Non Invasive Prostate Biopsy

Mike,

The word biopsy implies a tissue sample, so a non-invasive biopsy is kind of an oxymoron.

Yes color doppler can give you a location, the other testing can tell you different aspects of your prostate health, but until the pathologist can get a slide of your prostate under his microscope, he cannot tell if it is adenocarcinoma, and cannot assign a Gleason grade if it is PC.

The needle biopsy is probably as close to non-invasive as we are going to have in my opinion, compared to some biopsy techniques that actually take a slice of the tissue. (for other cancers) A needle isn't the worst thing to have happen.
And, it is realtively painless, and fairly effective.

But, what do I know. Who would have thought we would have a robot operated from a console digging around taking out my prostate a few years ago ? Maybe the little nanobot will be swallowed someday, and come back with a tissue sample, or better yet, send back the results.

Thanks for the reply. What I'm starting to find is this:


Normally, the next "step" after a high PSA score (4+) is to schedule a biopsy. What I'm learning is that there are several things that can be done BETWEEN these two steps (PSA>Biopsy).

In addition, care is needed to ensure that the PSA score accurately reflects levels.

http://www.prostate-cancer.org/education/preclin/PCRIViewOnTesting.html

Explains a bit on the different steps that should/can/may be taken between PSA and Biopsy.

Is there a better source that sort of outlines steps that can be taken after a high PSA score, and also things to look for/do to insure the PSA score is accurate?


Thanks,
Mike

Mike,
"Invasion of the Prostate Snatchers" by Dr Mark Scholz has an entire chapter on when to get a biopsy and different tests one can take in order to make the decision.
JohnT

A company called Health Discovery has invented a new urine test called the Four Gene Signature Urine Test. They have licensed the test to Abbott Labs and Quest Labs. In a few months, test kits should be in doctors hands. This test can tell with 90% accuracy whether or not a man has PC and a great many unnecessary biopsies can be avoided..This new test has the potential to revolutionize the early detection of PC by removing the uncertainty that comes with PSA testing alone..

Wow! TONS of great information to research!! Thank you very very much... and keep it coming.

I'm getting a plan of action together to deal with this effectively.

I have previously posted comments about the fact that PCa biopsy sampling still seems to be in the stone-age.
PCa biopsies seem so vague and random, just jabbing the needles in all over the place in the hope of hitting whatever might or might not be in there.

When women go for breast cancer biopsies the docs don't just jab needles into a breasts every few millimetres in the hope that they will cover all the breast tissue and find a cancer. No of course they don't, any more than they do with lung cancer and a pair of lungs; they don't do it randomly because there is an intermediate stage to the search for the cancer. A breast can be screened with a mammogram and a lung with a scan or an x-ray. If a "shadow" or other suspicious area is detected then that is the only area where they stick the needles to do the biopsy.

Many people here mention the color-doppler, but why is this or another apparatus to search for PCa not available in most hospitals, either that or some other device that is easy to use and whose output is easy to interpret? Heck they reckon you may be able to use dogs to sniff out some cancers! see:
www.newscientist.com/article/dn8549-xd-dogs-as-good-as-screening-for-cancer-detection.html
(Makes me wonder why my neighbour's dog always liked to sniff my crotch!!!)

We need something that tells uros exactly where to look and someone to tell uros to stop stabbing us at random in the hope that they get lucky.

And this is only part of the problem of the prostate getting a raw deal: How come there is an entire building about a mile away from me where they do nothing but screen the breasts of women in the area, who are all called up for check-ups by a nationally coordinated scheme based on dates of birth, and it's been doing it for decades!

Alf

would anyone have a prostate removed ( or treated) without having definitive proof that cancer cells exist ?

Would you chance being incontinent or impotent the rest of your life based solely on a blood test or ultrasound when a simple biopsy could prove or disprove cancer cell growth ?

