THE QUESTION
Is it dangerous to do a biopsy and even more so to do a superbiopsy? In other words, will a sampling open up a "needle track" that will permit cancer cells to escape outside of the prostate capsule and metastasize into the body, where it is more often incurable and could cause death?
Of course, the question is actually broader than that: Are the benefits and possibility of saving my life greater than the risks that could shorten my life?
At no place in the literature could I get an assessment or even an estimate of a range of the statistics related to both sides of the argument.
KEY MOTIVATOR FOR DETECTING ASAP
"The early diagnosis of the disease reduces the risk of dying of such a tumor. "
It would appear that there is a very significant difference!
WHAT ABOUT NON-INVASIVE ALTERNATIVES?
I ran across in a number of the scientific articles the suggestion that "There are non-invasive alternatives such as MRI scans and color Doppler scans that are just as accurate as biopsies."
This also seemed interesting: "A 3.0 Tesla MRI-S scan predicts and confirms the presence of prostate cancer almost 3 times more frequently than a randomized biopsy procedure." Source - Medicine Group.
Also: "The Prostate - C.M.P. has a sensitivity of 99.8% (it detects 5 times more diseases than conventional tests) thanks to the color processing after the exam. Its precision is also greater thanks to C.A.D. (computer aided diagnosis). Because of this, it usually does not require biopsies. (In contrast if a malignant tumor is small the biopsy is usually negative as the needle rarely penetrates it). If a tumor is not visible in ultrasound the biopsy will have a negative result for sure."
It would seem to make sense, if these statements are true, to try the latter or the scans mentioned above. Why would that not be the case, if the above is true?
THE SIDE BENEFIT OF USING THE MORE EXACT METHODS
Since it appears the "drilling for oil" (spots of cancer) is not as exact as taking an alternative view, it would appear to make sense that the biopsy, if still needed, could be much more effective if the scanning shows where the cancer is likely to be.
So, why would we not do the approach of taking a more precise view, which may rule out cancer and/or which would help to direct the sampling better than the less precise ultrasound?
WILL IT GET OUT?
I couldn't verify this: "The phenomenon of “needle tracking” takes place approximately 20-30 percent of the time." And I didn't see any numbers on how often it causes metastasis per se.
Normally the body tries to isolate that which is causing harm, including malignant tissue around which the organism usually builds an isolating wall. The more malignant the tumor, the weaker the wall.
When this wall is penetrated by an instrument, for example the needle for the biopsy, a hemorrhage is produced and the cells previously enclosed by the wall are released into the bloodstream and transported all over the body, facilitating metastasis, which are secondary points of tumor tissue outside of the original tumor.
When the tumor is perforated, tumor cells are released into the bloodstream, increasing the possibility of metastasis. In the case of the prostate, the metastases usually appear in the bones.
In summary: a small, slow growing cancerous tumor subjected to a biopsy may spread more rapidly all over the body, invade the bones, other organs and lead to death.
A UCSD study indicated: "The study says textually "Our results suggest that stimulating the inflammation of cancerous tissue, for example in prostate biopsies, may, ironically, promote metastasis…” Debra Kain
FACTORS AFFECTING WHETHER TO DO A BIOPSY SOON
A higher PSA - near 10 is pretty high
A low free PSA - about 11 is a strong indicator
Velocity of PSA changes - appears to have speeded up, which is a strong indicator
The 2nd to last PSA which indicated that it would be a good idea to do another biopsy was very likely done with a urinary infection, which was detected in the pre-op procedure. The doctor then cautiously postponed the surgery. I then took the antibiotics and tested clear. The next PSA test was a bit lower, but still pretty high, however there was no urinalysis set up to go with it, though it would seem to be appropriate, from a layperson view.
THE FREE PSA FACTOR
Although I could detect no discrepancy in the statistics related to free PSA, only one urologist kept using the test - and he was a real research guy. He did my first biopsy, which was negative, but then, based on free psa and my elevated psa, he recommended trying again (the first biopsy had to be limited to about 6 samples due to something that occurred, so it was possible that it was inadequate) as the indicators (the statistics) suggested a high probability of finding something. Again, it was negative. (That was 1999, when I was first tested for PSA by my general practitioner - all of this was at the same healthcare organization.)
My "free PSA" in 1999 was 11 and the same in 2002 and 2004 (with one instance in between where it rose to 16).
The odds of cancer occurring (being discovered, that is) with the following free PSAs are:
Free PSA Odds
0-10 55% (chance of cancer being discovered later)
10-15 45%
15-20 28%
So my "odds" would be about 50% or so.
Of course, the lower the free PSA indicated (the higher the odds of cancer being present) that it would be a good idea to go ahead and look for the cancer, presuming that dealing with the cancer could be dealt with with a positive net effect.
PSA VELOCITY AND ABSOLUTE SCORE
The original call from an alarmed general practitioner reported a 5.4 PSA (at age 57, 1999), but there had never been a baseline test. Two biopsies were negative.
My score, with occasional variations stayed in that vicinity, being 4.5 in 2005.
In 2006 and 2007, my scores were 6.1, 5.9, and 8.3 (without urinalyses), so the velocity seemed to indicate a rise of from 1.4 to 2.8 per year. The biopsy in 5/07 was negative.
Then it was 6.3 and 7.5 in 08 and 09, rising to 8.2 in '10, then 10.8 in 4/11, followed by an 11.7 7/11 (where there was a urinary infection, which was detected later), then a presumably normalized 9.5 in 11/11 (but no urninalysis was done).
Roughly that would be a 2.0 difference in one year, which indicates velocity that is an indicator for something going on that should be investigated.
THE SUPER-BIOPSY
When I learned that a new procedure was being done at the healthcare organization, I found out that the old biopsy method was very limited. Taking biopsies from the limited angle permitted by insertion in the colon caused only a certain part of the prostate to be accessible, leaving the other parts untested.
The new super-biopsy improves on the accessibility by going through the outer skin and then taking 70 samples instead of the normal 12-16. Well, that certainly made sense (offset, of course, by having more "needle tracks" and the cancer getting out). Detecting something earlier (plus even detecting it at all, which might not have happened at the old angle) certainly was of interest to me.
However, research appears to indicate that the possibilities, as discussed above, should include some more precise detection method first and then determining whether to proceed with the super biopsy.
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AN EARLIER SECOND OPINION
I went for a second opinion to another urologist and my elevating PSA scores, and he expressed high certainty and confidence that there was no need to be concerned about the scores as, if it is there, it was a slow growing cancer anyway, plus he told me that taking saw palmetto does not help at all. It was interesting to note that at the same health organization several of the urologists universally recommended it. I never went to that guy (he was also sarcastic and critical) ever again.
