Getting a prostate biopsy is one thing that you shouldn’t do if you want to maintain your prostate health. It’s the next thing that a doctor orders if you flunk the PSA test and the digital rectal exam.
Sure, it confirms prostate cancer, but it’s a risky test that comes with a lot of potential problems. Here we’ll tell you everything you need to know about prostate biopsy and why getting it is the wrong thing to do.
Overview: What Is A Prostate Biopsy?
A prostate biopsy is a procedure used to detect prostate cancer. Small samples of the prostate are removed and then observed under the microscope.
A urologist or surgeon usually performs this procedure, and looks at the prostate cell samples to see if they are cancerous. Cancer cells are often irregular in size and shape, and exhibit aggressive growth.
Doctors usually recommend a biopsy of your prostate gland based on certain findings. One is when your prostate-specific antigen (PSA) blood test results are higher than normal for your age. Another is when your doctor detects some signs of a prostate problem during your digital rectal exam (DRE).
Although the PSA and DRE indicate a possible problem with your prostate, a biopsy is needed to confirm if it’s cancer.
A prostate biopsy involves collecting minute samples of the prostate gland. The doctor passes a needle through the rectal wall or makes a small cut in the area between the anus and rectum to obtain the samples. A CT or MRI scan is also used to guide them through the procedure.
Prostate biopsy takes about 10 minutes and is usually done in the doctor’s office. The samples will be sent to a lab, and will be looked at under a microscope to see if they contain cancer cells.
If cancer is detected, it will also be assigned a grade. The results are available after 1 to 3 days, but it can sometimes take longer.
2 Main Types of Biopsies
There are 2 main types of biopsies a doctor will recommend: a transrectal ultrasound (TRUS) guided biopsy and a transperineal biopsy. Let’s talk about these types in detail.
TRUS Guided Biopsy
The TRUS Guided Biopsy is the more common type of prostate biopsy. A thin needle is passed through the rectal wall to take tissue samples of the prostate.
If you’re getting a TRUS guided biopsy, you’ll be asked to lie on your side on a table, with your knees brought up towards your chest. The doctor will use a probe that is about the width of a finger, and is lubricated before it is placed in your rectum. The probe produces sound waves that enter the prostate.
Echoes are then created, and the probe picks them up. A computer turns these echoes into an image of the prostate. The doctor will then use the image as a guide to select the location to get tissue samples.
After this, the doctor will inject a local anesthetic to numb the area around your prostate. This will also reduce any discomfort. The doctor will then insert the needle next to the probe, through the rectal wall and into your prostate. About 10 to 12 tissue samples will be taken from different areas.
This type of biopsy usually takes about 10 to 15 minutes. After the procedure, the doctor may ask you to wait until you’ve urinated before you go home. As for the results, it normally takes up to 2 weeks.
If cancer is detected, it is graded according to the Gleason system. Grades are based on how much the cancer looks like normal prostate cells:
- Grade 1: If the cells look a lot like normal prostate cells.
- Grade 5: If the cells look abnormal.
- Grades 2-4: If the cells have features in between normal and abnormal (precancerous). Our recommendation is to make changes to diet and lifestyle and take appropriate supplements.
- Grade 6-9: Cancerous; the higher the number, the more virulent cancer.
- normally, Gleason 6 or 7 will not require any immediate attention. However, doctors will often prescribe watchful waiting. Our recommendation is to make urgent changes to diet and lifestyle and take appropriate supplements while monitoring the progress of the cancer.
- normally, Gleason 8 or 9 will normally mean a doctor will recommend early invasive intervention. Our recommendation (if you can afford it) is to have less invasive and more natural procedures at an integrative cancer clinic. But most medical insurance will not cover procedures at an integrative cancer clinic so it needs to be paid privately.
Prostate cancers often have areas with different grades. Because of this, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are then added to obtain the Gleason score.
Unlike the TRUS Guided Biopsy, this is where the doctor inserts the needle into the prostate through the skin between the testicles and the anus. This area is called the perineum. The needle is inserted through a template or grid.
It takes more tissue samples from more areas of the prostate with this method. The number of samples may vary, but it is around 30 to 50. One advantage of this method is that there is a greater chance of finding prostate cancer cells.
