Unnecessary Prostate Biopsy?

This blog started over 10 years ago out of concern over unnecessary prostate biopsies.  These procedures are so common now that they are done as routine outpatient procedures.  They generate a lot of money for urologists and hospitals.  They also have a relatively high risk of complications and false negative rate.  Though blood, urine and MRI technology are improving, for many men, the necessity of a random 12+ core biopsy to search for cancerous cells is a page out of a 1960s medicine book.  Improvements in the procedure have been made, but the basic theory is still using one needle to find another proverbial needle in the haystack.  The problem is this particular needle costs over $1000 and can cause major complications, like sepsis.

In 2009, I had my first prostate biopsy.  I had hoped to avoid it if at all possible, but multiple physicians deemed it necessary.  At least I was able to do so in a free study designed to improve MRI imaging of the prostate that might some day reduce the need for biopsies.  As it turned out, my first biopsy was probably unnecessary, other than any value to the research study.  I didn’t have any major risk factors for prostate cancer, other than a relatively high PSA caused by an enlarged prostate.  My MRI didn’t show any lesions and was determined to be low risk (PI-RADS score of 1).  The biopsy was negative.

By 2019, newer technology is starting to help with protocols to reduce unnecessary biopsies.  From advanced biomarker blood and urine tests to high resolution MRI, the hope is that some combination can help many men avoid an unnecessary prostate biopsy.  Sadly, it didn’t help me avoid another one.  My second MRI showed a moderately high risk lesion in my prostate (PI-RADS 4).  Fortunately, the biopsy (12 sextant cores plus 2 targeted cores) was negative in my case.

I am so thankful that I have twice avoided a biopsy positive for cancer.  I have also avoided serious infection and other major side effects of a trans-rectal prostate biopsy.  I now have some personal experience with both necessary and unnecessary prostate biopsy.  I am still of the opinion that a trans-rectal biopsy is probably performed far too often.  The problem is that there is little consensus of what combination of less invasive tests and metrics might reduce unnecessary prostate biopsies.

 

One thought on “Unnecessary Prostate Biopsy?”

  1. The MRI targeted ones are not much better in my experience, but maybe my bad experience is unusual. I’ll comment although this is probably a little late now!There is also the OncotypeDX and Prolaris but they are terribly expensive and I suspect a good proportion come back with people in the middle of the range which is not really much help given the outlay but one never knows. As I wrote in another post I have now had 3 MRIs and am unimpressed. The first very worrying [4/5] but after a biopsy nothing in the targeted area but ironically a 0.4mm 3+3 spot outside it so on AS. Routine one last year 2xPIRADS 2. I assume the knew of the existing spot but also knew it was low risk hence the insignificant PIRADS score. Then. just had another routine one: 4/5 in the existing spot and 5/5 in another area. After a 42 core [yes, 42] targeted/fusion biopsy nothing in the 5/5 area, only the existing spot, which this technician obviously decided he’d better show as “significant” given he already had the information about it. The 5/5 reading caused terrible anxiety of course. It’s probably more down to the technician, but if they consistently get it wrong I think they need to be investigated given the capacity for mental harm to patients.

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