The digital rectal examination

This is an ultrasound examination of the prostate gland. The test is performed if your doctor suspects you have prostate cancer. Prostate cancer is suspected when your prostate specific antigen (PSA) blood test is above 4 ng/ml or your doctor has found a suspicious nodule in your prostate gland upon digital rectal examination.

Transrectal ultrasound (TRUS) usually takes 15 to 20 minutes. It allows your doctor to view your prostate using a special ultrasound probe and take sample tissues from several parts of your prostate to examine for the presence of cancer.

TRUS is essentially a painless procedure and is performed as a day surgery case.

• There is no special preparation for this test.
• If you suffer from constipation, a laxative or enema may be needed to clear the faeces from your rectum.
• If you are on anticoagulants, such as aspirin or warfarin, stop these medications seven days before the procedure to reduce the chances of bleeding.

• A dose of sedation and antibiotics will be given if a biopsy (a tissue from the prostate that is sent for examination) is required.
• Patients are asked to lie on their side for this test, with their knees flexed at the chest. This position facilitates insertion of the rectal ultrasound probe.
• The probe is lubricated first and will be gently inserted into your rectum.
• This probe emits sound waves that are sent to a computer in the ultrasound machine. A black and white picture of your prostate will appear on the TV monitor.
• The probe has a small tube at its side which allows your doctor to take a biopsy of the prostate.
• You may feel a sharp, quick jab as the needle passes through the wall of the rectum and into the prostate where a small amount of tissue is extracted. The pain is minimal and usually subsides by the time the procedure is completed.
• As many as six or eight biopsies may be required to optimise the chances of detecting and accurately establishing the stage of a cancer.
  
  

  The biopsy process

• It is very common to have some blood in the urine or faeces or sperm at the time of ejaculation. These symptoms usually subside over time. You are advised to drink extra fluids for the first one or two days.
• After the biopsy, you may experience a burning sensation on urination. This symptom will subside over time. Painkillers, such as panadol, can ease these discomforts.
• You may experience difficulty in urination after the biopsy is due to swelling of the prostate gland after the biopsy. A urinary catheter may be inserted to drain the urine.
• If you experience persistent problem in urination, an indwelling catheter is inserted and you will be hospitalised.
• You will be given oral antibiotics at the end of this procedure to prevent infection. You must complete the course of the antibiotics.
• You will be discharged when you are able to urinate.
• You should contact your doctor or the Continence Nurse at 8502586 if you experience:
  • persistent bleeding beyond the second day at home, or if it gets visibly worse
  • inability to pass urine
  • fever (over 39 degrees Celsius) and chills
  • Alternatively, you can return to the Accident & Emergency Department and the doctor may admit you if you have significant infection or urinary retention.

1. Are there any risks from TRUS?

• The risk of complication from the procedure is minimal.
• Many patients may notice some blood in their urine or stool for
  a day or two after the biopsy.
• The only risk is the possibility of an infection in the prostate or bladder following the procedure. This risk can be minimised with antibiotics.

2. When will the test results be known?

A pathologist will examine your prostate samples under a microscope. You will be informed of the results at your next visit with your doctor.

3. What happens if the test is positive?

• If the biopsy is positive for cancer,specialised X-rays, such as bone scan, CT Scan etc are required to see whether the cancer is limited to the prostate gland or has spread to other parts of the body.
• Your doctor will discuss the appropriate treatment when the result of these tests are known.

4. What happens if the test is negative?

If the test is negative, you will be reassessed in six to twelve months' time. The biopsy may be repeated if the repeat PSA and digital rectal examination are highly suggestive of prostate cancer.

5. How accurate is TRUS?

Transrectal ultrasound is not 100% accurate. A small cancerous lesion may be missed. It is therefore important to have serial PSA tests and follow-up visits with your doctor.

• BPH
  
  
• Erectile Dysfunction
  
  
• Male Menopause
  
  
• Nephrolithiasis
  
  
• Prostatitis
  
  
• Urinary Incontinence
  
  
• Urology
  
  
• UTI
  
  
• TURP
  
  
• What is Intravenous Urography Examination
  
  
• What is Urodynamics
  
  
• What Is Transurethral Resection Of Prostrate (TURP)
  
  
• What is Transrectal Ultrasound (TRUS)
  
  
• IPG : Extracorporeal Shock Wave Lithotripsy (ESWL)
  
  
• IPG : Transurethral Resection of Prostate (TURP)