Transrectal ultrasound of the prostate with biopsy

What is it?

A transrectal ultrasound (TRUS) is an ultrasound technique that is used to view a man’s prostate and surrounding tissues. The ultrasound transducer (probe) once inside the rectum sends sound waves through the wall of the rectum into the prostate gland, which is located directly in front of the rectum. TRUS may also be called prostate sonogram or endorectal ultrasound.


Although there are different indications for performing this type of exam, the main reason remains when prostate cancer is suspected (abnormal digital rectal exam and/or elevated PSA levels) and needs to be confirmed or inferred. A TRUS may be done to:

  • diagnose prostate cancer
  • determine prostate gland size
  • assist with guidance when prostate biopsies are performed
  • assist with diagnosis of certain male infertility etiologies
  • assist in monitoring evolution and/or treatments for prostate cancer
  • assist in certain cases of prostate infection

How is the exam performed?

The examination will be performed with you lying on your left side with knees bent towards your chest. A gown will be provided. You will be conscious and awake during the procedure.

The examination will begin with a digital rectal exam of the prostate (finger test). A thin ultrasound probe will then be inserted into the rectum through the anal orifice to visualize the prostate on a screen and perform a series of biopsies.

These are done in suspicious areas or randomized normal looking zones with a very fine needle that is projected rapidly next to the probe through the rectal wall into the prostate to obtain tissue samples. A minimum of 6 biopsies will be collected and sent off for histopathological analysis to determine if there are any cancer cells present. Biopsies are generally not very painful and well tolerated.

The entire procedure usually takes 10-15 minutes. Even though the result of the ultrasound will be given immediately at the time of the test, the pathology results of the tissue samples can take up to 2-3 weeks to obtain.

Is it painful?

The patient may feel pressure or have a sensation of fullness in the rectum when the transducer is in place. As for the biopsies, these are generally not very painful and well tolerated as the actual prostate gland is not very sensitive.

What to do before the exam?

On the day of the examination, fasting is not necessary and you may eat normally. The preparation that was prescribed by your urologist needs to be taken accordingly. It will consist of taking preventive antibiotics orally and performing a rectal enema a few hours before the procedure. All anticoagulants (blood thinners) should be discontinued prior to the test as per your urologist’s instructions (5-7 days beforehand depending on which medication is used).

What are the risks of a transrectal ultrasound?

After the procedure, it is normal to observe some bleeding in the urine and/or the stools. This bleeding is usually minimal and of short duration (a few days to a week or so). It will resolve on its own spontaneously. It is also perfectly normal to observe blood in the semen (hematospermia). It can be red, brown, or black. Contrary to the presence of blood in the urine and stool, hematospermia can last a few months with episodes of normal semen in between. It does not require treatment, will resolve on its own, and is not a contraindication for sexual intercourse. Regardless of the taken precautions, prostate infections can occur and will require appropriate antibiotic treatment. Blood thinners that were discontinued prior to the examination can be started 48hrs after.

Abnormal and heavy bleeding after the procedure (such as important and continuous blood flow or blood clots with urinary obstruction), fever/chills, or rarely difficult urination due to swelling of the prostate should prompt you to seek immediate medical attention. These situations are quite infrequent if given instructions are respected.



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