Following any abnormality indicated by a DRE examination and/or the PSA test, a trans-rectal ultrasound (TRUS) and biopsy of the prostate is usually recommended first. This is done at the hospital as an out-patient. The test itself normally takes no longer than about ten minutes, although sometimes it may be necessary to remain in hospital for a little longer. A local anaesthetic is given, but some men can still find the procedure a little uncomfortable.
A lubricated ultrasound probe is first inserted through the back passage in order to provide a ‘map’ of the prostate. The doctor will then pass a fine needle through the prostate to extract samples of tissue (typically 8 - 12). These are sent for examination to a pathologist, who will then determine whether any cancerous tissue is present. Antibiotics are given prior to and immediately following the procedure. There may be some blood in the urine and/or the back passage from a few days to up to three weeks after a biopsy, and blood in the semen for 4 - 6 weeks. This is not a cause for concern and is normal, but any other symptoms should be referred immediately to your GP or hospital.
As a biopsy takes tiny sample cores from the prostate, it is possible that the cores removed may miss the cancer. The greater number of samples taken, the more likelihood of finding the cancer. Greater sampling, however, can lead to increased risk of complications. Research suggests that it is possible that prostate biopsies may sometimes under-estimate the extent of the disease, due to sampling error.
A more precise test, a template biopsy, may be conducted for some forms of treatment, or when suspicions are high but normal biopsy results are inconclusive. This involves having a general anaesthetic.