Controversies And Misconceptions Surrounding Prostate Biopsies
The PSA test measures the levels of PSA proteins in the body, and when it was first developed, it was quickly implemented by many physicians as a screening test for prostate cancer. The thought was that since PSA proteins are only produced by the prostate, elevated levels could be an indication of prostate cancer. As a result, most men with an abnormal PSA test underwent a prostate biopsy.
The increase in biopsies resulted in the number of advanced, untreatable prostate cancers decreasing significantly because more prostate cancers were caught earlier, when the disease is easier to treat. But the problem with many patients being diagnosed sooner was that some patients were being aggressively treated when they should have been monitored instead.
Though many in the field of urology believe it was flawed, a controversial study attempted to assess the benefits of the PSA test as a screening tool for prostate cancer, and its results led to the recommendation that most men shouldn’t get the test because it didnt appear to improve mortality rates from prostate cancer. This, combined with growing awareness that many cases of prostate cancer were being treated unnecessarily or prematurely, led to a reduction in prostate biopsies. This controversy led to a reduction in prostate cancer screening and an increase in the number of diagnoses of advanced prostate cancer.
How Long Does An Ultrasound Guided Prostate Biopsy Take
The ultrasound and biopsy procedure itself takes approximately 30 minutes.
The procedure together with preparation such the blood test, enema, injection of antibiotics, and observation time afterwards will take a couple of hours. If rectal bleeding occurs immediately after the procedure , you may be kept a little longer for observation until the radiologist or nurse feels that it is safe for you to go home.
Should I Get A Prostate Biopsy An In
Rising or elevated prostate-specific antigen levels, an abnormal digital rectal exam , or both, may indicate the presence of prostate cancer, and having those conditions may lead your doctor to recommend a prostate biopsy. But controversy surrounding the PSA blood test and concerns about prostate biopsies cause many patients to ask:
- Should I get a prostate biopsy?
- Are the risks of a prostate biopsy worth it?
- Are there alternatives to a prostate biopsy?
- If I have prostate cancer, is treatment necessary if Im not experiencing symptoms?
If youre looking for answers to these questions, you may find conflicting and confusing information across the medical field, in the news and on prostate cancer websites. Some dispute the necessity of prostate cancer screening and discourage men from getting a PSA test to begin with. Others suggest that prostate cancer is overtreated and that the risks associated with biopsies and treatment arent worth the potential benefit.
While the 10-year survival rate of men with a diagnosis of prostate cancer is approximately 98 percent, prostate cancer remains the second leading cause of cancer deaths in American men. The American Cancer Society estimates that 248,530 new cases of prostate cancer will be diagnosed in the United States in 2021 and that one in every 41 men diagnosed will die from the disease.
To help you better understand this topic and whether you should get a prostate biopsy, this article will cover:
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Screenings Can Lead To High Costs
The cost for a PSA test is fairly lowabout $40.
If your result is abnormal, the costs start adding up. Your doctor will usually refer you to a urologist for a biopsy. Costs may include:
- A consultation fee .
- An ultrasound fee .
- Additional professional fees .
- Biopsy fees .
If the biopsy causes problems, there are more costs. You might also have hospital costs.
Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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What Does The Equipment Look Like
Ultrasound equipment:
Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer or probe that is used to do the scanning. The transducer sends out inaudible high frequency sound waves into the body and then listens for the returning echoes. The principles are similar to sonar used by boats and submarines.
The ultrasound image is displayed on a video screen that looks like a computer or television monitor. The resulting image is based on the amplitude and frequency of the signal. The ultrasound image makes an image taking into account signal travel time, tissue composition, and type of body structure through which the sound travels.
The ultrasound probe used in prostate biopsies is about the size of a finger. Once the probe is placed in the rectum, the biopsy is performed with a spring-driven needle core biopsy device, or biopsy gun. The handheld device includes a long but very thin needle specially designed to open inside the prostate, take the sample and then close.
