TRUS Guided Prostate Biopsy

Procedure Steps & Safety Information

TRUS (Transrectal Ultrasound) Guided Prostate Biopsy is a diagnostic procedure used to collect small tissue samples from the prostate gland. It is the standard way to check for prostate cancer when a PSA test is elevated or a physical exam is abnormal.

Part 1: The Procedure (Step-by-Step)

The entire procedure typically takes 10 to 15 minutes and is performed in the urology clinic.

Step 1: Positioning

You will be asked to undress from the waist down and lie on your left side with your knees bent up toward your chest (fetal position). This is the most accessible position for the ultrasound.

Step 2: Ultrasound Insertion

The urologist inserts a lubricated ultrasound probe (about the width of a thumb) into the rectum.

Sensation: You will feel pressure, similar to a prostate exam, but it should not be painful.

Imaging: The probe uses sound waves to create a video image of your prostate on a monitor, allowing the doctor to measure the gland and identify any suspicious areas.

Step 3: Local Anesthesia (The "Block")

To minimize discomfort, the doctor injects a local anesthetic (numbing medication) around the nerve bundles at the base of the prostate.

Sensation: You may feel a slight pinprick or sting, but the numbing takes effect almost immediately.

Step 4: Taking the Biopsy Samples

A thin, spring-loaded needle is passed through a guide on the ultrasound probe.

The needle moves in and out extremely fast (in a fraction of a second) to take a tiny tissue core.

The Sound: You will hear a loud "click" or snapping sound each time the device fires.

The Count: Standard biopsies usually take 12 samples (cores) from different zones of the prostate to ensure thorough sampling.

Sensation: You may feel a tap, pinch, or dull pressure with each sample, but the anesthetic usually prevents sharp pain.

Part 2: Possible Issues & Complications

Complications are generally minor, but because the needle passes through the rectum (which contains bacteria), infection is the primary safety concern.

A. Common & Expected Side Effects (Not Alarming)

1. Blood in the Urine (Hematuria)

Frequency: Very Common (>50% of men).

What to expect: Your urine may look pink or red for 3–5 days after the biopsy. Drinking plenty of water helps flush this out.

2. Blood in the Stool (Hematochezia)

Frequency: Common.

What to expect: You may notice streaking of blood on the toilet paper or in the stool for 1–2 days. This is from the needle puncture site in the rectum.

3. Blood in the Semen (Hematospermia)

Frequency: Very Common.

What to expect: Your semen may look rust-colored, dark brown, or black. This can last for 4 to 6 weeks as the prostate heals and old blood is cleared. It is not harmful to you or your sexual partner.

B. Rare but Serious Complications

1. Infection / Sepsis (The Main Risk)

Risk: Approx. 1–2% of patients.

Cause: Bacteria from the bowel enter the prostate or bloodstream.

Prevention: This is why taking your prescribed antibiotic exactly as directed is critical.

Warning Sign: Fever and Chills. If bacteria enter the bloodstream, it can cause sepsis, which is a medical emergency.

2. Urinary Retention (Inability to Pee)

Risk: < 2% of patients.

Cause: The prostate may swell slightly from the biopsy, closing off the urethra.

Warning Sign: You feel a strong urge to urinate but nothing comes out. This requires a temporary catheter.

3. Heavy Bleeding

Risk: Rare (<1%).

Cause: Usually related to blood-thinning medications.

Warning Sign: Passing large blood clots in urine or filling the toilet bowl with bright red blood from the rectum continuously.

Part 3: When to Seek Emergency Care

Go to the nearest Emergency Room IMMEDIATELY if you experience:

Fever: A temperature higher than 100.4°F (38°C).

Chills: Uncontrollable shaking or shivering (rigors), even without a fever.

Inability to Urinate: Painful full bladder with no flow.