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Alternatives To Prostate Needle Biopsy

What Is A Biopsy

Dr. Crawford Discusses Alternatives to Biopsy in Prostate Cancer

The process of conducting a biopsy is considered a critical part of diagnosing prostate cancer in male patients for many doctors.

A biopsy is not only a diagnostic tool used in men suspected to suffer from prostate cancer warning signs, but also forms an integral part of diagnosing other cancers too.

During a biopsy, a small piece of the tissue suspected to be affected by cancer is removed from the patients body. In the case where a male patient is suspected of suffering from prostate cancer, the doctor will remove a tiny piece of the prostate gland.

The doctor usually looks at the prostate with an imaging test such as transrectal ultrasound or MRI, or a fusion of the two .

With prostate cancer, many doctors prefer to remove tissue from different parts of the prostate gland. This helps to cover a larger area and provides for a more accurate way of diagnosing the patient with this disease.

Once the doctor removed the tissue sample from the prostate gland, it is placed in a specialized tube. The tube is then sent to a laboratory, where the biopsy is tested.

Scientists at the laboratory facility will look at the tissue underneath a special microscope and see if cancerous cells are present in the prostate gland of the patient.

Transrectal Versus Transperineal Biopsy

In the United States transperineal biopsy is seldom performed. In contrast, in some European and Asian centers, it is the standard technique. Theoretically, the direction of the transperineal biopsies might be better than the transrectal route because of the longitudinal sampling of the peripheral zone. Initially the transperineal route was demonstrated to be less accurate than the transrectal route in terms of identifying hypoechoic lesions80 and systematic sextant-directed detected cancer.81 However, in a simulation experiment, Vis and collegues82 have shown that the 2 approaches did not differ in terms of prostate cancer detection. Moreover, Emiliozzi and associates83 reported that sextant transperineal biopsy is superior to transrectal biopsy for detecting prostate cancer in humans. On the other hand, 2 studies have shown that the overall cancer detection rate did not differ between the 2 approaches when the same number of cores was used.84,85 Indeed, 12-core transperineal prostate biopsy is superior to 6-core biopsy, and the number of cores may have a greater impact on cancer detection than the route of the prostate biopsy.83,86 In the last few years the concept of extended biopsies has been equally applied to the transperineal approach, with results similar to those achieved with the transrectal approach.84,85

Recent Study Shows More Complications With Alternative Prostate Biopsy Method

  • By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

If a screening test for prostate cancer produces an abnormal result, the next step is typically a biopsy. In the United States, this is almost always done by threading a biopsy needle into the prostate through the rectum. By watching on an ultrasound machine, doctors can see where the needle is going. Called a transrectal ultrasound biopsy, this procedure comes with a small but growing risk of infections that are in turn increasingly resistant to current antibiotics.

Today, technical advances are making it possible for doctors to perform TP biopsies under local anesthesia in their own offices. And with this development, pressure to limit infections by adopting this approach is growing.

During a recent study, Harvard scientists looked at how the two methods compare in terms of cancer detection and complication rates. In all, 260 men were included in the study, each closely matched in terms of age, race, prostate-specific antigen levels, and other diagnostic findings. Half the men got TRUS biopsies and the other half got TP biopsies, and all the procedures were performed at a single medical practice between 2014 and 2020. Per standard clinical protocols, all the men in the TRUS group took prophylactic antibiotics to prepare. By contrast, just 43% of men in the TP group took antibiotics, in accordance with physician preferences.

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Main Body Of The Abstract

We searched for online publications published through June 27, 2018, in PubMed, Scopus, Web of Science, and Chinese National Knowledge Infrastructure databases. The relative risk and 95% confidence interval were utilized to appraise the diagnosis and complication rate. The condensed relative risk of 11 included studies indicated that transperineal prostate biopsy has the same diagnosis accuracy of transrectal prostate biopsy however, a significantly lower risk of fever and rectal bleeding was reported for transperineal prostate biopsy. No clue of publication bias could be identified.

Benefits Of Getting A Prostate Biopsy

Optimization of Prostate Biopsy

A prostate biopsy is the only way to definitively determine whether you have prostate cancer and, if you do, how aggressive it is.

While prostate biopsies arent always conclusive, in general, a biopsy gives men the reassurance of knowing whether they have cancer or not. If you know you have prostate cancer, youre more likely to be appropriately treated.

