Wellington Urology Associates Wakefield Hospital, the largest private hospital in the Wellington region
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Prostate Biopsy

Prostate biopsies are indicated when there is a suspicion of prostate cancer. Usually, this is on the basis of elevated PSA (prostate blood test) or abnormal prostate examination and in this situation, the overall likelihood of finding cancer is 20%. If significant cancer is present, this will be detected in 90% of cases with one set of biopsies, and in 95-98% of cases with 2 sets of biopsies.

Just as prostate examination is performed by rectal examination, so prostate biopsies are taken transrectally, under ultrasound guidance (TRUSS). This is a brief procedure, usually performed under local anaesthetic on a day-visit basis. Following injection of local anaesthetic, some 10-14 biopsies are taken in a standard pattern. The best quality biopsies are achieved using a biopsy gun. A bang is heard with each biopsy and some discomfort may occur occasionally. Discomfort may be minimised by relaxing, breathing slowly and deeply, thus avoiding sphincter spasm. Some patients prefer sedation for TRUSS biopsies. This is advisable for patients who find prostate examination unusually painful and for some patients requiring a repeat procedure with more extensive biopsy sampling.

Pre-procedure:

  • urine sample to the laboratory 1 week prior to surgery
  • discontinue aspirin 1 week prior, other medications may need to be stopped
  • ciprofloxacin 500mg antibiotic evening before and morning of the procedure, continuing on the evening of and morning after
  • microlax enema morning of the procedure for PM appointments/Night prior for AM
  • normal diet day of procedure for Local anaesthetic/ See Admission Booklet regarding diet restrictions for General anaesthetic and/or Sedation

Post-operatively:

  • stay < 1 hour post-procedure under Local/ 1-4 hrs post procedure under GA/Sed
  • reinstate usual medications
  • some peri-anal ache and burning with voiding may occur, but these usually settle rapidly
  • bleeding may be seen into the urine, the bowel motion and the semen. The urine and bowel motion clear promptly, but the semen may remain bloody for days to weeks
  • increase fluid intake to wash out the bladder
  • there is no restriction on driving nor on normal activities, unless the biopsies were under General Anaesthetic or Sedation in which case you may not drive

The principal risk from TRUSS biopsies is infection, which occurs in 3% of patients.Other complications are considered rare and extraordinary.

  • Infection may present as burning � frequency � urgency, requiring oral antibiotic treatment, or fevers, sweats and shivers for which urgent admission to hospital for IV antibiotic is needed.
  • Bleeding usually settles spontaneously, but rarely causes clots and urinary retention and may require catheterisation and bladder wash out.
  • Patients with underlying bladder obstruction may develop urinary retention requiring catheterisation.