prostate cancer, they may need to carry out a further test, called a TRUS biopsy.
The decision to have a biopsy is something you have a say in. Talk to your doctor about the advantages and disadvantages of having a biopsy.
Having a high PSA level alone does not necessarily mean you must have a biopsy as prostate cancer is also found in men with a normal PSA level. The aim of a prostate biopsy is to detect prostate cancer that has the potential to cause disruptions to your life style and/or life expectancy.
If your PSA is very high the cancer may have already spread to the bones and therefore there may be no need to do a biopsy at all 1. Your specialist will advise you on this and whether you will need a biopsy or not by using other tests together with your medical history and other risk factors such as your age and ethnicity.
The prostate needle biopsy involves taking a number of small pieces of prostate tissue to be looked at more closely under the microscope.
You may be given an appointment to come back to the hospital to have the biopsy taken, or you may be offered a biopsy there and then. You will be asked to stop taking certain medicines (particularly ones which thin the blood) before the appointment. Your hospital will give you advice on this.
The biopsy will be taken either in the X-ray department or in the prostate clinic. You should be given a local anaesthetic injection into the prostate to help reduce any discomfort when the biopsy samples are taken. It is all over within about 10-15 minutes and you will be able to go home soon after.
How does TRUS work?
Trans Rectal Ultrasound Scans use sound waves to make an image of the prostate. This is shown on a screen similar to a small television. The scan allows the specialist to measure the size of the prostate and helps them to guide the biopsy needles.
What happens at the biopsy appointment?
The biopsy will be taken either by the urologist, a radiologist, or a specialist nurse who is trained in the use of ultrasound. The ultrasound probe is lubricated with gel and passed into your back passage (rectum). The probe is the size of a very fat finger and should not feel any more uncomfortable than the DRE. The needle is then placed down the shaft of the probe and is passed through the wall of the back passage into the prostate gland, under the guidance of the ultrasound image.
You may feel a short sharp sensation as the needle goes in. Each man is different and while some describe the biopsy as painful, others have only slight discomfort.
Depending on the preference of your specialist, you may have six, eight, ten, or twelve samples taken. If you have a bigger prostate you may have more samples taken. You should be told how many to expect, but do ask if you are not told, so that you are prepared.
What about the risk of infection?
You will be given an antibiotic injection or tablets before the biopsy to help prevent any infection. Afterwards, you may be given an antibiotic suppository in your back passage and you will need to take antibiotic tablets at home. A small number of men (about one per cent)2 do get an infection of the blood called septicaemia, which can feel like a bad case of flu. It is very important to take all of the antibiotics that you have been given to help prevent this happening.
If you have a high temperature or any pain or burning when you pass urine, you may have an infection, even if you have been taking antibiotics. Your hospital will give you information on symptoms to look out for, with a telephone number to call if you need advice. If you have these symptoms you should see your GP.
What are the side effects?
Short-term bleeding and infection are possible side effects of the biopsy 2. Once you have gone home, you may see blood in your urine or bowel motions for up to two weeks. You may find blood in your semen for up to six weeks. If it takes longer than this to clear up, or gets worse after a period of recovery, you should visit your GP for advice.
What do the results mean?
Your prostate biopsy will be examined by a pathologist and will tell your urologist if any of the tissue samples contain cancer and if so, how many samples are affected and how much cancer is present in each sample.
If no cancer is found this is obviously reassuring. However, strictly speaking the biopsy result means ‘no cancer found’ rather than ‘no cancer present’. There could be a small cancer that the needles did not hit. Your doctor will want to keep an eye on your prostate with further PSA tests and DRE’s. If your PSA stays higher than normal or increases and the doctor cannot find any other cause, you may be advised to have another biopsy in the future.
If further TRUS biopsies are negative but your doctor still suspects that cancer is present, you may be offered a different type of biopsy (a ‘saturation’ or ‘template’ biopsy) under general anaesthetic. This involves taking more tissue samples from different areas of the prostate gland.
There is a greater chance of finding prostate cancer cells using one of these biopsies because more of the prostate is being examined, but the cancer may be small or very slow growing 2 and may not cause any disruptive symptoms or shorten your life expectancy. Talk to your doctor about the advantages and disadvantages of this type of biopsy.
Benefits of having a biopsy
- It is an accurate way of finding out whether you have prostate cancer and how much cancer is present. This can help to determine the best type of treatment for you.
Risks of having a biopsy
- Infection.
- You may see blood in your urine or bowel motions for up to two weeks.
- You may find blood in your semen for up to six weeks.
References used in the production of this page.
1 National Institute for Health and Clinical Excellence. Prostate Cancer: Diagnosis and Treatment; Full Guideline. 2008
2 Eichler K et al. Diagnostic value of systematic prostate biopsy methods in the investigation for prostate cancer: a systematic review. Centre for Reviews and Dissemination, University of York; 2005.