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Prostate Gland Biopsy: Transrectal Ultrasound (TRUS) & Transperineal (TP) Biopsy

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​The Prostate Gland

The prostate gland is located below the urinary bladder surrounding the urethra.

Prostate Gland Biopsy - Transrectal Ultrasound (TRUS) and Transperineal (TP) Biopsy 1.jpg

What is Ultrasound (US) Guided Prostate Biopsy?

It is a procedure done to determine if the patient has prostate cancer. Ultrasound will guide a small needle to obtain tissue samples for the examination.
US Guided Prostate Biopsy is a minor procedure.
It takes about 30 minutes and is performed at the Urology Clinic.

What to Expect from the Procedure?

Before the Procedure

Inform your doctor if you are taking anti-coagulant or anti-platelets (blood thinning) medicine. You will be advised to stop these medications (including TCM) for a few days before the procedure to reduce the risks of bleeding.
You will be prescribed two types of medications before the procedure:

  1. Laxatives to clear your bowels before the appointment
  2. Short course of antibiotics (three days or less)

*No fasting is required for the procedure.

Prostate Gland Biopsy - Transrectal Ultrasound (TRUS) and Transperineal (TP) Biopsy 2.png

2 Types of US Guided Prostate Biopsy

1) Transperineal (TP) Prostate Biopsy

  • You will lie on your back and legs apart to provide access to the perineal skin.
  • An Ultrasound probe will be placed in the rectum to identify the prostate.
  • Local anaesthetic will be injected on each side of the perineal skin.
  • A biopsy needle will pass through the perineal skin to obtain tissue samples from the prostate

2) Transrectal Ultrasound (TRUS) Prostate Biopsy

  • You will lie on your side.
  • A small ultrasound probe will be placed in the rectum.
  • Local anaesthetic will be injected near the prostate through the transrectal probe.
  • Tissue samples will then be taken from the prostate gland using a biopsy needle through the transrectal probe.

After the Procedure

  • You will be monitored for two hours after your biopsy.
  • Please inform the nurse if there is excessive bleeding in your urine or stools.
  • Upon discharge, you should be accompanied home by someone.
  • Increase your fluid intake to 1.5 litres (seven to eight cups) of water for the next two days after the biopsy.
  • Your doctor will schedule an appointment with you for your biopsy results.

What Precautions Should I Take After the Procedure?

  • Avoid over exerting when you pass urine and motion after the procedure.
  • Avoid strenuous exercises for one week and sexual activity for two weeks.

What are the Potential Side Effects of the Procedure?

Possible side effects include:

  • Mild rectal bleeding and blood in your urine for a few days.
  • Blood or brown discolouration in your semen for a few weeks.
  • Discomfort in your rectum or pelvis for a few days.
  • Urinary retention which will require temporary insertion of a urinary catheter for a few days.
  • Excessive bleeding or severe infection may occur in very few cases (<5%).
    *This may require hospital admission for further treatment.

Transperineal (TP) Prostate Biopsy VS Transrectal Ultrasound (TRUS) Biopsy

  • TP biopsy has a lower post-procedure infection risk.
  • More prostate tissue samples can be taken when doing TP biopsy.
  • Shorter course of antibiotic is required for TP biopsy (one dose instead of three days).
  • TP biopsy has a slightly higher risk for urinary retention.

Please ask your urologist for more information regarding both procedures, and for advice on which one to go for.

Inform Your Doctor Immediately if You Have:

  1. Persistent fever which is higher than 38oC and chills
  2. Excessive blood or clots in your urine or stools
  3. Difficulty or inability to urinate

The instructions in this pamphlet are non-exhaustive. In specific cases, you may receive different or additional instructions from  your doctor.
You are advised to follow any specific written or  oral instructions given to you by your  healthcare team.

Please clarify any queries with your healthcare team when you are in doubt.

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