Uroflowmetry or flow rate provides us with information about how well you pass urine. It can tell us whether there is likely to be obstruction to the urinary flow by the prostate or a stricture & a bladder scan afterwards can show how well you empty your bladder. This is an essential test prior to any prostate surgery. This is a non-invasive test which simply measures your urinary flow by getting you to pass urine into a flow machine which records the speed & pattern of your flow & gives us a measurement of your peak flow rate.
Flexible cystoscopy involves passing a small camera into the urethra under local anaesthetic. This camera is then passed through the prostate into the bladder. Water is then run through the scope into the bladder. Images are displayed on a TV screen that you are able to watch if you wish. The first step is to place the local anaesthetic jelly into the urethra. This can cause a stinging sensation which quickly wears off. We can discuss the findings from the cystoscopy with you there & then. After the procedure men may see some blood in the urine for a day or two & it will sting to pass urine for the first few voids. There is a very small risk of getting a urine infection (<2%). The whole procedure is very quick & usually takes less than 5 minutes & you can return to normal activities straight away. As we fill your bladder with water during the procedure you will need to pass urine afterwards.
A biopsy is a procedure to take a sample of the prostate to provide tissue that can be examined under a microscope by a pathologist. This is the only way to diagnose cancer & to grade it's aggressiveness & predict the behaviour of a cancer. It's therefore an essential test in diagnosing prostate cancer, or ruling out cancer. Samples are taken from the prostate using a small needle to remove a "needle-core" biopsy. There are 2 approaches to placing the needles to take the biopsy - through the rectum, or through the perineum (the area between the testes & anus). Each approach has it's pro's & con's. For both approaches an ultrasound probe is placed into the rectum to allow scanning of the prostate to guide needle placement.
Transrectal Ultrasound Guided Biopsies (TRUS)
TRUS biopsies are the standard way prostate biopsies are obtained. With the patient awake & lying on his side an ultrasound probe is placed into the rectum. Local anaesthetic is injected around the prostate to numb the area. Using the ultrasound images to guide the needle placement about 12 needle samples are taken (6 from each side). Cancerous areas cannot be seen on ultrasound so the images are just used to ensure that systematic samples are taken throughout the prostate. However, using this approach it can be difficult to sample the front (anterior) part of the prostate. The procedure takes about 15mins & the patient can get up & go after a few minutes.
The main risk of this approach is of infection as needles are being placed through the rectum. Antibiotics are given before and after to reduce this risk & it is also good practice to take a rectal swab in advance of the biopsy to check there are no antibiotic resistant bacteria present which may not respond to the usual antibiotics. Patients may also see blood in the urine/semen/bowel movements.
Transperineal Template Biopsies
In this approach the biopsies are taken through the perineum, the area between the testes & anus, and the needles are placed through the skin not through the rectum. An ultrasound probe is still placed into the rectum to provide images to guide needle placement. This procedure is performed under general anaesthetic with the patient lying on his back, with his legs raised up in stirrups. This approach allows better access to the front (anterior) part of the prostate and also to the apex of the prostate. As the patient is asleep more biopsies can be taken & a grid (template) is used to guide needle placement. Typically 24-48 needle cores are taken depending on prostate size. As there are no needles placed through the rectum there is a lower risk of infection & sepsis. As more biopsies are taken there is a small risk of the prostate swelling & causing temporary difficulty in passing urine. Again, patients may see blood in the urine or semen.