Transrectal ultrasound scan and prostate biopsy

User

Posted 13 Mar 2019 at 11:01

Hello all, I'm 57 years old. I recently had a blood test to check my PSA levels they came back quite high 24. The Doctor has now referred me to my local hospital, Worcester UK.

I have checked on the website and they seem to offer the Transrectal ultrasound scan and prostate biopsy. It's worrying me a bit having this procedure done although I understand its essential. Is anyone able to give me some idea of what I can expect on the day by the way of pain?

Thank you, I am pleased I found this forum.

Patrick

User

Posted 13 Mar 2019 at 11:27

Hi Patrick, welcome to the community.

I had a TRUS biopsy in April 2015. apart from leaving your dignity somewhere else and a bit of pressure when the needle clicks it was fine. Antibiotics and local anaesthetic are provided.

Blood in semen afterwards but no infection.

Not the most pleasant thing I've had done but not the worst either e.g. endoscopy.

I’m sure you will be well looked after.

Ido4

User

Posted 13 Mar 2019 at 11:54

You should try and get an MRI scan done first, and allow time for the result to come back.

I had an MRI first, but the result didn't come back in time, so I had the TRUS biopsy. The MRI result then came back and said a TRUS was pointless and I needed a template biopsy (and indeed the TRUS didn't reveal significant cancer, which the later template biopsy did).

Anyone will be concerned about such a procedure first time. However, the TRUS was almost completely painless, and it's not something I would worry about having again if it was ever necessary.

Was given a couple of powerful antibiotic tablets (2 x 500mg Ciprofloxacin) about 40 mins before (to allow time to get into blood stream), and continued taking them for 3 days afterwards. (I seem to recall you have to avoid dairy products 2 hours before and after taking them, as dairy stops them working.)

You are warned you may get blood in urine, semen, and rectum. There was very little in my urine (only first time, and only in first few cc's). Blood in semen was much more dramatic, and if I hadn't read some other forums first, I would have been quite alarmed at the extent - bright red semi-congealed. Was told not to hold off ejaculating, although I waited 24h out of fear it might be painful, but it wasn't at all. After a few days, it turns brown (just as a bruise does), and it took 3 weeks to completely clear. Was told the blood is harmless if having sex with a partner, but out of politeness, you might want consider a condom. Also had some rectal bleeding after a large stool a few times over following weeks, and that area was mildly uncomfortable occasionally, but not painful.

They told me they would fit a catheter, but they didn't. Turned out that's only in case of incomplete bladder voiding.

Anyway, the procedure was a lot less significant than I imagined it would be. They are very good at preserving your dignity, etc.

User

Posted 13 Mar 2019 at 13:34

Hi Patrick,

You should insist on an mpMRI scan before any biopsy, and avoid the TRUS biopsy in favour of a far more accurate and reliable template biopsy under general anaesthetic if at all possible.

The former biopsy is largely obsolete in private medicine, but is preferred by the NHS as it is quicker and cheaper. It also carries a much greater chance of infection, as the bowel is punctured multiple times.

When I was diagnosed, two friends who had had TRUS biopsies ended up having template biopsies anyway subsequently, and told me to eschew a TRUS, which I did. I advise men to do the same.

Speak to your consultant about it. He knows that the TRUS test is not the best. We get regular visitors here who have had a TRUS, and then have to enjoy the bonus of a template afterwards.

Hope you get the all-clear whichever biopsy you end up having.

Best of luck.

Cheers, John.

Edited by member 13 Mar 2019 at 13:35 | Reason: Not specified

User

Posted 13 Mar 2019 at 16:04

Patrick, in terms of pain, I'd reckon a TRUS biopsy to be on a par with having a filling at the dentist; there's a sharp scratch at the start as the local anaesthetic (the same anaesthetic that a dentist uses) is injected, and after that all you'll feel is a "click" and a vibration as the spring-loaded sampler takes each sample from you. You will feel some discomfort after the anaesthetic wears off, but it should be nothing worse than soreness.

It's an extremely undignified procedure, but it shouldn't be a painful one.

