Transrectal Ultrasound and Prostate Biopsy

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” • Prostate Biopsy – Abbreviation: “Bx” • Transrectal Ultrasound With Prostate Biopsy: • “TRUS/Bx” • Benign Means “Not Cancer”

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

6. PSA – The Basics • Prostate Specific Antigen = “PSA” • PSA Is A Harmless Protein • Screening Blood Test For Prostate Cancer • 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”) • Targeting Of Suspicious Areas • Guidance For Systematic Biopsies

9. TRUS – Additional Information • Prostate Size Estimate • PSA Density • The Relationship Of The PSA To Prostate Size • 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 • 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 • 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 • Even 81 Mg “Baby Aspirin” • Stop 1 Week Before • Anti-inflammatory Pain Relievers • Motrin, Advil (Ibuprofen), Aleve (Naproxen) • Relafen (Nabumetone) • Stop 1 Week Before • Plavix-discuss Specific Plan With Prescribing Physician • 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 • Please Check With Your Urologist • Tylenol (Acetaminophen) Is Ok • This Pain Reliever Does Not Cause Bleeding Problems Tylenol

14. PreparationsThe Day of 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 • Give Yourself A Fleet Enema • 2 Hours Before The TRUS/Bx • Available Over-the-counter

15. How is the TRUS/BX Done • Office Procedure • You May Drive Yourself to the Appointment • Local Anesthesia (Lidocaine) • Time From Beginning To End Is About 60 Minutes • Rectal Procedure Through The Anal Opening • 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. • Local Anesthesia (Lidocaine) Is Injected Before The Biopsies Are Done • 10-12 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 • Sense Of A “Poke” And “Pressure” Discomfort When The Local Anesthesia Is Injected. • Rubber Band-like “Snapping” Sensation 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 • 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” • 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 Rectum • Rectal Or Prostate Discomfort Or Pressure

21. What To Expect After the TRUS/Bx? • 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 • Usually Resolves Within A Few Days

22. What to Expect After the TRUS/Bx? • 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. • Red, But Clear = Ok (Like Diluted Red Punch) • This Is Expected • Drink More Water • 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 • 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 • 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. • Special Staining And Second Reviews May Take Longer. • Your Results Will Be Given To You By Phone • If You Have Not Heard From Our Office Within 10-14 Days, Please Call

27. Consent Form • Please Thoroughly Read The Consent Form • It Explains In More Detail The Ultrasound Procedure • 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

28. Billing • Your Insurance Will Be Billed For: • The Procedure by Hartford Clinical Associates • A LaboratoryWill 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 • Hartford Clinical Associates for the Procedure • A Pathologist Group for the Pathological Analysis • Another Laboratory for the Technical Preparation of Slides