Prostate Biopsy

Prostate biopsies have been recommended when the PSA (Prostatic Specific Antigen) gets higher. However, there are many conditions besides prostate cancer that heighten the PSA, being the most frequent urinary infections, tumors, cysts, stones, sexual activity, transrectal exams and specially the prostate biopsy.

What is the Prostate Biopsy?
Prostate biopsy is a surgical procedure to obtain tissue from the prostate gland and examine it to detect cancer.

How is it done?
There are three techniques: transrectal, transurethral and transperineal. The transrectal and transperineal methods use a cutting needle attached to a spring loaded device (gun). The most common method is the transrectal biopsy, when the doctor inserts a needle attached to an ultrasound probe through the wall of the rectum until the prostate gland, shots the gun and removes the needle. This is done several times from 7 up to 24 times or more.

Does it hurt?
Yes. It is painful. Local anesthesia is useless. General anesthesia helps but it requires the operating room and hospital admission. That increases costs -and risks, and your  insurance company might refuse to pay for all that, so prostate biopsy is usually performed without general anesthesia and it hurts.

TRUS Prostate Biopsy: needle in red; prostate in magenta
As seen, it is easy to hurt the bladder

Is the prostate biopsy risky?

Yes. It is: The more punctures the higher risk. These are the risks:

1. Infections: septicemia (sepsis), hepatitis, AIDS, urinary infections

2. Hematuria: blood in the urine

3. Urine retention: obstruction because of inflammatory activity

4. Hematochezia: blood during bowel movement

5. Hematospermia: blood in the semen

6. Arteriovenus Fistula

7. Needle track seeding: implantation of malignant cells

8. Repetitive biopsies can cause chronic inflammatory reactions because they are traumatic *

* Investigating the link between cancer and inflammation
http://medicine.nus.edu.sg/phys/Projects_Investigating_Lina.htm

The relationship between cancer and inflammation is an important, undefined area, derived from the fact that cancer originates at sites of chronic inflammation, and the interplay between the two is now acknowledged. Malignancy is thought to develop from chronic inflammation, where uncontrolled cell proliferation occurs in a milieu rich with pro-inflammatory cytokines, mediators and growth factors normally involved in chronic and unresolved inflammation. Together with primary DNA alterations by carcinogenic or mutagenic factors, chronic inflammation or factors released during inflammation can promote cancer growth. In normal tissues, anti-inflammatory homeostatic cytokines and proteins are up-regulated synchronically after the pro-inflammatory cytokines are produced, leading to the resolution of acute inflammation. In chronic inflammation, however, the inflammation persists, possibly due to the lack of production of anti-inflammatory mediators, which can result in cancer development. This may result in increased production of reactive oxygen species (ROS), leading to oxidative DNA damage and reduced DNA repair, and increased proliferation.

Thus we are investigating the mechanisms of action of a particular anti-inflammatory protein, known to have homeostatic properties, and whose expression is reduced or abolished in certain cancers. We propose that it plays an important role in cancer and inflammation, and this research may lead to unraveling the link between the anti-inflammatory activity of this protein and its ability to regulate cell proliferation, and provide a mechanistic understanding of its anti-tumor activity in vitro and in an in vivo mouse model. Consequently, the proposed work could have potential implications for the identification of novel targets for the treatment of cancer.

Collaborators and Team Members
Lina Lim Hsiu Kim (Principal Investigator)
Ng Swee Phyaw (Laboratory Officer)
Shazib Pervaiz (Collaborator)

Other link that reports imflammation and cancer relationship
 

Experiment  shows what happens to the prostate with the biopsy

You will need:

1. A long needle or similar device

2. Two apples (or pears, or oranges), similar size and color

3. A knife

a- Dig the needle into some soil. This makes conditions similar to the rectum contamination

b- Puncture ten times one of the fruits in different angles and starting in a surface less than 2 square centimeters. Move the needle back and forth two times for each puncture. That is like the prostate biopsy is performed.

c- Do nothing to the other fruit

d- Leave both fruits alone for 10 days

e- Now, cut both fruits doing parallel cuts. Compare both fruits. The same happens with the prostate biopsy.

If for any change the punctured fruit had a worm (analogy between cancer and worm) and the worm was punctured, you will find worm's tissues seeding through the needle track. The chances they puncture a worm are almost the same they puncture a cancer.

