Attending for your Prostate Scan Patient Information The aim of this booklet is to give you enough information: To help you prepare for your hospital visit To give properly informed consent for the procedure To help you prepare for your procedure To guide you through the procedure To advise you following the procedure Please note that you may be at the clinic for 2 3 hours. Department of Urology Please check which hospital you are being asked to attend. If you wish to change your appointment or cannot attend the appointment, you must notify us as early as possible so the appointment can be given to someone else. If you need patient transport, please telephone 0300 123 1236 to arrange this. Your urology care team will aim to treat you with the privacy and dignity you deserve, taking into account your physical, communication and cultural needs. During your visit You will be welcomed by a member of the urology team. We would ask that you come to the clinic with a comfortably full bladder, as we would like to perform a flow test and a bladder scan to check how well your bladder empties. We will also require to perform a simple urine test. During your visit we will also ask you to complete two health questionnaires (which will take no longer than five minutes to complete). The nurse or doctor may also ask to repeat your digital rectal examination and they will gather some more clinical information through discussion with you, to inform whether or not a TRUS prostate biopsy is required. What is your prostate gland? The prostate gland is only present in men and is about the size of a walnut. Your gland lies at the base of your bladder and surrounds the urethra (the tube that carries urine and semen out of your body). Its main function is to produce a thick liquid and nutrients, which is mixed with your sperm to become semen. Page 1 of 8
Why do I need a transrectal prostate ultrasound scan? You have been referred to the prostate clinic by your GP or healthcare professional (urologist/specialist nurse) for a prostate assessment because: Your healthcare professional found a lump or abnormality of the prostate during a digital rectal examination (DRE); and/or You have had a blood test showing a high level of PSA (prostate-specific antigen): PSA is a protein that is released into your blood from your prostate gland. High levels of PSA on more than one occasion or an irregular feeling prostate may indicate cancer. However, there may be another reason for this. The aim of this appointment is determine whether you require further investigation to establish the cause of this. What is a TRUS and biopsy? A prostate ultrasound scan allows the healthcare professional to gain more information about your prostate gland. The ultrasound probe is approximately the size of a man s thumb and is covered in a sterile sheath for cleanliness. This is then inserted into your back passage to allow images of your prostate to be displayed and viewed on a screen, which can help the professional obtain its size and volume. A biopsy is a small sample of tissue taken from the prostate with a very fine needle which will be passed through the ultrasound probe. This tissue will be sent to be examined under a microscope by a pathologist. The biopsy can find out whether any of your prostate cells have become cancerous. It can also diagnose other conditions such as: benign prostatic hyperplasia enlargement of the prostate prostatitis inflammation of the prostate usually caused by a bacterial infection What happens if biopsies are to be taken from my prostate? The healthcare professional will explain the procedure to you and you will be required to take an antibiotic one hour prior to the biopsy. The antibiotic is Ciprofloxacin x 2 (500mg) tablets. Page 2 of 8
If you receive a prescription in the post with your appointment letter, take this prescription to your local pharmacy. Once you have obtained the antibiotics it is important to take both tablets1 2 hours before the procedure/ appointment time We will ask you for a specimen of urine to ensure there is no sign of infection, as this is a risk for the biopsy. If there are signs of infection then we will postpone your biopsy until this has cleared. During the biopsy You will be taken to the procedure room where you will meet the staff involved in the procedure. NHS Tayside is a teaching hospital and as such nursing and medical students may be present. If you would prefer not to have students present then please advise the nursing staff. The procedure itself will take around 10 15 minutes. You will be asked to lie on your left side on the couch. The healthcare professional performing the procedure will assess your prostate with a gloved finger, and then gently insert the ultrasound probe. Local anaesthetic is used to make the procedure more comfortable and most men only feel mild discomfort and/or a feeling of pressure on the bladder. Small biopsy samples (usually twelve) are then taken from the prostate using a biopsy needle, which makes a loud click each time a sample is taken. You will be informed of the number of biopsies to be taken at time of consent. The samples of tissue from your prostate will be sent to the hospital laboratory to be examined under the microscope. What are the risks? Like most procedures there are potential risks associated with prostate biopsies. These include: Infection this can be in the urine, requiring antibiotics (1 in 10 patients); or may be more severe leading to septicaemia (blood infection) requiring emergency admission for treatment (1 in 50 patients). Taking antibiotics before the procedure usually prevents an infection from developing. Blood in the urine can be seen for up to 3 4 weeks (almost all patients). Blood in the stools can occur for up to 3 4 weeks (almost all patients). Blood in the semen can be seen in the ejaculate for up to 6 weeks (almost all patients). Discomfort in the prostate from bruising (1 in 10 patients) this can cause temporary problems with erections (1 in 20 patients). Bleeding which makes it difficult to pass urine and may cause clot retention (inability to pass urine) (1 in 50 patients). Page 3 of 8
