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Transrectal Ultrasound and Prostate Biopsy PATIENT INSTRUCTIONS and CONSENT FORM.

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Presentation on theme: "Transrectal Ultrasound and Prostate Biopsy PATIENT INSTRUCTIONS and CONSENT FORM."— Presentation transcript:

1 Transrectal Ultrasound and Prostate Biopsy PATIENT INSTRUCTIONS and CONSENT FORM

2 Appointment You Have Been Scheduled For A Transrectal Ultrasound And Possible Biopsy On __________________________at _________________________a.m/p.m. In our office located at [ ] Avon, 120 Simsbury Road [ ] Farmington: 399 Farmington Ave. [ ] Glastonbury: 330 Western Blvd. [ ] Hartford: 85 Seymour Street, Suite 416 [ ] Meriden: 455 Lewis Street

3 Let’s Get You Ready

4 First: The Terminology Transrectal Ultrasound – Abbreviation: “TRUS” Transrectal Ultrasound – Abbreviation: “TRUS” Prostate Biopsy – Abbreviation: “Bx” Prostate Biopsy – Abbreviation: “Bx” Transrectal Ultrasound With Prostate Biopsy: Transrectal Ultrasound With Prostate Biopsy: –“TRUS/Bx” Benign Means “Not Cancer” Benign Means “Not Cancer”

5 The Goal of Prostate Biopsies To Determine If Prostate Cancer Is Present To Determine If Prostate Cancer Is Present Why? Why? –Because PSA Lab Tests Are Elevated –Because The Digital Prostate Exam Is Abnormal

6 PSA – The Basics Prostate Specific Antigen = “PSA” Prostate Specific Antigen = “PSA” PSA Is A Harmless Protein PSA Is A Harmless Protein Screening Blood Test For Prostate Cancer Screening Blood Test For Prostate Cancer Many Causes Of Elevated PSA Many Causes Of Elevated PSA –Prostate Cancer –Enlarged Prostate (BPH or Benign Prostate Hyperplasia) –Prostate Or Urinary Infection –Prostate Irritation Or Trauma –Genetics –Transient Variations –Unknown Reasons - Common

7 Digital Rectal Exam of the Prostate Prostate Physician Palpates the Prostate to Feel for Size, Presence of Nodules and Other Abnormalities

8 Purpose of The Transrectal Ultrasound: (“TRUS”) Assist In Obtaining Prostate Biopsies (“Bx”) Assist In Obtaining Prostate Biopsies (“Bx”) –Targeting Of Suspicious Areas –Guidance For Systematic Biopsies

9 TRUS – Additional Information Prostate Size Estimate Prostate Size Estimate –PSA Density  The Relationship Of The PSA To Prostate Size Identify Benign Causes Of Abnormal Digital Rectal Exam Identify Benign Causes Of Abnormal Digital Rectal Exam –Calcium Deposits –Cysts –Shape Irregularities

10 TRUS/BX – Cancer Information If Cancer Is Detected On The Prostate Biopsies If Cancer Is Detected On The Prostate Biopsies –Determine The Gleason Grade Of The Cancer (Natural Aggressiveness) –Estimate The Extent Of Cancer –Cancer Location Information –Determine The PSA Density  Relationship Of PSA Value To Prostate Size

11 Preparation for TRUS/Bx Stop All Blood Thinner Medications Seven Days Before The Biopsy Stop All Blood Thinner Medications Seven Days Before The Biopsy –They May Cause Excessive Or Prolonged Bleeding From The Biopsy Site –Let Your Urologist Know The Medications You Take  Prescribed  Over-the-counter  Vitamin E  Glucosamine –Let Your Urologist Know  If You Have Heart Valve  If You Have An Artificial Joint  If You Are Allergic To Local Anesthesia –Novocaine –Xylocaine –Dental Anesthesia

12 STOP Blood Thinning Medications Aspirin Aspirin –Even 81 Mg “Baby Aspirin” –Stop 1 Week Before Anti-inflammatory Pain Relievers Anti-inflammatory Pain Relievers –Motrin, Advil (Ibuprofen), Aleve (Naproxen) –Relafen (Nabumetone) –Stop 1 Week Before Plavix-discuss Specific Plan With Prescribing Physician Plavix-discuss Specific Plan With Prescribing Physician Coumadin (Warfarin), Lovenox, Ticlid Coumadin (Warfarin), Lovenox, Ticlid –Stop At Least 7 Days Before –Discuss Specific Plan With Prescribing Physician

13 What is OK to Continue? Your Usual Medications That Are Not Blood Thinners Your Usual Medications That Are Not Blood Thinners –Please Check With Your Urologist Tylenol (Acetaminophen) Is Ok Tylenol (Acetaminophen) Is Ok –This Pain Reliever Does Not Cause Bleeding Problems Tylenol

14 Preparations The Day of the TRUS / Bx Do Not Eat Or Drink 4 Hours Before The TRUS/Bx Do Not Eat Or Drink 4 Hours Before The TRUS/Bx Take Your Antibiotic as Directed (1 hour) before the TRUS/Bx Take Your Antibiotic as Directed (1 hour) before the TRUS/Bx Give Yourself A Fleet Enema Give Yourself A Fleet Enema –2 Hours Before The TRUS/Bx –Available Over-the-counter

15 How is the TRUS/BX Done Office Procedure Office Procedure –You May Drive Yourself to the Appointment Local Anesthesia (Lidocaine) Local Anesthesia (Lidocaine) Time From Beginning To End Is About 60 Minutes Time From Beginning To End Is About 60 Minutes Rectal Procedure Through The Anal Opening Rectal Procedure Through The Anal Opening Done Using A Finger Shaped Ultrasound Probe Done Using A Finger Shaped Ultrasound Probe