How would you feel if once they removed your prostate without having a biopsy and a post op pathology report shows no cancer cells. Which is more barbaric, doing a blind removal or doing a simple test prior

Sure there may be other tests, but the clincher is having cells in hand ( so to speak) that proves a growing problem is actually their

Mr G - I'm not saying I think people should take invasive action based solely on imaging -- at least not with the current options available to us.

What I'm saying is that there is a major gap between the most basic test (PSA) and the next "step" (Needle Biopsy).

It appears that countless biopsies are performed without need, and with some known or still (seemingly) unknown risks down the road.

Mr. G. -- I agree and AM suspect of the MD (I assume you mean ABnormal??), hence why I am here posting and learning more and more. I feel very strongly about be an informed patient.

A quick search on any major search engine (as well as other sources) and you can see that biopsies are OFTEN performed when they may not be needed.

Risks? Again, a simple search should net you answers to this. The one that would alarm me the most is the chance for cell migration. However, more can be found:

--

Biopsy Complications

No biopsy should ever be considered a "routine" or simple procedure.

Even the US Preventative Services Task Force and The National Cancer Institute are opposed to routine PSA testing (the most widely used test for trying to detect cancer). The reason is, they believe the risks of follow-up tests (prostate biopsies) may outweigh the possible benefits.(ref: WebMD May 27, 2003)

A study at the Mayo Clinic shows that of 2,258 prostate biopsies, 17% were associated with at least 1 complication requiring further treatment.

Typical prostate biopsy complications include:

* Painful infection
* Bloody semen
* Inability to urinate
* Bleeding rectum

The American Urological Association has a more comprehensive list of Complications from prostate biopsy.

--

Again, I can't stress enough that I *do* feel a biopsy (needle) should be the last "test" done before the "final" phase (deciding if treatment is warranted). However, it seems that MDs jump right the biopsy.

Thanks for your input...

Cooper, Thanks for all the information! I've literally read hundreds of pages on this so far and you, among others, have given me some GREAT leads and helped formulate a plan.

Right now ALL we have is a PSA of 9.9, at last test 2 years ago it was 7.5. HOWEVER this information is possibly VERY VERY VERY flawed for several reasons.

First, I am still in process of getting the actual test results, so the dates and/or numbers may not be right... until I see it in writing, it means little -- along with the dates of the tests
Second, there were some "things" that were done that would cause an increase in PSA
Third, No f-PSA was done.
Next, the MD that did the first PSA test appears to have been an idiot and didn't advise additional testing or anything.

Basically -- We're starting all over. New test, proper protocol BEFORE the test -- and a proper plan in place based on the findings of the test. This will be coupled with a doctor that is more amicable toward patients that are well advised.

Thank you again for all the information... and if anyone has anything else... please... and THANKS! :)

Alf,

A biopsy is not really a random sticking of needles in a pin-cushion. It is a systematic sticking of needles in defined areas. If it is a 6 point biopsy, they divide the prostate into 6 sections and try to stick a needle in each of the six sections. The doctor calls out the location, and the nurse records it on the sample. Obviously the more points they choose, the better chance of finding the PC. The "saturation" biopsy can be 32 or more points.

Mike,

I had a nodule on my prostate. The uro did a biopsy and found high grade pins but no cancer. Was that a wasted exercise ? I don't think so. Just finding the HPINS made us watch it more closely. The color doppler may not have found anything. The Prostascint would most likely have found nothing either.

A year and a half later, a new uro ordered another biopsy , probably because he had not felt the nodule yet. Gleason 9, in 2 out of 12 sticks.

I really owe my current status as <.01 to biopsies, that to the best of my knowledge, the "non-invasive" techniques would not have found.

I am still trying to decipher the rationale behind your thread. Is it the fear of a biopsy with blood in the semen that is bothering you, the pain, or are you just having an academic discussion about biopsies ? It is still the most reliable way of determining what is really going on in there.

Incidentally, most uro's will give you an antibiotic to combat infection. the inability to urinate is a fairly rare side effect which I can say I have never heard reported on here, and a bleeding rectum is a fairly predictable minor issue because you just stuck 12 needle holes in it.

Good luck on your quest.