The doctor will recommend this procedure if you have problems that make a TRUS guided biopsy risky. This method may also be done as a follow-up procedure if no cancer was found with a TRUS biopsy. Cancer may still be present, and the doctor sometimes uses this method to double-check.
This type of biopsy is often done under general anesthesia, so you’ll be asleep and won’t feel any discomfort. A spinal anesthetic may also be given so that you won’t feel anything in your lower body.
The doctor will then put an ultrasound probe into your anus. Like the probe used in TRUS biopsy, it will produce an image of the prostate, and this will guide the doctor in taking the samples.
A grid will be placed over the perineum, and the doctor will insert the needle through the holes in the grid and into the prostate.
This procedure takes a longer time, about 20 to 40 minutes. Because of the effects of anesthesia, you need to wait a few hours before going home.
It also advised that someone takes you home to ensure your safety. Your doctor will also recommend that you only engage in light physical activities for at least 48 hours.
Results are obtained in a few weeks. Like a TRUS biopsy, cancers are graded according to the Gleason system.
Are Prostate Biopsies Accurate?
A prostate biopsy produces accurate results when samples are taken from the right locations of your prostate.
But even if you take many samples, biopsies can still sometimes miss a cancer. This occurs if none of the biopsy needles pass through the rights areas. Thus, the biopsy will have a false-negative result.
This is one major disadvantage. One study has found that the detection rate with a 12-core biopsy in prostate cancer patients is very low. The research team collected and compared pre-op and post-op biopsy results of 90 prostate cancer patients. And they also analyzed the influence of age, prostate weight, PSA levels and each patient’s Gleason score.
The study reveals that the biopsies detected only 67.8% of prostate cancers. This is despite the overwhelming evidence of prostate cancer that was obtained from the patients’ other assessment data. The research team concluded that the accuracy of the procedure might be influenced by other patient characteristics.
Even so, a repeat biopsy is often recommended if the doctor strongly suspects the presence of prostate cancer. Such assumptions are valid if signs and symptoms are found, like high PSA levels or an enlarged prostate.
However, prostate biopsy does have certain risks, and you need to make sure that the benefits outweigh them before deciding to go for it.
How Safe Are Prostate Biopsies?
Although one of the most common procedures for detecting prostate cancer, biopsies carry many potential risks and side effects:
Just like any invasive procedure, bleeding will occur. Although it’s normal to see a small amount of blood in your semen or urine for about 2 weeks, it becomes a major problem if bleeding takes a longer time or if it gets worse.
If you experience severe bleeding or are passing a lot of blood clots, then you need to contact your doctor right away.
You’ll expect some pain or discomfort in your back passage for a few days or weeks after the procedure. This is because of the injury caused by the needle on your prostate cells. While some may find it very painful, some people only report a slight discomfort.
Regardless, pain is a very important symptom to monitor. Worsening and persistent pain may indicate a bigger problem. If this is the case, you need to see your doctor for a follow-up.
Surgeons will normally prescribe strong antibiotics before the procedure to reduce the risk of infection.
However, infection almost always occurs and sometimes can be very severe. In some cases, the result of the infection is that there is long-term sexual dysfunction. Occasionally, the infections can turn into life-threatening sepsis.
4) Acute Urine Retention
About 1 in 50 men who have undergone prostate biopsy experience acute urine retention. The procedure does injure the prostate gland, causing it to swell. And this makes it hard for you to pass urine.
Acute urine retention is a medical emergency, and you need to seek help at once. The doctor often inserts a catheter to drain the retained urine, and it will take a few days for you to recover.
5) Sexual Problems
Some men who have undergone prostate biopsy find it hard to get and keep and erection. This happens rarely and should improve over time. If it persists, you should consult your doctor so that the problem can be assessed further.
Do Biopsies Risk Spreading Cancer Cells?
In February 2008, there was widespread fear over a press release that prostate biopsy spreads cancer cells. The term “track seeding” was coined.
Studies reveal that new tumors are formed in “tracks” or the path within the prostate gland where biopsy needles are inserted. Some experts believe that the new tumors are implanted when tumors extracted by biopsy needles are “seeded” along the path of insertion.
A 2014 study provides evidence for this. The research team reviewed related papers about the incidence of seeding and clinical findings. They also looked at some risk factors like the type of needle used, TRUS guided biopsy vs transperineal biopsy, and the cancer’s grade and stage.
