In most cases prostate size and bladder issues are performed via transabdominal imaging (see Renal/Urinary Tract Ultrasound). However, there are some occasions when specialised imaging and interventional procedures are required when looking at the prostate.
This examination, and sometimes the associated biopsy, is performed by transrectal ultrasound. This involves a thin transducer being placed into the rectum which allows direct visualisation of the gland in high detail, as well as associated structures such as the seminal vesicles and prostatic urethra.
Some common reasons for this study are infertility assessment, raised PSA or increased risk of prostate cancer.
In the cases of prostate cancer assessment, the transrectal ultrasound is performed in conjunction with a biopsy of the prostate gland. This involves taking a number of small samples of prostate tissue with a small needle to be sent to a pathology laboratory for assessment.
How is a Transrectal Prostate ultrasound performed?
Your examination will be performed by a sonographer. Upon being taken into the examination room the sonographer will introduce themselves, confirm your identity and examination. You will then be asked to change into a gown, and to empty your bladder.
You will lie on the ultrasound bed on your side and a sonographer will place an ultrasound probe into the rectum. They may take some initial measurements and images.
If you are proceeding to a biopsy the radiologist will administer local anaesthetic and then take several biopsy samples using the ultrasound probe to guide the needle. The exact number of samples taken can vary due to a number of factors, but will be at least six. Whilst uncomfortable, it is not usually overly painful. On completion, the probe is removed and any post procedural care will be explained.
What are the risks & side effects?
Transrectal ultrasound is a safe relatively pain free examination. If a biopsy is required then there may be some additional discomfort, but it general terms 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 infection may be introduced into the prostate as the needle passes through the bowel wall.
If treated early this should resolve easily. If left untreated it can lead to abscess formation and in rare cases may be fatal.
To minimize the 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.
Some bleeding is common and should settle down with time. This can be from the rectum, in the urine, or mixed with sperm.
You may experience some discomfort. If required, a simple analgesic such as paracetamol (Panadol) should be sufficient. DO NOT use Aspirin.
You should avoid strenuous activity for 24 hours following the biopsy.
Please contact your referring doctor if you:
- notice continued or increased bleeding
- feel unwell or develop a fever
- experience abdominal pain.
Before your Scan
For a general transrectal ultrasound to assess anatomy for cases such as infertility there is no preparation required other than to have an empty bladder and rectum.
For a Prostate biopsy:
It is advisable to cease taking any anti-coagulant medication (eg Warfarin) for 1 week prior to the procedure. Please confirm this with your referring or local doctor first. If your doctor thinks it is not safe to stop your anticoagulation they will need to discuss the biopsy request with a radiologist.
You will be asked to arrive 1 hour prior to 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 performed 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 exam is reasonably short in duration.