Transrectal Ultrasound
and Prostate Biopsy
PATIENT INSTRUCTIONS and
CONSENT FORM
Appointment
You Have Been Scheduled For A Transrectal Ultrasound And Possible Biopsy On
__________________________at _________________________a.m/p.m.
In our office located at
[ ] Avon, 120 Simsbury Road
[ ] Farmington: 399 Farmington Ave.
[ ] Glastonbury: 330 Western Blvd.
[ ] Hartford: 85 Seymour Street, Suite 416
[ ] Meriden: 455 Lewis Street
Let’s Get You Ready
First: The Terminology
Transrectal Ultrasound – Abbreviation: “TRUS”
 Prostate Biopsy – Abbreviation: “Bx”
 Transrectal Ultrasound With Prostate Biopsy:

– “TRUS/Bx”

Benign Means “Not Cancer”
The Goal of Prostate Biopsies
To Determine If Prostate Cancer Is Present
 Why?

– Because PSA Lab Tests Are Elevated
– Because The Digital Prostate Exam Is Abnormal
PSA – The Basics




Prostate Specific Antigen = “PSA”
PSA Is A Harmless Protein
Screening Blood Test For Prostate Cancer
Many Causes Of Elevated PSA
– Prostate Cancer
– Enlarged Prostate (BPH or Benign Prostate
Hyperplasia)
– Prostate Or Urinary Infection
– Prostate Irritation Or Trauma
– Genetics
– Transient Variations
– Unknown Reasons - Common
Digital Rectal Exam of the Prostate
Prostate
Physician Palpates the Prostate to Feel for Size, Presence of Nodules and Other Abnormalities
Purpose of The Transrectal
Ultrasound: (“TRUS”)

Assist In Obtaining Prostate Biopsies
(“Bx”)
– Targeting Of Suspicious Areas
– Guidance For Systematic Biopsies
TRUS – Additional Information

Prostate Size Estimate
– PSA Density
 The Relationship Of The PSA To Prostate Size

Identify Benign Causes Of Abnormal
Digital Rectal Exam
– Calcium Deposits
– Cysts
– Shape Irregularities
TRUS/BX – Cancer Information

If Cancer Is Detected On The
Prostate Biopsies
– Determine The Gleason Grade Of The
Cancer (Natural Aggressiveness)
– Estimate The Extent Of Cancer
– Cancer Location Information
– Determine The PSA Density
 Relationship Of PSA Value To Prostate Size
Preparation for TRUS/Bx

Stop All Blood Thinner Medications Seven Days Before The Biopsy
– They May Cause Excessive Or Prolonged Bleeding From The Biopsy
Site
– Let Your Urologist Know The Medications You Take
 Prescribed
 Over-the-counter
 Vitamin E
 Glucosamine
– Let Your Urologist Know
 If You Have Heart Valve
 If You Have An Artificial Joint
 If You Are Allergic To Local Anesthesia
– Novocaine
– Xylocaine
– Dental Anesthesia
STOP Blood Thinning Medications

Aspirin
– Even 81 Mg “Baby Aspirin”
– Stop 1 Week Before

Anti-inflammatory Pain Relievers
– Motrin, Advil (Ibuprofen), Aleve (Naproxen)
– Relafen (Nabumetone)
– Stop 1 Week Before


Plavix-discuss Specific Plan With Prescribing Physician
Coumadin (Warfarin), Lovenox, Ticlid
– Stop At Least 7 Days Before
– Discuss Specific Plan With Prescribing Physician
What is OK to Continue?

Your Usual Medications That Are Not Blood
Thinners
– Please Check With Your Urologist

Tylenol (Acetaminophen) Is Ok
– This Pain Reliever Does Not Cause Bleeding
Problems
Tylenol
Preparations
The Day of the TRUS / Bx
Do Not Eat Or Drink 4 Hours Before The
TRUS/Bx
 Take Your Antibiotic as Directed (1 hour)
before the TRUS/Bx
 Give Yourself A Fleet Enema

– 2 Hours Before The TRUS/Bx
– Available Over-the-counter
How is the TRUS/BX Done

Office Procedure
– You May Drive Yourself to the Appointment
Local Anesthesia (Lidocaine)
 Time From Beginning To End Is About 60
Minutes
 Rectal Procedure Through The Anal
Opening
 Done Using A Finger Shaped Ultrasound
Probe

