What does the procedure involve?
This procedure involves using an ultrasound probe, inserted via the back passage, to scan the prostate. Biopsies are taken through the skin behind the testicles (the perineum) using a special grid. The sampling is targeted and the number of samples taken depends on the size of the prostate, usually ranging from 30 to 50 samples. The reason this is done is because you have already undergone a number of biopsies (via the rectum), which have not identified the cause of your elevated PSA; further transrectal biopsies would carry a significant risk if performed in this number. I may recommend a detailed MRI scan of the prostate before the biopsy to help target any suspicious areas.
What are the alternatives to this procedure?
Observation with repeat blood tests but without biopsies particularly if an MRI scan does not show any suspicious areas in your prostate.
What should I expect before the procedure?
You will usually be admitted to hospital on the same day as your surgery. You may receive an appointment for a “pre-assessment” to assess your general fitness for an anaesthetic.
You will be asked not to eat and drink for six hours before surgery. Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy.
If you are taking warfarin, you must inform Dr Nathan so that you can be advised when to stop it before the procedure. It is usual to stop warfarin for 3 days and then do a blood test (INR) before your biopsy. Also if you are taking other strong blood thinners such as Xarelto, Pradaxa, Plavix, Iscover, or Brilinta you need to let Dr Nathan know at least 2 weeks before surgery.
If you are taking aspirin, you do not need to stop this.
Dr Nathan will give you a 3-day course of antibiotic (Norxin) which you should start taking one day before your biopsy. Also, you will normally be given an intravenous injection of antibiotic at the time of your anaesthetic.
Please tell your Dr Nathan (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for warfarin, aspirin or clopidogrel (Plavix®).
What happens during the procedure?
After the general or spinal anaesthetic has been given, your legs will be placed in special supports, which allow the surgeon to reach the skin behind your testicles. The surgeon will examine the prostate through the back passage (anus) before inserting the ultrasound probe into the rectum. This probe is as wide as a man’s thumb and approximately 4 inches long. In order to take samples (biopsies) of the prostate, a special grid is used so that all areas of the prostate can be included. The biopsy needles are inserted into the prostate through the skin of the perineum, guided by the ultrasound probe (pictured). After the biopsies have been done, a dressing will be applied to the perineum.
What happens immediately after the procedure?
You may experience mild or moderate discomfort in the perineum for which you can take paracetamol. Blood in the urine is common for 2 to 3 days, with the occasional blood clot, but this should clear quickly if you increase your fluid intake. You may expect to see blood in the semen for up to six weeks.
Are there any side-effects?
Most procedures have possible side-effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.
Common (greater than 1 in 10)
- Blood in your urine for up to 10 days.
- Blood in your semen for up to 6 weeks; this is harmless and poses no risk to you or any sexual partners.
- Bruising in your perineal area.
- Urinary infection (10% risk).
- Sensation of discomfort due to bruising.
Occasional (between 1 in 10 and 1 in 50)
- Failure to detect a significant cancer of the prostate.
- The procedure may need to be repeated if the biopsies are inconclusive or your PSA level rises further.
- Inability to pass urine (retention of urine).
Rare (less than 1 in 50)
- Blood infection (septicaemia) needing hospitalisation (<1%).
- Haemorrhage (bleeding) needing hospitalisation (1% risk).
What should I expect when I get home?
It is important that you:
- Sit quietly at home for the first 48 hours after the biopsies.
- Drink twice as much fluid as you would normally for the first 48 hours.
- Maintain regular bowel function.
- Avoid physically demanding activities.
- Complete your three-day course of antibiotics.
- Any discomfort can usually be relieved by simple painkillers.
What else should I look out for?
If you experience symptoms of cystitis (frequency and burning on passing urine), you should contact your Urologist or GP. If there is a lot of bleeding in the urine, especially with clots of blood and difficulty urinating or you develop a fever 38°C, feel shivery and very unwell you need to contact your Urologist or attend your local hospital emergency department.
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.