16 Transrectal Ultrasound

17 Prostate Biopsies Prostate Biopsies Are Done With A Biopsy Needle Device Passed Through A Special Port In The Ultrasound Probe. Prostate Biopsies Are Done With A Biopsy Needle Device Passed Through A Special Port In The Ultrasound Probe. Local Anesthesia (Lidocaine) Is Injected Before The Biopsies Are Done Local Anesthesia (Lidocaine) Is Injected Before The Biopsies Are Done Biopsies Are Done In Most Instances Biopsies Are Done In Most Instances –Each Biopsy Looks Like A ½ Inch Thread –6 Prostate Zones Are Usually Biopsied

18 What to Expect During the TRUS/BX? Mild Anal And Rectal Discomfort During The Ultrasound Mild Anal And Rectal Discomfort During The Ultrasound Sense Of A “Poke” And “Pressure” Discomfort When The Local Anesthesia Is Injected. Sense Of A “Poke” And “Pressure” Discomfort When The Local Anesthesia Is Injected. Rubber Band-like “Snapping” Sensation During The Biopsies Rubber Band-like “Snapping” Sensation During The Biopsies Strong Sense Of Urgency To Void During The Biopsies Strong Sense Of Urgency To Void During The Biopsies

19 How Painful Will The Procedure Be? The Pain Men Experience Varies Widely The Pain Men Experience Varies Widely –Some Men Say The Procedure Was Nearly Painless –Most Men Say The Procedure Was Mild To Moderately Painful –Some Men Say The Procedure Was Really Painful  Anxiety Heightens The Pain Response

20 What to Expect Immediately After the TRUS/Bx? Occasionally Patients Feel “Sweaty” And “Faint” Occasionally Patients Feel “Sweaty” And “Faint” –Irritation Of The Rectum Can Lead To A “Vagal” Response That Can Lead To Fainting –Patients Are Asked To Lay Flat Several Minutes Until This Reaction Goes Away Blood In The Urine Blood In The Urine Blood In The Rectum Blood In The Rectum Rectal Or Prostate Discomfort Or Pressure Rectal Or Prostate Discomfort Or Pressure

21 What To Expect After the TRUS/Bx? Blood In The Urine Blood In The Urine –Typically Resolves Within A Few Days, But May Last A Few Weeks –Blood Clots Can Block Urination Causing Inability To Urinate –Drink Lots Of Water To Prevent Blood Clots From Forming –Avoid Aspirin And Other Medicines That Cause Bleeding Until Bleeding Has Resolved For A Few Days. –Avoid Sexual Activity Or Strenuous Work If Blood In The Urine Significant (Dark, Thick, Red Urine – Like Tomato Soup) Blood From The Rectum Blood From The Rectum –Usually Resolves Within A Few Days

22 What to Expect After the TRUS/Bx? Blood In Semen Blood In Semen –Harmless –The Amount Of Blood Can Be Impressive  Some Patients Choose To Use A Condom During Sexual Activity –Typically, Lasts A Few Weeks To A Couple Of Months –There Is No Treatment To Make This Go Away Sooner –Rectal Or Prostate Discomfort Or Pressure  Tylenol Is Very Helpful  Usually No Need for Stronger Medication

23 Blood In Urine – What to Look For Look At Your Urine In A Clear Glass If You Are Worried About The Amount Of Blood You See. Look At Your Urine In A Clear Glass If You Are Worried About The Amount Of Blood You See. Red, But Clear = Ok (Like Diluted Red Punch) Red, But Clear = Ok (Like Diluted Red Punch) –This Is Expected –Drink More Water Thick And Dark Red = Too Bloody Thick And Dark Red = Too Bloody –Rest And Drink More Water

24 What to Call Us About

25 Please Call Fever Higher than 100 Degrees Fever Higher than 100 Degrees –About 1% Of Men Develop Infection Of The Prostate And Urinary Tract Even With Precautionary Antibiotics. Dark Thick Red Urine That Does Not Clear With Increased Fluid Intake And Rest Dark Thick Red Urine That Does Not Clear With Increased Fluid Intake And Rest Significant Difficulty Or Inability To Void Significant Difficulty Or Inability To Void –Sometimes A Blood Clot Blocks The Urinary Canal –Men With Very Large Prostates Are Particularly Vulnerable To Urinary Retention

26 Prostate Tissue Pathology Results Typically Results Are Back Within 10 Working Days. Typically Results Are Back Within 10 Working Days. –Special Staining And Second Reviews May Take Longer. Your Results Will Be Given To You By Phone Your Results Will Be Given To You By Phone If You Have Not Heard From Our Office Within Days, Please Call If You Have Not Heard From Our Office Within Days, Please Call

27 Consent Form Please Thoroughly Read The Consent Form Please Thoroughly Read The Consent Form It Explains In More Detail The Ultrasound Procedure It Explains In More Detail The Ultrasound Procedure Ask Yourself: Ask Yourself: –Are You Comfortable With Knowing About The Procedure? –Have All Your Questions Been Answered? When Complete, Please Sign The Consent Form Indicating You Have Read And Understand The Procedure. Bring It With You To Your Appointment When Complete, Please Sign The Consent Form Indicating You Have Read And Understand The Procedure. Bring It With You To Your Appointment

28 Billing Your Insurance Will Be Billed For: Your Insurance Will Be Billed For: –The Procedure by Hartford Clinical Associates –A Laboratory Will Bill For The Pathological Analysis.  A Reference Laboratory May Bill For The Technical Preparation Of The Slides For The Pathologist. Number of Bills You May Receive Number of Bills You May Receive  Hartford Clinical Associates for the Procedure  A Pathologist Group for the Pathological Analysis  Another Laboratory for the Technical Preparation of Slides


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