Transrectal prostatic ultrasound and biopsy

What is this?

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 18) are taken

What alternatives are there?

Observation with repeat blood tests but without biopsies

What to expect before 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. You will also be asked to undergo swabbing of your nose & throat to ensure that you are not carrying MRSA. 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 at or the pre-assessment 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 biopsy may need to be postponed or alternative arrangements made.. After checking for allergies, you will normally be given an antibiotic tablet (Ciprofloxacin 500mg) to prevent infection in the prostate, the urine or the bloodstream.

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. 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.

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 if 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.

Potential side effects