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Microsoft word - ultrasound guided prostate biopsy

Ultrasound guided prostate biopsy
clopidogrel, dabigatran, prasugrel, dipyridamole or asasantin (for more Consumer Information
information about these medications, go to NPS: http://www.nps.org.au/medicines). Contributors:
Blood thinning medications will need to be stopped for a period of days, or your normal dose reduced, before this procedure is carried out. It is very important that you do not stop any of these Prof Rob Gibson, Ms Ann Revell, Prof Grant Russell, medications or change the dose without consulting both the hospital radiology clinic or department and your own doctor. They will give you specific What is an ultrasound guided prostate
instructions about when to stop and restart the medication. These drugs are usually prescribed to prevent stroke or heart attack, so it is very An ultrasound guided prostate biopsy is a procedure important that you do not stop taking them without where a special needle is inserted into the prostate being instructed to do so by your doctor or the gland to take a small sample of tissue from the radiology practice or both. Aspirin is usually not gland. The sample is then sent to a laboratory for testing, to determine the presence or absence of prostate cancer. A blood test may be required to check your blood Why would my doctor refer me to have
The urologist, medical oncologist or radiation this procedure?
oncologist (specialist doctors) who referred you for the biopsy procedure will discuss and arrange your Your doctor would refer you to have this procedure, If you suffer from any heart valve condition or have 1. Your prostate-specific antigen (PSA), an artificial heart valve or similar device, you must measured through a blood test, is high or inform the radiologist (specialist doctor) carrying out the biopsy before having the procedure so that you 2. Your doctor may have felt an abnormality in can be given additional antibiotic cover. your prostate when carrying out a digital rectal examination (DRE), where your doctor Often, an intramuscular injection (an injection into a had inserted a gloved finger in your rectum muscle) of an antibiotic called Gentamicin is given to (anus) to feel your prostate for any abnormal further reduce the likelihood of infection. What happens during an ultrasound
If you have a very strong family history of guided prostate biopsy
During the procedure, you will be asked to lie on
How do I prepare for an ultrasound
guided prostate biopsy
The radiologist will first carry out a DRE with a Preparation for an ultrasound guided prostate biopsy An ultrasound probe, which is about the thickness of 1. Taking antibiotic tablets by mouth, usually a thumb, will then be inserted into your rectum. The for 1 or 2 days before the biopsy, and on the probe is sterilised, covered with two condoms to morning of the procedure, to help prevent contamination, and a lubricant to help it glide easily You may have a small enema inserted into your rectum half an hour or so before the Sometimes an injection of local anaesthetic or procedure to clean out your bowels and clear sedative may be given into the area of your rectum the rectum of faeces (so that the prostate to minimise discomfort during the procedure. Often the procedure is carried out after you have been given a light general anaesthetic, which means you will be asleep or sedated during the procedure. 3. You may have an injection of antibiotics just After having examined your prostate with the ultrasound, the radiologist will then take biopsies. 4. When you make your appointment for the To take the biopsies, a very fine needle is guided, ultrasound guided prostate biopsy, you need using pictures or images the radiologist can see on the ultrasound screen, through the wall of your department know if you are taking any blood rectum into the prostate and a sample of tissue is A RANZCR Quality Research and Development Program Initiative taken. The sample is sent to a pathology laboratory for analysis by another specialist doctor called a shivering. This will generally happen within 12–72 hours after the procedure. It is This biopsy sampling is repeated several times to immediately, or go to the nearest hospital ensure that any visible abnormal area is adequately sampled, and that as much of the prostate gland as is necessary is also sampled. Usually, between six  Bleeding immediately after the procedure. and 14 individual samples will be taken and sent for Occasionally, some patients experience a small amount of bleeding from the rectum immediately after the procedure, sometimes When this is over, the probe is removed and, if you when they are still on the procedure table. If have had a general anaesthetic, you are woken up. this occurs, it will cease with gentle pressure, You are then given a small pad to wear around your bottom in case of any bleeding, and you will be kept If you have had a light general anaesthetic or under observation for a while until you can urinate. sedation, you will usually have a feeling of mild When the doctor or nurse is happy with your ‘wooliness’ in the head for a day or so. condition, you are allowed to leave – provided How long does an ultrasound guided
NOTE: The ultrasound guided prostate biopsy can prostate biopsy take?
