Office (Transrectal) Prostate Biopsy
A prostate biopsy is a very common procedure performed by nearly every Urologist, but how it is done can differ from practice to practice. At Urologic Surgeons of Washington, if being biopsied for the first time, our patients will have this done in our downtown office. We know some offices will do this in their facility for billing reasons, but having sedation is entirely unnecessary. It is a procedure that takes only six minutes or so and has minimal recovery afterward. You will be asked to stop all blood thinners before the biopsy, and you will be given prescriptions for prophylactic antibiotics to be started three days before the biopsy and for a few days afterward. You will also be given antibiotics in the office just before the biopsy. Patients are positioned on their side so that an ultrasound probe can be passed into the rectum. This is used to see the prostate, which lies on the other side of the rectum. In this way, we can numb the prostate by injecting lidocaine strategically, taking a picture and measuring the prostate, and getting a sense of individual anatomy. After this step, the patient feels very little while we use a special needle that sounds almost like a staple gun to get between 12 and 18 small cores of prostate tissue. This tissue is sent to a pathology lab, and we inform patients of the results three days later.
Patients can expect to see blood in their urine, semen, and stool after a biopsy due to the needles, and this is variable but absolutely normal. Blood in the urine is usually present for a day or two, blood in stool only usually until the next bowel movement and blood in semen can linger far longer.
The only real complication of a trans-rectal prostate biopsy that all patients need to know about is infection. When this happens, it can be serious, so all patients are made aware of this more than once. This will come in the form of fevers, chills, and not feeling well, typically the night of or the next day after a biopsy. If this happens, time is of the essence. At this point, the patient should go to their nearest emergency room and tell them they just had a prostate biopsy. The ER doctor should be asked to call us so that we can ensure they are administering the right antibiotics for this type of infection. These infections result from getting very unlucky in that bacteria had to be perfectly pushed into a vein and that bacteria needed to be resistant to all the antibiotics given for the procedure. Fortunately, these sepsis infections have become very rare as we doctors have stopped overusing drugs related to Ciprofloxacin, which selected out for a very resistant strain of E. Coli. Still, all patients need to know about them and act quickly if they are the unlucky ones.