Prostate Biopsy Part II: They’re not just for testing a tumor anymore

Yesterday, I discussed some of the various unpleasantries involving a prostate biopsy.

If that wasn’t unpleasant enough, here’s the kicker.  Unlike other cancers, you don’t get a “Yes or No” (malignant or benign) diagnosis from a prostate biopsy.  You see, with most cancer, a tumor is found by hand, CT scan, MRI or other diagnostic.  Then, a biopsy is done to see if it is malignant or not.  For whatever reasons, they use an invasive biopsy to actually search for cancer of the prostate.  It’s a semi-random core sampling of 12 or more small areas within the much larger prostate gland.  If you are unlucky and have a cancer and they are lucky enough to hit the right spot, then you know it’s “Yes.”  It’s also quite possible they miss the spot.  Then you know nothing at all because of frequent false negatives.  Maybe you got it, maybe you don’t.  Some people have multiple biopsies over a period of years before they finally hit the right spot and find the cause of their worsening symptoms.  Hopefully by then, it’s not too late.

With some patients, there’s a clear marker for prostate cancer.  They feel bumps or irregularities on a digital rectal exam.  They have high PSA levels, maybe over 10.  Their PSA increases rapidly within a short time or their free PSA level is quite low.  One or more of these might be a very compelling medical reason to do a biopsy. 

Then there are those who don’t have cancer.  They might have a chronic prostate infection or something called BPH (Benign Prostatatic Hyperplasia).  These have similar symptoms to prostate cancer, but some urologists may still only recommend biopsies, because that’s what they’ve always done and all they know how to do.  In fact, these causes may be more likely than cancer, especially in younger men.

So what to do with people like me, with no real smoking gun?  Even going on a pessimistic assumption that I do have a small tumor, isn’t there another way to find it, other than an invasive biopsy that is akin to looking for a needle in a haystack?  You’d think they would have a lab test or CT scan or something to find the cancer, then do a biopsy to confirm it, as they do with other cancers.  Apparently, that  isn’t considered an alternative because there is not yet any convincing proof that any other method works any better than a biopsy.  Granted, a biopsy doesn’t appear to work all that well in the first place in terms of locating cancer, though it may be the only way to confirm it.  If you do have a biopsy positive for cancer, they will sometimes do an MRI, CT Scan or special ultrasound (color flow or power doppler sonogram) to see the extent of the tumor so that they can properly stage an appropriate surgery.  Huh?  That’s a bit of a contradiction.  An MRI can see cancer after a biopsy, but not before?

To me, this all seemed very backward; using an invasive procedure to randomly search for a tumor first, before even considering any non-invasive alternatives for patients with a lower risk of cancer.  I have no medical training.  I have no idea what makes the prostate so different in regard to how they find and diagnose cancer compared to other areas of the body.  I admit that my line of thinking may be overly affected by fear and an emotional connection to the issues.  On the other hand, I do know a little bit about scientific method and testing and some of the things I learned set off a red flag.  Plus, it was nearly impossible to get much information from my busy urologist.  He’d already told me what was to be done and hurried off to the next patient.  Hello, Google.

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