sometimes be carried out through the perineum The ultrasound and biopsy procedure itself takes (the area of skin between the base of the penis and the rectum). This is called a trans-perineal approach. A local anaesthetic is injected into the The procedure together with preparation such the perineum to numb the area before the biopsy. blood test, enema, injection of antibiotics, and The ultrasound probe is inserted into the rectum observation time afterwards will take a couple of to guide the biopsy, but the samples from the hours. If rectal bleeding occurs immediately after prostate are taken through the skin with a the procedure (a rare occurrence), you may be kept a little longer for observation until the radiologist or nurse feels that it is safe for you to go home.  it is the radiologist’s preferred method; What are the risks of an ultrasound
 a possible cancer is suspected at the front of guided prostate biopsy?
the prostate gland, the part furthest away For the risks of an ultrasound guided biopsy, please also refer to the section on after effects.  Haematospermia (blood in the sperm) occurs The radiologist can advise you before the in over 90% of patients having the procedure procedure whether a trans-rectal or trans- and this can persist for 2 or more weeks.  Haematuria (blood in urine) is very common Are there any after effects of an
 Blood in the faeces is fairly common, but is ultrasound guided prostate biopsy?
The after effects of an ultrasound guided prostate  Infection is very rare (less than 1% of patients overall), but this can be severe if Some discomfort in the area of the prostate as  Internal haemorrhage. This is exceedingly uncommon (less than 0.01% of patients), but sometimes clots) in your sperm or ejaculate, and is extremely common after this type of  Rarely, urine retention can occur. If the prostate is very enlarged to start with, and bleeding occurs within the prostate as a result common side-effect, it results from the fact of having the biopsy, this relatively small that the urethra – the small canal transporting amount of bleeding may be enough to cause a urine from your bladder to the penis – goes blockage of the urethra – the canal that transports urine out of the bladder and passes through the prostate. This can then lead to retention, which is the temporary inability to  Blood or clots when you first open your pass urine. This is relieved by the passage of a catheter, a sterile rubber tube, which is inserted into the urethra to relieve the  Infection. This is extremely rare, because of all the precautions taken. To help prevent this, your antibiotic cover may be continued for some days after the procedure. If you do get an infection, you will start feeling unwell as if you are getting the flu, often will have a A RANZCR Quality Research and Development Program Initiative What are the benefits of an ultrasound
Useful websites ultrasound guided
guided prostate biopsy?
prostate biopsy
The main benefit of an ultrasound guided prostate 1. Trans-rectal Ultrasound Guided Prostate biopsy is that it helps accurately diagnose the presence or otherwise of cancer in the prostate. urology.ucsf.edu/patientGuides/pdf/uroOnc/P If cancer is found, it helps diagnose the extent of the cancer and the appropriate treatment can then 2. Prostate Biopsy Procedure, Effects, Uses, Who does the ultrasound guided prostate
http://www.prostate-cancer.com/prostate- cancer-treatment-overview/overview- The ultrasound guided prostate biopsy is carried out by a radiologist or urologist (specialist doctors), assisted by a sonographer (a trained technologist Please note:
who helps to prepare and operate the ultrasound This information is of a general nature only and is equipment), and often a nurse who helps look after not intended as a substitute for medical advice. It is designed to support, not replace, the relationship An anaesthetist will be present if the procedure is that exists between a patient and his/her doctor. It is recommended that any specific questions regarding your procedure be discussed with your family doctor or medical specialist Where is an ultrasound guided prostate
biopsy done?
An ultrasound guided prostate biopsy is carried out
either in a hospital as an outpatient procedure or in
a day procedure centre. It can also be carried out in When can I expect the results of my
ultrasound guided prostate biopsy?
The pathology result generally takes a few days to
The time that it takes your doctor to receive a written report on the test or procedure you have had will vary, depending on:  the urgency with which the result is needed;  the complexity of the examination;  whether more information is needed from your doctor before the examination can be  the time it takes for the pathology specimens to be prepared in the laboratory, prior to their  the time it takes for the pathologist to examine the many slides produced and whether a second opinion is needed;  how the report is conveyed from the practice or hospital to your doctor (in other words, Please feel free to ask the private practice, clinic or hospital where you are having your test or procedure when your doctor is likely to have the It is important that you discuss the results with the doctor who referred you, either in person or on the telephone, so that they can explain what the results A RANZCR Quality Research and Development Program Initiative Additional Information for Health Care
What are the adverse effects of an
Professionals
ultrasound guided prostate biopsy?
Immediate:

