Procedures
Prostate Biopsy
Transrectal ultrasound of the prostate is performed most commonly to help direct prostate needle biopsies. The prostate must be biopsied to diagnose prostate cancer. Transrectal prostate ultrasound is a relatively painless procedure. A narrow ultrasound probe is carefully inserted into the rectum. The prostate can then be indirectly observed on the ultrasound screen. An accurate size determination of the prostate can be made and sometimes abnormal areas within the prostate can be identified. However, the main role of prostate ultrasound is to direct the needle placement for biopsy. Before taking a biopsy, a small amount of a local anesthetic is injected into the peri-prostatic tissues. Then a biopsy needle is used to take tiny slivers of tissue from the prostate. With each biopsy you will hear a spring sound and feel some light pressure on the prostate. We generally take about a dozen separate biopsies from various areas of the prostate so that we have a good sampling of the entire gland. The entire procedure takes about five minutes. After the procedure you will experience some bleeding from the rectum and in your urine. We ask that you refrain from ASA at least one week prior to the procedure and any other anti-coagulents will also need to be temporarily held (the physician will discuss this with you). We will ask that you drink plenty of water for the 48 hours after the procedure, refrain from sexual activity for 1-2 weeks and take antibiotics for five days. If you experience any problems such as fever > 101.5, inability to urinate or excessive bleeding, you should go immediately to the emergency room and have the ER doctors notify me.
The biopsy tissue is sent to a laboratory and an expert pathologist will carefully examine the tissue for evidence of cancer. The biopsy report will generally take 3-7 days to be completed. Sometimes it is necessary for the pathologist to special imunohistochemical staining to confirm the diagnosis of prostate cancer.
Common indications for prostate biopsy include an abnormal elevated PSA, a rapidly rising but normal PSA, or a digital rectal examination suspicious for prostate cancer.
Cystoscopy
Cystoscopy is a simple five minute procedure which is frequently perfomed in the office. It allows the doctor to visually inspect the urethra, prostate (in men) and the bladder. It is generally not painful. We perform cystoscopy with a tiny fiber optic scope which when placed into the urethra, is similar to having a catheter placed. Some indications for cystoscopy include blood in the urine, stones or voiding problems.
Urine Flow Test
Uroflowmetry is a very simple non-invasive test which can be helpful in providing objective evidence of urinary outflow obstruction, most commonly secondary to prostate problems. You will be asked to simply urinate into a funnel attached to an electronic measuring device. The device is attached to a computer and will record a graphic chart of your voiding pattern. It is very important that your bladder is adequately full before the test.