The C.A.D Color ultrasound of Prostate + Uro   included in the Premium Medical Check-up can make unnecessary prostate biopsy

Can Biopsies spread cancer?

Yes. They can. If you refer to the experiment above, you remember what happens to the worm's tissues after puncturing the worm and removing the needle. O happens to the cancer cells: they spread through the needle path. Once spreading is a fact that they can grow because they are alive and have proper conditions to grow: the same conditions that allow the cancer to grow inside the prostate allow the cancer to grow outside the prostate.

These items increase the probability of spreading cancer:

• The needle thickness: The thicker the needle the more possibilities to spread cancer

• The number of punctures: 12 punctures produce more chances to spread cancer than 7 punctures

• The number of biopsies: The more biopsies, the more punctures

• The invasiveness of the cancer: the higher the invasiveness the higher the risk

Taken from the uscd research published on march 19/2007 (http://ucsdnews.ucsd.edu/newsrel/health/03-07Prostate.asp):

“Our findings suggest that promoting inflammation of the cancerous tissue – for instance, by performing prostate biopsies –  may, ironically, hasten progression of metastasis,” said Karin.  “We have shown that proteins produced by inflammatory cells are the ‘smoking gun’ behind prostate cancer metastasis.  The next step is to completely indict one of them.”

Is the prostate biopsy infallible?

No. It is not. Just less than 1% of prostate tissue is examined with the biopsy. So, there are 99% of chances of not detecting cancer. The cancer detection rate was 29% on the first biopsy ( Dr. Roehl's report published in the June issue of The Journal of Urology)

Prostate biopsy accuracy depends on sampling the tumor. If the tumor is small or difficult to puncture the needle could surpass the tumor and the biopsy would result negative. It is scientifically impossible to rule out cancer. besides, the biopsy may not contain enough tissue to make a diagnosis, or the Gleason score may be not clear enough, which is common.

If they cannot detect a prostate tumor with ultrasound, probably they would not puncture the tumor with the biopsy. Always do a prostate ultrasound before the biopsy, not during the biopsy. If you can have a  C.A.D Color ultrasound of Prostate + Uro (included in the  Premium Medical Check-up), taken you could avoid the biopsy.

Can the prostate biopsy be avoided?

Yes. It can. Prostate biopsy is just a diagnostic method and it is not infallible (no method is infallible).  There are other alternatives that combined offer diagnosis sound enough to select a treatment. For instance, the  C.A.D Color ultrasound of Prostate + Uro results, included in the Premium Medical Check-up along with the PSA may be sufficient to decide a conduct.

The goal of the prostate biopsy is detecting and staging prostate cancer, but this can be done now during prostate surgery. In several cases the tumor has spread (metastasis) to bones and biopsy would not be necessary because the bone gammagraphy would show it and the gammagraphy is safe compared to the prostate biopsy. Some times the patient cannot be operated on, or does not want to be operated on, or does not want to get any treatment. In such cases there will be no need to do prostate biopsy. Before planning a prostate biopsy we should check both the physical and psychological health of the patient so that we can help him make a decision.

References:

Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 1975–2001, National Cancer Institute. Bethesda, MD, 2004 (http://seer.cancer.gov/csr/1975_2001).

Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level 4.0 ng per milliliter. The New England Journal of Medicine 2004; 350(22):2239–2246.

Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. The Journal of Urology 1994; 151(6):1571–1574.

University of California, San Diego research published March 19,2007

Sum up this facts:

• Biopsy can distinguish cancer from non-cancer just when they puncture the cancer. Statistics show that for any reason most Biopsies do not puncture cancer

• Biopsy is not infallible

• Biopsy has important risks

• Biopsy can spread cancer

• Biopsy hurts

• Biopsy is expensive (about USA $1000=)

• There are safer alternatives with different approaches

Conclusion: The PSA gets higher because of many conditions besides prostate  cancer. If they want you to have a prostate biopsy taken because your PSA is high you should first find out what is heightening your PSA and try solve it. If they can solve it and the PSA normalizes, there will be no need to perform any biopsy.

C.A.D. Color Prostate Ultrasound with Urosonography detects most conditions heightening the PSA and makes the prostate biopsy unnecessary.

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