Prostate Biopsy (TRUS/Biopsy)

Prostate Biopsy

This is easily done in the clinic to confirm prostate cancer. Prostate cancer is suspected when the serum PSA (prostate specific antigen) level is > 4 ug/L or an abnormal prostate nodule is felt. An ultrasound probe slightly larger than a finger is inserted into the anus. After measuring the size of the prostate and noting any abnormal features, local anaesthesia is injected around the prostatic nerves to reduce any pain during the biopsy. Biopsies are taken using a spring-loaded needle. Some 10 to 12 cores are taken. The whole procedure takes 15 minutes and the results should be ready by the 3rd day.

Normally, the accuracy rate of detecting prostate cancer is > 95%. A repeat biopsy may still be needed if the PSA continues to rise over the years, as the tumour may initially be so small that it can be missed at the first sampling. Prior to biopsy, any blood-thinning medication like aspirin, plavix and ticlid must be stopped. Also, preventive antibiotics are to be given at least 2 hours before the procedure.

Complications include:

  • infection. This is more common in diabetics and if there is underlying prostate infection. With antibiotics, the risk of severe infection should be < 5%. The symptoms are burning pain during urination, bloody urine and high fever. If this happens, hospital admission for intravenous antibiotics is needed.
  • bloody urine. If excessive bleeding occurs, blood clots can block the bladder and cause painful retention of urine. If this happens, catheterisation and washout of the clots is the remedial action.
  • bleeding from the anus. This occurs more commonly in those who have large piles. If excessive bleeding occurs, hospital admission is needed.