The prostate is part of the male reproductive system. It a walnut-sized gland located beneath the bladder and in front of the rectum in men. It surrounds the urethra (tube that carries the urine and semen out of the body). Prostate tissue produces part of the seminal fluid (the milky substance that combines with sperm to form semen). Prostate specific antigen (PSA) is a protein made by prostate tissue and is found in the blood. Three conditions can affect the prostate and this can cause problems with urination and elevation of the PSA. This include infection of the prostate, a condition known as prostatitis, benign enlargement of the prostate, a condition known as BPH (benign prostatic hyperplasia) and cancer of the prostate. Although, in many cases we will be able to differentiate between the three conditions by history and digital rectal examination, definitive diagnosis can only be reached by obtaining a specimen of the prostate using the Ultrasound machine, a procedure called transrectal ultrasound with biopsy (TRUS)

TRUS, also called prostate ultrasound involves using a special device (transducer) that reflects high-frequency sound waves off the prostate to create detailed images that allows the physician to examine the gland to assess prostate size, an important information in planning your treatment and detect any abnormalities. Prostate biopsy can be used to diagnose prostate cancer.

Preparation for TRUS and prostate biopsy:

If you are scheduled only for TRUS to size your prostate, you don’t need any special preparation.
However, if biopsy is planned, you will need to do the following:
You need to stop any blood- thinning medications (e.g., Aspirine, ibuprofen) for a week to 10 days prior to undergoing TRUS and prostate biopsy.
You need to take an antibiotic called Cipro 500mg starting on the morning of the procedure and one at night after the procedure to help to prevent infection.
You need to do a fleet enema few hours before the procedure to cleanse the bowel.

Procedure:

The procedure is performed while you are lying down on your side with your knees bent. A small transducer, which is well lubricated will be inserted into the rectum and a picture of your prostate gland will be displayed on a monitor. The will allow measurement of the size of the prostate.

In the presence of an abnormal PSA and /or if he results of the TRUS are suspicious for prostate cancer, a prostate biopsy is performed. A local anesthetic called lidocaine will be injected into the prostate to numb it and make the procedure more comfortable. A total of 12-18 samples will be obtained from all parts of the prostate.

The biopsy samples are sent to a pathologist (physician who identifies diseases by studying cells under a miscroscope) who analyzes the samples for the presence of prostate cancer. The grade of prostate cancer is evaluated using a method called Gleason score that Dr. Aboseif will discuss with you in the follow-up visit.

Possible risks of TRUS/biopsy:

Following prostate biopsy, you may experience blood in the urine, in the semen, or in the stools. You may also experience a dull ache in the perineum (area between the scrotum and anus). These side effects are usually minor and diminish within 1-2 weeks.

Occasionally in approximately 7% of patient, they may experience fever, chills , severe pain during urination, a large number of blood clots or difficult urination. In this case, you need to either contact Dr. Aboseif office or come to the emergency room.

It is advisable to refrain from sexual activities for 3-5 days after the procedure.