Transrectal Ultrasound
Prostate Biopsies

Prostate Biopsies Are Done With A Biopsy
Needle Device Passed Through A Special Port In
The Ultrasound Probe.
Local Anesthesia (Lidocaine) Is Injected Before
The Biopsies Are Done
 10-12 Biopsies Are Done In Most Instances

– Each Biopsy Looks Like A ½ Inch Thread
– 6 Prostate Zones Are Usually Biopsied
What to Expect During the
TRUS/BX?
Mild Anal And Rectal Discomfort During
The Ultrasound
 Sense Of A “Poke” And “Pressure”
Discomfort When The Local Anesthesia Is
Injected.
 Rubber Band-like “Snapping” Sensation
During The Biopsies
 Strong Sense Of Urgency To Void During
The Biopsies

How Painful Will The Procedure Be?

The Pain Men Experience Varies Widely
– Some Men Say The Procedure Was Nearly
Painless
– Most Men Say The Procedure Was Mild To
Moderately Painful
– Some Men Say The Procedure Was Really
Painful
 Anxiety Heightens The Pain Response
What to Expect Immediately After
the TRUS/Bx?

Occasionally Patients Feel “Sweaty” And
“Faint”
– Irritation Of The Rectum Can Lead To A
“Vagal” Response That Can Lead To Fainting
– Patients Are Asked To Lay Flat Several
Minutes Until This Reaction Goes Away
Blood In The Urine
 Blood In The Rectum
 Rectal Or Prostate Discomfort Or Pressure

What To Expect After the TRUS/Bx?

Blood In The Urine
– Typically Resolves Within A Few Days, But May Last A Few
Weeks
– Blood Clots Can Block Urination Causing Inability To Urinate
– Drink Lots Of Water To Prevent Blood Clots From Forming
– Avoid Aspirin And Other Medicines That Cause Bleeding Until
Bleeding Has Resolved For A Few Days.
– Avoid Sexual Activity Or Strenuous Work If Blood In The Urine
Significant (Dark, Thick, Red Urine – Like Tomato Soup)

Blood From The Rectum
– Usually Resolves Within A Few Days
What to Expect After the TRUS/Bx?

Blood In Semen
– Harmless
– The Amount Of Blood Can Be Impressive
 Some Patients Choose To Use A Condom During Sexual
Activity
– Typically, Lasts A Few Weeks To A Couple Of Months
– There Is No Treatment To Make This Go Away Sooner
– Rectal Or Prostate Discomfort Or Pressure
 Tylenol Is Very Helpful
 Usually No Need for Stronger Medication
Blood In Urine – What to Look For


Look At Your Urine In A Clear Glass If
You Are Worried About The Amount Of
Blood You See.
Red, But Clear = Ok (Like Diluted Red
Punch)
– This Is Expected
– Drink More Water

Thick And Dark Red = Too Bloody
– Rest And Drink More Water
What to Call Us About
Please Call

Fever Higher than 100 Degrees
– About 1% Of Men Develop Infection Of The Prostate
And Urinary Tract Even With Precautionary Antibiotics.
Dark Thick Red Urine That Does Not Clear With
Increased Fluid Intake And Rest
 Significant Difficulty Or Inability To Void

– Sometimes A Blood Clot Blocks The Urinary Canal
– Men With Very Large Prostates Are Particularly
Vulnerable To Urinary Retention
Prostate Tissue Pathology Results

Typically Results Are Back Within 10
Working Days.
– Special Staining And Second Reviews May
Take Longer.
Your Results Will Be Given To You By
Phone
 If You Have Not Heard From Our Office
Within 10-14 Days, Please Call

Consent Form
Please Thoroughly Read The Consent Form
It Explains In More Detail The Ultrasound
Procedure
 Ask Yourself:


– Are You Comfortable With Knowing About The
Procedure?
– Have All Your Questions Been Answered?

When Complete, Please Sign The Consent Form
Indicating You Have Read And Understand The
Procedure. Bring It With You To Your
Appointment
Billing

Your Insurance Will Be Billed For:
– The Procedure by Hartford Clinical Associates
– A Laboratory Will Bill For The Pathological Analysis.
 A Reference Laboratory May Bill For The Technical
Preparation Of The Slides For The Pathologist.

Number of Bills You May Receive
 Hartford Clinical Associates for the Procedure
 A Pathologist Group for the Pathological Analysis
 Another Laboratory for the Technical Preparation of Slides