All the best,

Chris

User

Posted 14 Mar 2019 at 12:18

Does it say which department to go to, e.g. urology, or scanning, or something else?

It seems too late in the day to be a "One-stop Shop" Urology appointment, where they try and do lots of diagnosis things on the same day, as they usually say allow 4-5 hours for that.

Seems rather late for Urology anyway - I don;t think they normally work much out normal hours. Some scanning departments work much longer hours to make most effective use of expensive MRI scanners.

Ring them and ask. My first appointment was a scan, before I saw urology at all. Even before that happened, I got a second appointment with Urology One-stop shop, but it had a covering letter explaining in some detail all the possible things that might happen and that I should allow 4-5 hours for the appointment.

User

Posted 14 Mar 2019 at 12:30

Hi Patrick,

I don't think it's normal to give you no information about a procedure. As far as I recall I was sent a leaflet saying what to expect.

With a suspected cancer you'd expect to be referred as urgent. It could be they're busy and have fit you in at a special evening clinic. I've found our hospital does that when they get behind.

I'd ring and ask if it's a biopsy as you should have it fairly quickly. Although as others have said an MRI is usually first nowadays.

I'd also say I've had nothing done that was painful. The most pain is in the mind.

Regards Peter

Edited by member 14 Mar 2019 at 12:31 | Reason: Not specified

User

Posted 14 Mar 2019 at 14:27

This will be your initial urology appointment. The urologist will decide what sort of scan and/or biopsy is appropriate for you.

Chris

User

Posted 14 Mar 2019 at 15:21

I think some of the responses above are causing you unnecessary concern. It is quite right to offer you an initial appointment with a urologist - s/he will want to hear about your symptoms, do another DRE themselves and then agree with you a course of action. Urologists have a responsibility (under NHS guidelines) to discuss with you the risks and benefits of going ahead with diagnositc tests before they book those tests.

A couple of people have suggested that you might want to 'insist' on a particular type of biopsy, or the order of tests that you want. I am not sure that it is helpful to go into that consultation ready to demand things - your urologist will probably already have a view about what tests are needed. As it happens, Worcester NHS Trust already offers mpMRI to PROMIS standard so if the uro thinks that is needed, s/he will offer it without you needing to insist on anything. With a PSA of 24, and depending on what s/he feels when the DRE is done, he may advise that you only need the image guided TRUS anyway.

My view is that if you go in with a set opinion of what you should be offered, based on well meaning advice here, and actually what you think you should be offered is not what the uro thinks is right for you, it is only going to lead to conflict, mistrust or frustration.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User

Posted 13 Mar 2019 at 11:27

Hi Patrick, welcome to the community.

I had a TRUS biopsy in April 2015. apart from leaving your dignity somewhere else and a bit of pressure when the needle clicks it was fine. Antibiotics and local anaesthetic are provided.

Blood in semen afterwards but no infection.

Not the most pleasant thing I've had done but not the worst either e.g. endoscopy.

I’m sure you will be well looked after.

Ido4

User

Posted 13 Mar 2019 at 11:54

You should try and get an MRI scan done first, and allow time for the result to come back.

Anyone will be concerned about such a procedure first time. However, the TRUS was almost completely painless, and it's not something I would worry about having again if it was ever necessary.

They told me they would fit a catheter, but they didn't. Turned out that's only in case of incomplete bladder voiding.

Anyway, the procedure was a lot less significant than I imagined it would be. They are very good at preserving your dignity, etc.

User

Posted 13 Mar 2019 at 13:34

Hi Patrick,

You should insist on an mpMRI scan before any biopsy, and avoid the TRUS biopsy in favour of a far more accurate and reliable template biopsy under general anaesthetic if at all possible.

When I was diagnosed, two friends who had had TRUS biopsies ended up having template biopsies anyway subsequently, and told me to eschew a TRUS, which I did. I advise men to do the same.

Speak to your consultant about it. He knows that the TRUS test is not the best. We get regular visitors here who have had a TRUS, and then have to enjoy the bonus of a template afterwards.

Hope you get the all-clear whichever biopsy you end up having.

Best of luck.

Cheers, John.

