Prostate Biopsy Found to Spread Prostate Cancer Cells

Researchers have identified a previously underestimated risk that routine prostate biopsy performed to detect prostate cancer spreads cancer cells, and may be the reason that men have a recurrence of disease many years after the prostate was removed successfully with clear surgical margins.

Conventionally, an ultrasound and prostate biopsy are commonly recommended and performed by urologists when a patient presents with a prostate-specific antigen (PSA) of 2.5 ng/ml or above. Men have been long told that the procedure is safe and the only way to diagnose prostate cancer. While this paradigm represents the current standard, the system exposes far too many men to needless biopsies; as the number one reason PSA increases is prostatitis, not prostate cancer. Still other men may have a small cancer that is missed based on the inability of this standard procedure to target a suspected lesion in question (sampling error). Regardless of the justification for a biopsy, all men suffer the potential risk for bleeding, scarring, infection, or sepsis and needless intrusion that has reportedly resulted in impotency and/or incontinence in some patients.

According to specialists at the Diagnostic Center for Disease (Sarasota, FL, USA), a more important issue that is frequently not discussed between physician and patient involves the possibility of "needle tracking”; the very real possibility of spreading cancer cells beyond the prostate when a biopsy is performed. An extensive review of the literature confirmed that once a needle penetrates the capsule of an organ, a phenomenon called needle tracking takes place. When the needle is withdrawn from the targeted organ, the chance of spreading cancer cells (when encountered) establishes itself, and every puncture of the prostate adds to this risk.

A recent evaluation of data from patients with a positive MRI-S scan performed at the Diagnostic Center for Disease found that 75% of the biopsies performed yielded a tumor, allowing men without cancer to avoid a biopsy procedure. This is a great leap from the blind biopsy approach enabling the potential savings of millions of dollars to the healthcare industry. The secret to success involved the use of a 3.0 Tesla magnetic resonance imaging spectroscopy scan (MRI-S), which predicted and confirmed the presence of prostate cancer.

This technology represents the most sensitive and specific diagnostic modality for the prostate evaluation worldwide, replacing other scanning procedures such as the positron emission tomography (PET) scan, computed tomography (CT) scan, and Prostascint scans. The MRI-S at 3.0 Tesla allows imaging of the entire prostate, thereby creating a roadmap, allowing selective targeting of specific areas of interest for biopsy when indicated. In many cases, a biopsy is not recommended as no cancer is found. Furthermore, this methodology allows for fewer biopsies versus the "shot in the dark” 12-24 core biopsy approach or the saturation biopsy, thereby minimizing risk to the patient.

A recent case of a 71-year-old man evaluated at the Center illustrates the benefit of the 3.0 Tesla MRI -S. In 1997, his PSA was measured at 3.7 ng/ml. Presumed to be normal, the PSA was not tested again until 2001, when it was 7.2 ng/ml-well above the 4.0 ng/ml level of concern. A biopsy using a traditional ultrasound evaluation resulted in eight negative cores. The following year, the patient's PSA was 11.5 ng/ml. This time, in addition to the gray scale ultrasound, physicians used color flow Doppler (CFD) ultrasound to isolate areas of blood flow, important to prostate cancer growth. Despite the use of CFD to target areas of interest, the biopsy results were once again negative. Frustrated, the patient turned to the 3.0 T MRI -S scan. Despite a lack of evidence for cancer on the physical examination of the prostate, the scan located a discreet, well-defined 4.5 mm lesion deep within the peripheral zone of the mid-prostate on the left side. Subsequently, five targeted biopsies identified an aggressive cancer. Having established that the tumor was organ-confined with no evidence of spread to the surrounding tissue, the patient was now able to focus on viable treatment options.


Related Links:
Diagnostic Center for Disease