• Reference Number: HEY-1273/2022
• Departments: Ultrasound Department
• Last Updated: 1 May 2022

INTRODUCTION

You have been referred for a Transperineal Ultrasound Guided Prostate Biopsy under Local Anaesthetic (LATP Bx).  This leaflet has been produced to give you general information about your procedure.  Most of your questions should have been answered by this leaflet/booklet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it, you have any concerns or require further explanation, please discuss this with a member of the health care team who has been caring for you.

WHY HAVE I BEEN OFFERED TO HAVE A PROSTATE BIOPSY?

You have probably been troubled by some symptoms related to your bladder/prostate or you have had a blood test which has shown a raised PSA (Prostate Specific Antigen). Following this, you have been referred to see a specialist urology doctor or nurse, who makes decisions on the tests you require based on your symptoms, PSA levels and family history. These tests are performed to confirm or exclude a diagnosis of prostate cancer. This does not mean you have cancer, but your doctor may want to exclude this possibility.

Some patients may require an MRI (Magnetic Resonance Imaging) scan prior to their biopsy. The MRI looks for areas of change within the prostate which may have caused the PSA level to increase. In these cases, the MRI scan and biopsy are booked at the same time. For patients with a close family member who has had prostate cancer, both MRI and biopsy, or biopsy only, will be offered.

For patients without a positive family history, or any other risk factor, you will continue to your biopsy appointment if the MRI result shows areas of change. If the MRI is negative, one of the radiology nurses will contact you. Your biopsy will be cancelled or delayed until you have had a follow up consultation with a prostate nurse specialist.

**Please do not be alarmed by how quickly you are given your appointment for your biopsy. The pathway you are on is a NHS timed pathway and the speed with which you receive your appointments is a normal part of this service**

WHAT IS A TRANSPERINEAL ULTRASOUND GUIDED PROSTATE BIOPSY?

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

DO NOT DRINK ALCOHOL 24 HOURS PRIOR TO THE PROCEDURE.

YOU CAN EAT AND DRINK (NON-ALCOHOL) NORMALLY

 

PLEASE CONTACT THE DEPARTMENT IF YOU HAVE:

• A regular prescription for a blood thinning agent (for example warfarin, aspirin, clopidogrel, rivaroxaban or dabigatran);

• A latex allergy

• An allergy to Lidocaine (local anaesthetic)

IT IS ADVISABLE IF YOU ARE COMING TO THE HOSPITAL IN YOUR OWN VEHICLE TO BE ACCOMPANIED BY SOMEONE WHO CAN DRIVE YOU HOME.

WHAT SHOULD I EXPECT TO HAPPEN?

Summary:

• Report to the Radiology (X- Ray) department reception, entrance 2 Castle Hill Hospital.
• You will be directed to the Ultrasound Department where a member of staff, either a nurse or support worker will take care of you
• A member of the team will talk to you about the procedure and ask you to provide your written consent to proceed
• The procedure will be performed by two sonographers. There will also be a nurse and a support worker present in the room. Sometimes further individuals may be present during the examination for teaching purpose with your consent
• You will be given a local anaesthetic – Lidocaine – during the procedure
• A probe will be inserted into the anus during the procedure

• You could be in the ultrasound department for up to 4 hours as there is some preparation and recovery time required before and after your procedure.

More details

Report to the Radiology (X-Ray) department reception, entrance 2 Castle Hill Hospital. You will be directed to the Ultrasound Department where you will be asked to take a seat until a member of the team calls you to discuss the procedure with you.

You will not be called immediately for your procedure and you may have a wait before your procedure commences. You will meet members of the team who will take some observations (BP, temperature etc) and others who will talk to you and obtain your consent. You could be in the ultrasound department for up to 4 hours to allow for this preparation before and for the recovery time required after your procedure.

The sonographer performing the biopsy will explain the procedure to you and answer any relevant questions you may have. You will then be asked to give written consent.

You will be changed into a hospital gown prior to the procedure.

During the procedure, you will be asked to lie on your back on a specially designed couch with your legs raised and held in position by supports. Your genitals will covered and supported up out of the way. Some warm ultrasound gel will be placed into the rectum to improve the ultrasound image of the prostate. An ultrasound probe will be inserted into the rectum to locate the prostate and determine the area requiring the anaesthetic injection. The perineum will then be cleaned

Local anaesthetic will be injected both underneath the skin and deeper around the prostate. This will cause some discomfort but will quickly ease. The ultrasound probe will be withdrawn and there will be a pause of approximately 5 minutes to allow the local anaesthetic to take full effect.

Following this, the procedure will continue. The probe will be reinserted to guide where the biopsy samples need to be taken from. You will hear a clicking noise as the sonographer takes a biopsy sample of the prostate. We may take up to 18 samples.

The pressure of the probe, and the effect of the anaesthetic may give you a sensation of needing to urinate, break wind or pass a stool. This is entirely normal and we can reassure you this will not happen. The feeling will ease.

WHAT HAPPENS AFTERWARDS?

Once the procedure has been completed you can get dressed and you will be asked to recover in our waiting room. We will get you some light refreshments.

Some men feel light headed after the procedure. Again, this is entirely normal. Should you feel lightheaded, we will ensure you are comfortable and laid on a trolley until you recover. This is nothing to be concerned about.

Whilst you recover, you will be given a jug to pass water into. This procedure can sometimes cause swelling of the prostate and we prefer that you stay in the department until we are sure you can pass urine normally. It is not uncommon for there to be some blood present in the urine following this procedure and your sample will be checked to make sure that if there has been any bleeding it is not excessive. Once your sample has been checked and found to be satisfactory you will be allowed home.

The biopsy results will be sent to your referring Urologist. This will take up to three weeks.

WHAT ARE THE POSSIBLE COMPLICATIONS?

Post procedure complications can include the following:

• Bleeding

Bleeding is a common side effect following this procedure and it can last up to two weeks following the procedure. You may find blood in your stools/from your rectum, into your urine (haematuria) or into your sperm (haematospermia). We recommend increasing your fluid intake following this procedure and this may help alleviate some of these symptoms. If you pass urine that looks like a red wine, you should immediately contact WARD 15, CASTLE HILL HOSPITAL on telephone number (01482) 623015 or  622708 and speak to the SENIOR UROLOGY HOUSE OFFICER ON CALL.

• Urinary Retention

This is difficulty urinating following the procedure. This can happen immediately after your procedure or develop within 72 hours of your procedure. This requires immediate medical attention as you may require the insertion of a temporary catheter into your bladder. Contact WARD 15, CASTLE HILL HOSPITAL on telephone number (01482) 623015 or  622708 and speak to the SENIOR UROLOGY HOUSE OFFICER ON CALL.

• Infection

It is unlikely that you will develop an infection. However an infection after an interventional procedure requires immediate medical attention. If you develop a fever, feel hot and sweaty, experience pain in the back passage or persistent pain when you urinate you should immediately contact WARD 15, CASTLE HILL HOSPITAL on telephone number (01482) 623015 or  622708 and speak to the SENIOR UROLOGY HOUSE OFFICER ON CALL.

 

In the majority of cases none of these problems arise.

 

Post-operative pain management – After the procedure you should not feel unwell but any discomfort can be relieved by taking the recommended dose of paracetamol tablets.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.