MRI equipment:
The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a table that slides into the center of the magnet.
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:
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Preparation For The Biopsy
You cannot take aspirin or other blood thinners, such as Plavix, Eliquis, Brilinta, Pradaxa, Coumadin, Warfarin, Ibuprofen, Naproxen, Aleeve, Advil, Celebrex, Ecotrin, and many others for several days prior to your scheduled biopsy. If you take any of these or other anticoagulants please discuss this with your Urologist beforehand. It might be necessary that you also consult with your Cardiologist prior to stopping.
How Do You Prepare For A Prostate Biopsy
Your doctor will get you tested for urinary tract infections . If UTI is detected, the biopsy will be postponed till the infection clears with antibiotics.
You need to stop taking blood-thinning medications such as aspirin and warfarin and any other medications as advised by your doctor several days before the surgery.
Your doctor or nurse may instruct you to take an enema before the procedure. This helps to keep the bowels clean during the surgery.
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Myths About Prostate Cancer
Here are some things that will not cause prostate cancer: Too much sex, a vasectomy, and masturbation. If you have an enlarged prostate , that does not mean you are at greater risk of developing prostate cancer. Researchers are still studying whether alcohol use, STDs, or prostatitis play a role in the development of prostate cancer.
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What Does My Prostate Do
The prostate is beneath the bladder and in front of the rectum. Itâs a walnut-shaped gland that surrounds part of the urethra. . Hereâs what it does:
- It produces fluid for semen, which includes sperm produced in the testicles.
- It prevents urine from being included during ejaculation.
If it gets too big, your prostate can block pee from passing through the urethra and out the penis.
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When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
Additional Tests That May Aid Prostate Cancer Diagnosis
There are few other diagnostic tools or tests, which can be performed before you have a prostate biopsy, that may help your physician gather more information about your specific case. These procedures may help determine the likelihood of the presence of cancer and its aggressiveness and increase the accuracy of a biopsy when performed. Those tests include:
4Kscore blood test is a molecular test that helps predict the likelihood and risk of a patient having aggressive prostate cancer. If you’re a patient whose PSA values are borderline for a prostate biopsy or you have a condition that could be aggravated by a biopsy, your physician may use this test before to help determine whether you should get a biopsy or a repeat biopsy.
Urine sample testlooks for biomarkers that may indicate the presence of prostate cancer cells in a patient’s body. This test may also be helpful when trying to determine whether a patient should be rebiopsied or not.
Multiparametric MRI
The use of multiparametric MRI imaging of the prostate gland before a biopsy has been a game changer in prostate cancer diagnosis, increasing the accuracy of biopsies over standard biopsies. The mpMRI doesn’t replace the standard biopsy, but by improving its accuracy, it may help decrease the number of biopsies needed.
The mpMRI has a higher resolution than a standard prostate ultrasound. This increases the ability to see suspicious lesions in the prostate, providing additional targets for the biopsy to sample.
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Why Is A Prostate Biopsy Done
A prostate biopsy is done to screen for prostate cancers. This is to confirm whether cancer is present, or if a prostate cancer diagnosis is aggressive. In a prostate biopsy, small samples of the prostate are removed and then observed under the microscope. Doctors usually recommend a biopsy of the prostate gland based on certain findings.
- If prostate-specific antigen blood test results are higher than the average age
- If the doctor detects signs of a prostate problem during a digital rectal exam
- If a biopsy is the only method to confirm the cancer
A prostate biopsy involves:
- Collecting minute samples of the prostate gland. A computed tomography or magnetic resonance imaging scan is also used to guide them through the procedure.
- A prostate biopsy takes about 10 minutes and is usually done in the doctors 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 in the patient, it will also be assigned a grade. The results are available after one to three days, but it can sometimes take longer.
A prostate biopsy may be done in several different ways which may include:
Precancerous Cells And Pin
Sometimes, the results will show that precancerous cells, or prostatic intraepithelial neoplasia , are present.