Edited by member 13 Mar 2019 at 13:35 | Reason: Not specified

User

Posted 13 Mar 2019 at 14:43

Thank you all very much for replying to my question. I've only known this is going to happen for a couple of days so it's all a bit scary. The Trus biopsy doesn't sound so bad other than the dignity issue. Although from what's been said here I would be better off with a Template Biopsy. Am I in a position to request a template biopsy even if a trus is offered? My doctor said an MRI would be done.

This site has been very informative. Reading posts from others and getting some real information. Before I found this site I was googling, I wish I hadn't by the end of the day I felt thoroughly depressed.

Thanks again.

Patrick

User

Posted 13 Mar 2019 at 16:04

It's an extremely undignified procedure, but it shouldn't be a painful one.

All the best,

Chris

User

Posted 13 Mar 2019 at 17:39

I was offered a TRUS biopsy there and then when I was called in to discuss the results of my mpMRI scan, as part of a local ‘one-stop shop’ programme. Forewarned and forearmed, I said: “Thanks, but no thanks, I would prefer a template biopsy.”

I was told there would be a long waiting list, which in the end turned out to be three weeks.

In the event, my cancer would have been picked up with either biopsy, but complications are more common with TRUS, and template is usually under a general anaesthetic, which carries its own attendant risks.

You can always let your consultant know your preference. You can look up the risks and benefits of both on-line, there’s lots of stuff about them.

My template biopsy was virtually painless, apart from my first few micturitions, which felt like pissing razor blades, and of course there is red/pink urine and semen for a while afterwards.

Cheers, John.

Edited by member 13 Mar 2019 at 17:40 | Reason: Not specified

User

Posted 14 Mar 2019 at 08:59

Originally Posted by: Online Community Member

Thanks Chris. I hope things are going well for you. Thanks for info its very helpful to me and has helped ease my mind somewhat.

Thanks Again

Patrick

User

Posted 14 Mar 2019 at 11:39

Hi. I had a letter through this morning giving me an appointment 25/03/19 19:15hrs. It makes no mention of any MRI scans or Biopsies so I have no idea what they are going to do. Is that normal not to give any further information?

I never knew I could feel this crap.

Thank you

Patrick

User

Posted 14 Mar 2019 at 12:18

Does it say which department to go to, e.g. urology, or scanning, or something else?

It seems too late in the day to be a "One-stop Shop" Urology appointment, where they try and do lots of diagnosis things on the same day, as they usually say allow 4-5 hours for that.

Seems rather late for Urology anyway - I don;t think they normally work much out normal hours. Some scanning departments work much longer hours to make most effective use of expensive MRI scanners.

User

Posted 14 Mar 2019 at 12:30

Hi Patrick,

I don't think it's normal to give you no information about a procedure. As far as I recall I was sent a leaflet saying what to expect.

With a suspected cancer you'd expect to be referred as urgent. It could be they're busy and have fit you in at a special evening clinic. I've found our hospital does that when they get behind.

I'd ring and ask if it's a biopsy as you should have it fairly quickly. Although as others have said an MRI is usually first nowadays.

I'd also say I've had nothing done that was painful. The most pain is in the mind.

Regards Peter

Edited by member 14 Mar 2019 at 12:31 | Reason: Not specified

User

Posted 14 Mar 2019 at 14:12

Thank you both for your replies to my question.

I have just called the number on the letter and spoke to the appointment maker. Apparently, this appointment is just to discuss my symptoms. I thought I'd already done that with the doctor.

I'm none the wiser what's happening. Not sure what I can do other than see my GP and find out what he thinks.

Patrick

User

Posted 14 Mar 2019 at 14:27

This will be your initial urology appointment. The urologist will decide what sort of scan and/or biopsy is appropriate for you.

Chris

User

Posted 14 Mar 2019 at 15:21

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 14 Mar 2019 at 19:11

Thank you, Chris and Lyn, for your posts.

Lyn, you have given me a lot of information and I'm very grateful.

I'm not great at writing long posts but I just wanted to say everyone's contribution has been of immense help to me.

I'm so pleased I found this community.

I'm sure I will be back with more questions as they come into my head.

Many thanks

Patrick

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