The study reveals that 26 published papers reported 42 cases of track seeding.
Safety Of Biopsy Under Scrutiny
Though critics acknowledge the results as valid, they think that the fear caused by the news is overblown. They emphasize that cases of track seeding are very rare. And that there’s almost no evidence to suggest that the spread of cancer cells through biopsy led to a “true spread” of prostate cancer.
Yet the findings are enough to compel us to think twice about the safety of the procedure. Over the past 20 years, there has been a massive increase in the number of prostate biopsies done each year. In 2013, about 2 million prostate biopsies were carried out in the US. Think about these numbers.
There is no doubt that biopsies risk spreading cancer cells. Though it is the standard way to detect prostate cancer, it might do more harm than good to you.
That is why it’s very important for you to talk to your doctor about the pros and cons of the procedure, and if it’s truly necessary for your case.
Indeed, there are cases in which prostate cancer is slow-growing and non-aggressive, and it wouldn’t make a difference if a prostate biopsy will confirm it or not.
MRI vs. Biopsy
A recent study suggests that MRI is twice as likely to spot prostate cancer. A group of researchers at the University College London led the Prostate MRI Imaging Study (Promis), and showed that MRI can pick up 93% of aggressive prostate cancer cells.
Unlike prostate biopsy that tends to miss cancer, MRI scans can easily detect it in a non-invasive way. The research team was also able to use MRI to see if the tumor is aggressive or slow-growing.
And because it has become much easier to identify tumors that are not life-threatening, it’s much easier to determine if treatment is needed or not. The study was also able to reduce cases of overtreatment by 5%.
Lead author Hashim Ahmed says that unlike MRI, a prostate biopsy does miss cancer because tissue samples are taken at random. Though it can detect its presence, it cannot confirm if the cancer is aggressive or not.
The findings are a breakthrough and could bring about change of practice in prostate cancer detection and treatment. Prostate Cancer UK helped fund the research, and is now working on bringing MRI scans into prostate cancer treatment facilities.
It’s only a matter of time before the practice of using MRI to detect prostate cancer becomes universal.
Alternatives To Prostate Biopsies
Doctors have long relied on biopsies to determine prostate cancer. And biopsies are proven to be dangerous. Often, a prostate biopsy finds traces of low-grade cancer that don’t need to be treated.
But in recent years, doctors have found out that new imaging studies like high-resolution MRI and ultrasound can be alternatives to prostate biopsy.
They have proven to be very accurate and safe. A multi-parametric MRI or a color Doppler ultrasound has a 95 to 98% chance of determining the location and grade of prostate cancer cells.
According to the Diagnostic Center for Disease, an MRI scan predicts and confirms the presence of prostate cancer more frequently than a biopsy. A hi-res MRI features the most sensitive and specific imaging modality that allows it to produce a very clear picture of the entire prostate and pelvic region.
Experts claim that this is a quantum leap from the blind biopsy approach. It will minimize the need for biopsies, and could potentially save millions of dollars for the healthcare industry.
The PCA3 test is another alternative. PCA3 stands for “Prostate Cancer gene 3”, a protein that is produced by prostate cancer cells at much higher levels. PCA3 leaks into the urine when the prostate gland is stimulated.
Unlike the PSA test, a high PCA3 test can only result from cancer – not from an enlarged prostate, inflamed prostate or other non-cancerous prostate problem.
For this test, you need to undergo a DRE. This will stimulate PCA3 to leak into the urine. A urine sample is then collected and sent to the lab. It takes about 1-2 weeks to get the results. The higher the PCA3 score, the more likely you have prostate cancer.
This test is also used to determine the effectiveness of cancer treatment. The higher the score, the more aggressive is the prostate cancer.
Should I Get a Prostate Biopsy?
You don’t need to undergo a prostate biopsy.
Prostate cancers are often slow-growing and non-aggressive. It wouldn’t matter if a non-aggressive cancer is detected or not, and it doesn’t need any treatment.
And even if you have an aggressive prostate cancer, there are alternatives to a prostate biopsy, like MRI and the PCA3 test. These methods are non-invasive and accurate. Plus, they don’t have the negative side effects that result from a prostate biopsy.
I wish you good health,
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