Failure to detect a significant cancer in your prostate (1 in 50 patients). Bleeding in your urine or bowel requiring emergency admission for treatment (1 in 100 patients) Need for repeat procedure if biopsies are inconclusive or your PSA levels rises further; or MRI scan detects abnormalities (1 in 250 patients). An allergic reaction to the medicines (1 in 1000 patients). Your healthcare profession will discuss these further with you should you require. Are there any alternatives? Currently, prostate biopsy is the more definitive way of diagnosing any abnormality present in your prostate gland. Observation with repeat PSA may be necessary repeating your blood tests and only investigating further if the tumour marker levels rise. If you do not wish to proceed with prostate biopsies, the team will have a discussion with you regarding your options. What preparation will I need? You can have your breakfast as normal Please check that you have no allergies to Ciprofloxacin or local anaesthetic Remember to take your normal medication However, if you take blood thinning medication such as Warfarin, Clopidrogel or Rivaroxaban/Apixaban, these require to be stopped.. Advice on medications that thin the blood To reduce the risk of bleeding, if you take any of the following: Regular Aspirin 150mg or above daily Please discontinue 5 days before the procedure. Restart the day after the biopsies. Clopidogrel Please discontinue 10 days before the procedure, if it is safe to do so. Restart the day after the biopsies. Warfarin Should be stopped 5 days prior to the procedure if it is safe to do so. Your blood is tested before the procedure to ensure that it is not too thin please attend your GP practice the day before to have your INR checked. Bring along your record book if you have one. Rivaroxaban/Apixaban Please stop 2 days prior to the procedure if it is safe to do so. Restart the day after the biopsy. Other medication If you are on any other medication to thin the blood please let your doctor or specialist nurse know. Should you have any concerns please contact ourselves or you GP regarding this. Page 4 of 8
What happens after the procedure? Following the biopsies, you will be given a drink and will be expected to remain in the clinic until you pass urine. You will be asked to avoid strenuous activities for about 24 hours. You may experience some mild discomfort in the rectal area for 1 2 days. If you are concerned about pain which you are experiencing then we would advise you to see your GP or contact NHS 24. You should drink plenty of non-alcoholic fluids whilst there is blood in the urine. You should try to avoid constipation. Contact your local GP or NHS 24 (111) if: your pain increases you have a fever higher than 100.4 F (37.5 C) you are unable to urinate within 8 hours you start to pass large clots of blood you have persistent and heavy bleeding you have any flu-like symptoms, cold and shivery, feeling generally unwell Will I have a follow-up appointment? Your biopsy results will be discussed at our multi-disciplinary meeting as soon as they are available (approximately 2 weeks after the procedure). You will receive an appointment with our specialist nurse 2 3 weeks following biopsy where you will receive the results of your biopsies and any further plans of care if needed. Key points to remember The procedure will be carried out under local anaesthetic in the outpatient department and takes about 10 minutes to complete. However, you may be in the clinic for 2 3 hours. Tell the healthcare professional if you are allergic to any medicines or take any antiplatelet medicines; or medicines to thin your blood. You will need to take antibiotics 1 2 hours before your biopsies. Take these at home. Expect some blood in your urine and from the back passage for up to two weeks, and in the semen for up to six weeks. You will need to drink plenty of non-alcoholic fluids to help clear this up. If you feel unwell, high temperature, cold/hot shivers, difficulty passing urine within 2 3 days you must contact your GP or NHS 24 (telephone 111) as this may require urgent attention and treatment with antibiotics. Page 5 of 8
Developed by Urology Nurse Specialists and has been reviewed by other staff and patients. Revised: 09/2017 Review: 09/2019 LN0378 Page 6 of 8
Patient demographic label Barcode NHS Tayside Consent Form Name of procedure(s): Trans-rectal ultrasound (TRUS) and prostate biopsies Inspection of the prostate via the rectum with an ultrasound probe (with or without biopsy and photography/video). Biopsy specimens will be retained. Statement of patient You have the right to change your mind at any time, including after you have signed this form. I have read and understood the information in the attached booklet including the benefits and any risks. I agree to the procedure described in this booklet and on the form. I understand: That any procedure in addition to those described above will only be carried out if it is necessary to save my life or to prevent serious harm to my health. That you cannot give me a guarantee that a particular person will perform the procedure. The person will however, have appropriate experience. Information, including digital information (video and/or photographic material) may be stored as part of the patients medical records and may be stored on computer databases. The University of Dundee is very active in medical research: donations of excess body tissues and agreement to the use of images are a valuable resource for researchers and clinical scientists. Please tick () the appropriate box if you agree to: Excess body tissue not required for diagnosis or future treatment being used for medical research Digital images (for example such as described above) being used for research, education and teaching in presentations (for example conferences or websites) and in publications. Whenever relevant, such images will be anonymised to protect patient privacy. (If consent is withdrawn at a later date, it may not be possible to withdraw images that are already in the public domain.) Page 7 of 8
Patient Signature:.. Date: Name (print in capitals): If you would like to ask further questions please do not sign the form now. Bring it with you and you can sign it after you have talked to the healthcare professional. Please remember to bring this booklet and form with you when attending for your appointment. Confirmation of consent (To be completed by a health professional when the patient is admitted for the procedure). I have confirmed that the patient/parent understands what the procedure involves including the benefits and any risks. I have confirmed that the patient/parent has no further questions and wishes the procedure to go ahead. Signed:.. Date: Name (print in capitals):. Job title: Additional discussions with patient Urologist signature:... Date: Page 8 of 8