What are the generally accepted
indications for an ultrasound guided
prostate biopsy?
The generally accepted indications for an ultrasound  Haematuria (>60%), and usually mild. Clots  Raised or rising PSA (especially if the PSA velocity is high. The PSA velocity is the rate at which the PSA is rising). Whilst a cut-off PSA Haematospermia (>90%). Small clots may be seen and the ejaculate may be brownish. May level of 4 is generally accepted as abnormal, a PSA of 2 in a 50-year-old patient, particularly if it is rising, warrants further investigation. Delayed:
Septicaemia (<1%): occurs usually 12– Digital rectal examination suggesting prostatic 72 hours after the procedure. Must be rapidly treated with antibiotics and may require NOTE: The ultrasound guided prostate biopsy can sometimes be carried out through the perineum, called a trans-perineal approach Is there any specific post-procedural care
required following an ultrasound guided

What are the prerequisites for having an
prostate biopsy?
ultrasound guided prostate biopsy done?
There is no specific special care that need apply 1. Cessation of warfarin with INR measured on after an ultrasound-guided prostate biopsy. the day before the procedure. The exact value for INR required to render the procedure ‘safe’ is determined by the Are there alternative imaging tests,
interventions or surgical procedures to an
ultrasound guided prostate biopsy?
2. Antibiotic cover. This is optimally provided Magnetic resonance imaging guided prostate biopsy is not currently carried out in Australia. commencing the day before the procedure, and often continued for a total of 7 days. Finger-guided prostate biopsy is carried out by some urologists, usually only if there is a very obvious penetrates the prostate gland. Trimethoprim Useful websites about ultrasound guided
What are the absolute contraindications
prostate biopsy
for an ultrasound guided prostate
1. Transrectal Ultrasound Guided Prostate Absence of an anus or rectum, for example after urology.ucsf.edu/patientGuides/pdf/uroOnc/P rectal resection, precludes a trans-rectal approach, but a perineal approach can be used in this 2. Prostate Biopsy Procedure, Effects, Uses, Complications, and More: Men.webmd.com/prostate-biopsy What are the relative contraindications for
an ultrasound guided prostate biopsy?
http://www.prostate-cancer.com/prostate-cancer-treatment-overview/overview- Intercurrent infection. This includes prostatitis. It is appropriate to wait until the infection is cured before proceeding with a biopsy. InsideRadiology is managed by the RANZCR and funded by the Australian Government Department of Similarly, anticoagulation must be ceased and an Health and Ageing under the Diagnostic Imaging Publication Date: January 31st 2012
The RANZCR is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any The RANZCR intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers. The RANZCR recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, The RANZCR, its officers, councillors and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests. A RANZCR Quality Research and Development Program Initiative

Source: http://www.insideradiology.org.au/PDF/T102RUS-Prostate-Biopsy.pdf

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