Appropriate prostate cancer treatment options depend on several factors, including the stage of the cancer, your age, your general health and which risk category your cancer falls into.

Localized prostate cancer is categorized into six risk categories, which range from very low-risk to very high-risk. The risk group is determined by the stage of your cancer, your PSA levels and the Gleason score obtained from the biopsy pathology report.

The National Comprehensive Cancer Network guidelines outline appropriate treatment options based on risk categories and whether the cancer has already metastasized.

Patients whose cancer is confined to the prostate and falls into the very low-risk and low-risk categories tend to have slow-growing cancers. Treatment options for these patients often include active surveillance, radiation therapy or surgery. Similar treatment options may be recommended to patients in the low-risk and favorable intermediate prostate cancer risk categories.

The NCCN guidelines recommend immediate treatment for patients with high-risk disease or those patients whose cancer has metastasized.

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Overdiagnosis And Insignificant Cancer

Clearly, the critical question is whether the cancer detected in sequential biopsies or saturation biopsies with increasing numbers of cores is clinically significant. There is mounting evidence that a substantial proportion of men with screen-detected prostate cancer would otherwise have not known about the disease during life in the absence of screening. In these men cancer treatment is not beneficial. Identifying the patients with newly diagnosed prostate cancer who have indolent disease for which surveillance or expectant management may be an appropriate alternative to immediate curative intervention is a timely and important issue. There is currently no marker of biologically indolent cancer. Although life expectancy and comorbidity are as important as pathologic characteristics of the cancer, most investigators have defined indolent disease according to pathologic stage, tumor volume, and cancer grade .

Positron Emission Tomography Scan

A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.

However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.

Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.

These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.

Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.

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How We Approach Prostate Biopsies And Prostate Cancer Diagnosis At Ctca

When you come to CTCA for a prostate biopsy or a second opinion, youll have access to tests that may help increase the accuracy of each biopsy. Our team has expertise with these tests and procedures, allowing us to work quickly and efficiently.

If youre diagnosed with prostate cancer, a multidisciplinary team of genitourinary experts, which may include a urologist, a urologic oncologist, a radiation oncologist and a medical oncologist, will review your case and develop a personalized plan based on your specific circumstances and needs.

We only treat cancer at CTCA, which means our cancer experts are skilled at assessing risk associated with each persons circumstances. We give you the pros and cons of the treatment options available to you, allowing you time to talk with your team of doctors and other experts about those options.

Our cancer experts are also vigilant about what patients need and when they need it. We know that when men are told they have slow-growing prostate cancer, some of them wont keep up with the necessary follow-ups, so we help keep them on track.

If you choose to receive treatment with us, you may benefit from our integrative approach to cancer treatment. Our multidisciplinary team works together to help prevent and manage the side effects of cancer and its treatment, providing supportive care services, such as:

Use Of Mri To Detect Prostate Cancer

A painless alternative for prostate cancer biopsies (Full Video)

Since the 1980’s, magnetic resonance imaging has been used to image the prostate gland. Advances in technology have led to the development of multiparametric MRI , thus allowing enhanced detection of clinically significant prostate cancer . Multiparametric MRI combines anatomic T2-weighted images with functional and physiological assessments, including diffusion weighted imaging and dynamic contrast-enhanced MRI.

In 2012, the Prostate Imaging Reporting and Data System was introduced to standardize the reporting of mpMRI results. PI-RADS utilizes a five-grade scoring system based on the likelihood that mpMRI findings correlate with csCaP within the prostate. Grade 1 lesions are highly unlikely to contain csCaP, whereas grade 5 lesions are considered highly likely to represent csCaP.

Using a similar scoring system, the likelihood of detecting csCaP in 825 men with grade 3 regions of interest at UCLA is shown in Figure 1. Men with grade 3 ROIs on mpMRI carry a 24% chance of csCaP on prostate biopsy, compared to an 80% chance of csCaP in those men with grade 5 ROIs.

Percent likelihood of clinically significant prostate cancer based on region of interest grade, . Region of interest grade is shown at lower left corner of each section. Chance of csCaP is directly related to ROI grade.

