In most cases, ultrasound to look at prostate size and bladder issues are done using transabdominal imaging (see Renal/Urinary Tract Ultrasound). However, there are some occasions when specialised imaging and interventional procedures are needed when looking at the prostate.
A prostate ultrasound, and sometimes the associated biopsy, is done using a transrectal procedure. This involves a thin transducer being placed into the rectum to allow direct visualisation of the prostate gland in high detail, as well as associated structures such as the seminal vesicles and prostatic urethra. Common reasons for this ultrasound include infertility assessment; raised PSA; and increased risk of prostate cancer.
For a prostate cancer assessment, the transrectal ultrasound is done with a biopsy of the prostate gland. The biopsy involves taking small samples of prostate tissue with a small needle to be sent to a pathology laboratory for assessment.
Your examination will be performed by a sonographer who will introduce themselves and confirm your identity and the procedure you are having. You will be asked to change into a gown and empty your bladder.
You will lie on the ultrasound bed on your side, and a sonographer will insert an ultrasound probe into the rectum. They may take some measurements and images.
If you have a biopsy, the radiologist will give you a local anaesthetic and take biopsy samples using the ultrasound probe to guide the needle. The exact number of samples taken can vary but will be at least six. Although uncomfortable, the procedure is not usually painful. The probe is then removed, and any post-procedural care will be explained.
Risks / Side Effects
Transrectal ultrasound is a safe and relatively pain-free examination. If a biopsy is required, there may be some additional discomfort, but it is well tolerated by most men. The transrectal transducer is disinfected before use, and a protective cover is placed over the transducer each time it is used.
With a prostate biopsy, there is a possibility of infection introduced into the prostate as the needle passes through the bowel wall. To minimise this risk of infection, you will be given an antibiotic before the procedure and will be given a second antibiotic (Ciprofloxacin 500mg) to take before going to bed the night of your biopsy.
If an infection is treated early, it should resolve easily. An untreated infection can lead to abscess formation and in rare cases, may be fatal.
Some bleeding from the rectum, in the urine, or mixed with sperm, is common and should settle down with time.
You may have some discomfort. If needed, an analgesic such as paracetamol (Panadol) should provide relief. DO NOT use Aspirin.
Avoid doing strenuous activity for 24 hours after the biopsy.
Please contact your referring doctor if you:
- notice continued or increased bleeding;
- feel unwell or develop a fever;
- have abdominal pain.
Before your Scan
For transrectal ultrasounds to assess anatomy (for example, to investigate infertility), there is no preparation other than to have an empty bladder and rectum.
For a Prostate biopsy:
If you are going to have a biopsy, we advise you stop taking any anticoagulant medication (eg Warfarin) for 1 week before the procedure. Please confirm this with your referring or local doctor first. If your doctor thinks it is not safe to stop your anticoagulation medication, they will need to discuss the biopsy request with a radiologist.
You will need to arrive 1 hour before your procedure to take a dose of antibiotic (Ciprofloxacin 500mg). We will give you this antibiotic, although it may also be prescribed by your referring doctor.
Please note that the study cannot be done unless the antibiotics are taken 1 hour before the biopsy time.
Approximately 30 minutes – 1 hour. Most of this time is preparation and post-procedural care, and the actual scan is short in duration.
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