If these PIN are low grade, the doctor will not consider this a matter of concern. Many men have low grade PIN.
However, if the PIN are high grade, there is a chance that cancer may develop. In these cases, a doctor may suggest further tests.
Carcinoma in situ refers to cells that are not yet cancerous but could become so. They can occur almost anywhere in the body.
The outlook depends on the results of the biopsy and other tests.
If results show that cancer is present in or around the prostate gland only, there is an almost 100% chance of surviving at least another 5 years. This is because effective treatment is available, and because many types of prostate cancer are slow growing.
However, if cancer has spread to other organs, such as the liver or lungs, the chance of someone surviving another 5 years or more falls to 30%.
Factors that affect the outlook for a person with prostate cancer include:
- their age and overall health
- the type of cancer present
- how far cancer has spread
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How Long Does It Take To Recover From A Prostate Biopsy
A patient may take about four to six weeks or even more recover after a prostate biopsy. The recovery process after biopsy usually depends on the patient’s health and age. Doctors may recommend only light activities for 24-48 hours after a prostate biopsy. The doctor prescribes painkillers, vitamins, and antibiotics for a few days to speed up the healing process.
After the biopsy, it is normal to experience the following sensations or symptoms:
- Burning urination: It may start within 24 hours after the biopsy and may continue until three to seven days. This burning sensation is a side effect of the procedure and usually considered normal.
- Frequent urination: It may gradually improve over the first 24-36 hours.
- Blood in the urine: It is considered normal to have slightly red-tinged urine or urine that resembles the color of a rose or red wine. This may last from 12 hours to 3 weeks after the biopsy.
- Blood in stool: A patient may notice red stains on the toilet tissue or see some bloody streaks in the stool. This may last for up to five days.
- Blood in the semen: This may persist for up to six weeks after the biopsy.
- Tiredness: A patient may feel tired for a month or two. It usually takes 30-45 days to regain full normal strength after the procedure hence, sufficient rest is usually advised by the doctor.
Post-biopsy restrictions and instructions:
What Are The Limitations Of Ultrasound
A biopsy can only show if there is cancer in the samples taken, so it is possible that cancer in unsampled areas of the prostate might be missed.
For MRI-guided biopsies, high-quality images are assured only if you are able to remain perfectly still while the images are being recorded. If you are anxious, confused or in severe pain, you may find it difficult to lie still during imaging, and the resulting images may not be of sufficient quality to be useful as a diagnostic tool.
Likewise, the presence of an implant or other metallic object sometimes makes it difficult to obtain clear MR images. A person who is very large may not fit into the opening of certain types of MRI machines.
MR imaging cannot always distinguish between cancer tissue and inflammation or the presence of blood products within the prostate, which sometimes occurs related to a prostate biopsy. To avoid confusing the two on imaging, prostate MR imaging may be performed six to eight weeks after prostate biopsy, if possible, to allow any residual bleeding to resolve itself.
MRI typically costs more and may take more time to perform than other imaging methods. Talk to your insurance provider if you have concerns about the cost of MRI.
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How To Get The Best Results
Most men do not find prostate biopsy excessively painful or uncomfortable, and the complications are usually not seriousbut can be. Certain steps taken before, during, and after the procedure can improve the outcome:
Take antibiotics. Taking preventive antibioticsbefore and after the procedurecuts the risk of infection substantially. Most infections are not dangerous but could become so if they get out of control. The overall chance of being hospitalized with an infection after prostate biopsy is 1% to 3%.
Review medications. Before the biopsy, your doctor may advise you to stop taking daily low-dose aspirin or an anticoagulant such as warfarin , dabigatran , edoxaban , rivaroxaban , or apixaban . These drugs reduce the blood’s ability to clot. Your doctor will weigh the chance of bleeding against the need for anticoagulants to prevent heart problems or stroke.
Expect anesthesia. Get local anesthesia for the biopsy. This means an injection of a numbing drug into the prostate gland to reduce pain during the biopsy.