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How Long Does It Take For The Prostate Gland To Heal After A Biopsy

The recovery process after biopsy depends on factors such as a patients age and overall health. While doctors keep saying prostate biopsy is easy, the recovery process isnt that simple.

It may take four to six weeks to recover. For some men, it can take longer than that, even when they adhere to all the instructions.

Isnt A Psa Test Enough

The prostate specific antigen test is a common screening test for prostate cancer. PSA is a protein that comes from the prostate gland. The test measures the amount of PSA in your blood. Its a simple blood test, and for some men, it turns out to be a lifesaver.

On the other hand, its value as a diagnostic tool is fairly limited. High PSA levels may be a sign of prostate cancer, but its not enough to diagnose the disease with certainty. Thats because there are other reasons your PSA levels could be high, including urinary tract infection and inflammation of the prostate.

Read more: PSA levels and prostate cancer staging »

Also, a single abnormally high PSA test result cant tell you if the high level is temporary or rising over time.

Low PSA levels cannot definitively rule out prostate cancer, either. The fact is that PSA tests can result in both false positives and false negatives.

PSA tests can be useful during and after treatment for prostate cancer. Rising PSA levels may signal that treatment is not effective or there is a recurrence of the cancer. If your PSA levels are decreasing, your current treatment is probably doing its job.

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Biopsy During Surgery To Treat Prostate Cancer

If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .

The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.

Prostate Cancer: Advancements In Screenings

Transperineal Biopsy Tips and Tricks

You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.

What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.

Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.

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Prostate Cancer Risk Factors

While all men are at risk of getting prostate cancer, certain groups of men are more likely to develop cancer than others. Key risk factors for prostate cancer include:


The most important risk factor is age: the older a man is, the more likely he is to be diagnosed with prostate cancer, with the odds for prostate cancer increasing dramatically after men reach 50 years old.

Family History


African American men are 1.8 times more likely to be diagnosed with prostate cancer and 2.5 times more likely not to survive the disease.2

Mri Guided Prostate Biopsy

Suspicious lesions identified on mpMRI can be targeted during fusion biopsy. Three methods of MRI targeted biopsy exist: cognitive fusion, in-bore, and MRI – ultrasound fusion. Cognitive fusion biopsy requires the operator to infer the location of suspicious lesions on MRI using TRUS images. In-bore biopsy is usually performed by a radiologist and involves targeting a suspicious lesion within the MRI tube. Landmarks and targets for biopsy are defined using the preceding diagnostic mpMRI. MRI – ultrasound fusion biopsy utilizes registration or fusion software to identify and target a lesion on MRI during TRUS – guided biopsy.

Increased detection of significant prostate cancer

Use of MRI ultrasound fusion to guide biopsy results in increased detection of clinically significant prostate cancer . In the largest series reported to date, Filson et al. recently evaluated the combined use of targeted and systematic biopsy in detecting csCaP in 1042 men. Combining both techniques diagnosed more csCaP than targeted biopsy or systematic biopsy alone. ROI grade was the strongest predictor of csCaP on fusion biopsy. When compared to men with a grade 3 ROI, those with a grade 5 ROI were found to have 9 times the odds of csCaP . Table 2 shows the likelihood of cancer detection in biopsy naïve patients, depending on degree of suspicion on mpMRI.

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Use In Men Who Might Have Prostate Cancer

The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.

PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.

  • Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
  • Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
  • If the PSA is more than 10, the chance of having prostate cancer is over 50%.

If your PSA level is high, you might need further tests to look for prostate cancer.

To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.

An Easier Way To Get The Same Information

MRI as an Alternative to Random Needle Biopsy

Tumor biopsies are an essential part of cancer care. They can confirm a cancer diagnosis, identify the cell type of the tumor, and, increasingly, they are used to determine whether a patients tumor contains particular genetic alterations that may make them candidates for targeted therapies.

However, tumor biopsies require invasive procedures, including surgery, and some patients may not be candidates because of poor health or because of a tumors location in the body. In addition, after the initial testing and analyses of biopsy samples, not enough additional tissue may be left for comprehensive molecular profiling, or it may not be of sufficient quality for profiling, Dr. Mack explained during a press briefing.

To overcome these barriers to gathering genetic information about a patients cancer, researchers have developed technologies for capturing and analyzing DNA and other types of genetic material released by tumor cells into blood.

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