Prostate biopsy, MRI, PSA and prostate cancer
In the 1980s, a technique was developed in which tissue samples were systematically taken from the prostate in the hope of locating a tumor within the prostate gland. Typically, men whose doctors discover elevated PSA levels, a common blood test to screen for prostate cancer, perform more than 1 million prostate biopsies per year. Most biopsies performed are conventional biopsies, also known as blind biopsies. Men who undergo these biopsies fear them, and for good reason. They are painful and 75 percent of the biopsies performed are negative for prostate cancer.
Despite this, many men with negative biopsies but elevated PSA levels may still harbor malignancies, tumors that are missed by these conventional biopsies. Most men who have a prostate biopsy will have additional biopsies. This is especially true since many men with negative biopsies but elevated PSA levels may still harbor malignancies, tumors that are missed by conventional blind biopsies.
A study at Johns Hopkins in 2011 found a significant increase in serious complications following prostate biopsy that required hospitalization. They found that this common outpatient procedure, used to diagnose prostate cancer, was associated with a 6.9 percent hospitalization rate within 30 days of biopsy. This does not include complications that were treated in an emergency department or in an outpatient setting. In 33% of men who have a prostate biopsy, they will experience side effects that men consider a “moderate or severe problem” such as pain, fever, bleeding, infection, and transient urinary difficulties. An increase in PSA (prostate specific antigen) may not warrant an immediate biopsy, especially since 20-30% of men will regress to a lower level simply by repeating the test.
A PSA (prostate specific antigen) test is still beneficial to you and your health care provider. Despite the fact that most men with an elevated PSA do not actually have prostate cancer, but may have other reasons for an elevated PSA, such as prostatitis or benign prostatic hyperplasia (BPH).
On August 30, 2011, an article titled “Prostate Cancer: The Dreaded Prostate Biopsy and Alternatives” outlines alternatives to a traditional biopsy. We are now in 2015. It is important to note that imaging a tumor, as discussed at the time, never understages a tumor, but actually makes it look worse than it is. Also in 2011, UCLA doctors published a study on “Prostate Cancer Now Detectable by Image-Guided Biopsy.” This really makes sense. If you are going to have a prostate biopsy, there really is no point in having a conventional blind prostate biopsy. The MRI options available today to detect prostate cancer with imaging make a conventional biopsy seem Jurassic by comparison. If you suspect you have prostate cancer, you should ask your specialist healthcare provider about having an MRI before considering a biopsy.