Biopsies Part I: What they won’t tell unless you ask

I was a bit freaked out the day I heard about the various cancers I might have and the biopsy that may be to come.  Of course, I turned to Google for answers.  It’s has been a great help, but also a big curse.  What I’ve learned is a bit surprising.

To most urologists, a prostate biopsy is routine.  They just do them.  A lot of them.  It’s a relatively quick, outpatient procedure done in their office, usually taking only 20 minutes or so.  Then you’re on your way with no restrictions, but $1000 lighter, plus or minus.  Of course, usually that’s covered by insurance, so many people don’t care.  You may know someone who had a biopsy and, being a man, they probably said it was no big deal.  Heck, around a million prostate biopsy procedures are done each year in the USA alone.  That’s a big business, measured in billions.  Still, I didn’t have any lumps.  My PSA wasn’t at an alarmingly high level and hadn’t increased much in the last year.  I don’t have any other symptoms at all, urinary, sexual or otherwise.  What was a biopsy and do they just do them as a matter of routine procedure on anyone who might have any risk whatsoever?

This is where Google comes in.  The procedure is basically some type of gun that is put up your butt, to put it lightly.  They use an ultrasound to guide it to the prostate.  Then, they shoot a needle though the wall of the rectum into different areas of the prostate a dozen times or more, depending on the circumstances.  If you ask, you’re told the risks are negligible (though I’m sure they happily make you sign a waiver before the procedure).  I’ve always been under the impression that breaking the sanitary barrier up there isn’t a good idea in regard to sepsis/infections, but perhaps that’s just hearsay.  For that, they tell you to start taking antibiotics before the procedure, just in case.  With all the resistant stuff going around, that wasn’t real assuring to me.  Prostate cancer is generally very slow moving and very treatable if caught early.  MRSA, multi-resistant E.Coli and other super bugs that are resistant to treatment can end your life pretty quickly.  There are other risks that deal with urinary and sexual function, but those these are apparently very rare.  Common side effects include having blood in your stool, urine and/or semen and that can persist for weeks or months.

Then there is the most insidious risk, the one you may never hear, unless you search for information.  It may be theoretically possible that the needle passes through a cancerous area on its way to get a sample, then spreads the cells, causing them to metastasize elsewhere.  This “needle tracking” or “needle track seeding” actually can happen with with other types of biopsies, like those of the liver or breast.  Unfortunately, there is no evidence one way or another that it poses any significant risk with the prostate.  Of course, I imagine that would be a pretty hard thing to determine and, if it did, likely to be sealed in an out-of-court lawsuit settlement agreement.  I’m sure it’s very unlikely, but I have to believe that it is at least remotely possible, given the manner in which this kind of biopsy is done.

Still, the fear about Cancer is very compelling.  If there’s something there, you really DO want to know as soon as possible.  Sure, there are horror stories on the internet, but that’s true of almost any medical procedure.  Given that the risks and side effects I mentioned above are either very rare, relatively minor or both, it’s worth doing such a quick and relatively painless procedure because you will know one way or the other.  Right?  That’s what I was led to believe, anyway.

7 thoughts on “Biopsies Part I: What they won’t tell unless you ask”

    1. The imagination is far worse than the actual pain. It’s not pleasant, no but it is manageable. By the time of the biopsy, you’ve shed just about all hangups about strangers staring at your anus. The worst part of my biopsy was the young female PA (new hire) who could not resist playing with the long needle used in the biopsy while we waited for the doctor. She kept clicking the thing over and over like she was dry-firing the gun to be used in the prisoner’s (patient) execution. I had to threaten her to knock it off before she finally put the d*mn thing down. Hopefully, you’ll get a PA with a sense of decency. Common sense would have worked too…

  1. Hi Andy-

    Prostate Biopsies are the only way to confirm prostate cancer. Unfortunately, as a tool to detect cancer, they inherently have false negatives because they sample only a very small percentage of the prostate volume. It’s easy for a cancer to be elsewhere in an area not sampled, so it would not be detected.

    Unfortunately, there are no other tools that are any better. PSA testing is turning out to be very controversial, depending on your age and other factors. There are high field MRIs and urine tests (like PCA3), but these suffer from false negatives as well and sometimes fales positives, too. Unfortunately, detection of prostate cancer is still in the 1950s compared to some other types of cancers. I cover some of these methods in other blogs here.

Leave a Reply

Your email address will not be published. Required fields are marked *