Your doctor has recommended an exam of your prostate with a Transrectal Ultrasound and
Prostate Biopsy.
Before we talk about this procedure let’s review some information about the prostate
and why these tests may be necessary.
The prostate is located under the bladder and behind the penis.
It is a walnut-sized gland that is part of the male reproductive system.
It helps make semen.
The Urethra is a tube that carries both urine and semen to the penis.
It passes through the prostate which surrounds it like a donut.
If you are scheduled for this procedure your surgeon is concerned that you may have prostate
cancer.
Prostate cancer is the most common cancer found in men.
At most risk are men age 50 and older and those with a family history, especially a
father or brother with prostate cancer.
But at highest risk are african american men and men over age 70
Usually there are no early signs of prostate cancer, but some men have problems with urination
or pain that warn a physician that more testing is needed
Prostate Cancer Screening can help physicians find prostate cancer early, before a patient
has problems.
The screening includes the digital rectal exam or DRE, where a physician
examines the prostate for lumps by placing a gloved finger in a man’s rectum and
Prostate specific antigen or PSA , is a blood test ordered for some men based on their age
and risk factors.
Routine PSA testing is not recommended after age 70.
A prostate ultrasound with biopsies is done to test for cancer when a nodule or lump is
felt.
It is also done for a high PSA and for some problems especially with urination that can
be a sign of prostate cancer.
With an ultrasound, your surgeon is able to scan and measure the prostate without xays
or radiation.
The ultrasound also guides the needle used to biopsy your prostate.
The tissue biopsies are sent to a pathology lab for examination.
The next steps for your care are discussed after the procedure and with the final lab
results.
This may take 1-2 weeks.
If cancer is found, the lab will give the tumor a number called a Gleason score, which
is a grade of how abnormal or aggressive the tumor cells look.
DNA gene testing is commonly done on the tumor cells as a new way to measure how aggressive
the tumor is.
This is different than a cancer stage which is based on where, how large and if the tumor
has spread.
Treatment decisions for prostate cancer are based on many factors including a patient’s
age and general health, the cancer gleason score, DNA results and stage
A biopsy can be false negative That means the biopsies did not find prostate
cancer that was there.
30 % of men with prostate cancer, about 1 in 3, will have normal biopsy results from
the first procedure.
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A second procedure with more biopsies is done to search for prostate cancer if a PSA stays
high, and cancer is strongly suspected but was not found with the first set of biopsies.
Sometimes MRI, Magnetic Resonance Imaging technology is used with the ultrasound to
help find or target a tumor for biopsy.
Ultrasound guided prostate biopsy tends to be a short procedure, available at many hospitals
and is the most common procedure used to biopsy the prostate
MRI technology uses magnetic coils to get detailed information about the prostate and
possible cancer.
MRI is very expensive, takes longer to do, is newer and still being studied, is less
available but is helpful in managing difficult cases
Now let’s talk a little more about what happens during a Transrectal Ultrasound and
prostate biopsy.
To start, you are positioned comfortably.
Most patients are awake for this procedure.
An ultrasound probe is coated with lubricant gel and gently placed into your rectum.
The gel helps the probe to be more comfortable for you and is needed to get clear ultrasound
pictures.
The size and shape of the prostate is checked and measured by gently moving the probe near
the prostate.
Numbing medication is injected near the prostate to decrease the discomfort of the biopsies.
The ultrasound probe is used to guide a needle biopsy device to take about 12 tiny pieces
of prostate tissue.
You will hear a snapping sound with each biopsy.