Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, you will be asked about symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.
Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.
After the exam, your doctor might then order some tests.
How Long Does It Take For The Prostate Gland To Heal After A Biopsy
The recovery process after biopsy depends on factors such as a patients age and overall health. While doctors keep saying prostate biopsy is easy, the recovery process isnt that simple.
It may take four to six weeks to recover. For some men, it can take longer than that, even when they adhere to all the instructions.
A New Biopsy Technique To Diagnose Prostate Cancer And Reduce Risks Of Infections
Each year, over 1 million men undergo prostate biopsies to diagnose or rule out prostate cancer. For these men who need a biopsy, there is now an alternative approach that is safer, with significantly lower risks of infection, and potentially higher rate of tumor detection.
While most prostate biopsies are performed through the rectum , there is a means to obtain prostate tissue samples through the perineum using an external entry point at the skin. The technique, known as transperineal biopsy, is now offered to men who are good candidates for this approach. In this modification of the standard transrectal approach, doctors take samples of the prostate tissue through needles directed through the perineum, the area of skin located between the rectum and the base of the scrotum.
In contrast to the transrectal approach, which typically involves 12 or more separate needle punctures from inside the rectum, a specially designed device used with the transperineal approach limits the number of biopsy needle insertion points to two – one for each side of the prostate. This further reduces the chance of infection and other side effects.
Fox Chase Cancer Centers urologic oncologist group has expertise in transperineal biopsy techniques and recently began offering this alternative procedure to patients.
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How We Approach Prostate Biopsies And Prostate Cancer Diagnosis At Ctca
When you come to CTCA for a prostate biopsy or a second opinion, youll have access to tests that may help increase the accuracy of each biopsy. Our team has expertise with these tests and procedures, allowing us to work quickly and efficiently.
If youre diagnosed with prostate cancer, a multidisciplinary team of genitourinary experts, which may include a urologist, a urologic oncologist, a radiation oncologist and a medical oncologist, will review your case and develop a personalized plan based on your specific circumstances and needs.
We only treat cancer at CTCA, which means our cancer experts are skilled at assessing risk associated with each persons circumstances. We give you the pros and cons of the treatment options available to you, allowing you time to talk with your team of doctors and other experts about those options.
Our cancer experts are also vigilant about what patients need and when they need it. We know that when men are told they have slow-growing prostate cancer, some of them wont keep up with the necessary follow-ups, so we help keep them on track.
If you choose to receive treatment with us, you may benefit from our integrative approach to cancer treatment. Our multidisciplinary team works together to help prevent and manage the side effects of cancer and its treatment, providing supportive care services, such as:
What Happens If You Have A Likert Score Of 3 Or More
This result on its own doesnt mean that you definitely have prostate cancer. But its more likely that you do. Your doctor is likely to recommend for you to have a biopsy.
The MRI scan also helps doctors know where to take the biopsy from. You usually have tissue samples taken from the suspected area of cancer and also from the rest of the prostate. Doctors call these targeted biopsies and systematic biopsies. This is because not all cancers can be seen on an MRI scan.
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Additional Tests That May Aid Prostate Cancer Diagnosis
There are few other diagnostic tools or tests, which can be performed before you have a prostate biopsy, that may help your physician gather more information about your specific case. These procedures may help determine the likelihood of the presence of cancer and its aggressiveness and increase the accuracy of a biopsy when performed. Those tests include:
4Kscore blood test is a molecular test that helps predict the likelihood and risk of a patient having aggressive prostate cancer. If you’re a patient whose PSA values are borderline for a prostate biopsy or you have a condition that could be aggravated by a biopsy, your physician may use this test before to help determine whether you should get a biopsy or a repeat biopsy.
Urine sample testlooks for biomarkers that may indicate the presence of prostate cancer cells in a patient’s body. This test may also be helpful when trying to determine whether a patient should be rebiopsied or not.
Multiparametric MRI
The use of multiparametric MRI imaging of the prostate gland before a biopsy has been a game changer in prostate cancer diagnosis, increasing the accuracy of biopsies over standard biopsies. The mpMRI doesn’t replace the standard biopsy, but by improving its accuracy, it may help decrease the number of biopsies needed.
The mpMRI has a higher resolution than a standard prostate ultrasound. This increases the ability to see suspicious lesions in the prostate, providing additional targets for the biopsy to sample.
Benefits Of Getting A Prostate Biopsy
A prostate biopsy is the only way to definitively determine whether you have prostate cancer and, if you do, how aggressive it is.
While prostate biopsies arent always conclusive, in general, a biopsy gives men the reassurance of knowing whether they have cancer or not. If you know you have prostate cancer, youre more likely to be appropriately treated.
Appropriate prostate cancer treatment options depend on several factors, including the stage of the cancer, your age, your general health and which risk category your cancer falls into.
Localized prostate cancer is categorized into six risk categories, which range from very low-risk to very high-risk. The risk group is determined by the stage of your cancer, your PSA levels and the Gleason score obtained from the biopsy pathology report.
The National Comprehensive Cancer Network guidelines outline appropriate treatment options based on risk categories and whether the cancer has already metastasized.
Patients whose cancer is confined to the prostate and falls into the very low-risk and low-risk categories tend to have slow-growing cancers. Treatment options for these patients often include active surveillance, radiation therapy or surgery. Similar treatment options may be recommended to patients in the low-risk and favorable intermediate prostate cancer risk categories.
The NCCN guidelines recommend immediate treatment for patients with high-risk disease or those patients whose cancer has metastasized.
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Biopsy During Surgery To Treat Prostate Cancer
If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .
The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.
Similar Frequency And Alteration Patterns
The study presented at the ASCO meeting used a test developed by California-based Guardant Health, called Guardant360. The test uses next-generation sequencing to analyze DNA shed by cancer cells, known as circulating tumor DNA .
Funded by Guardant Health, the study used blood samples from more than 15,000 patients with more than 50 types of tumors. The researchers compared whether the Guardant360 test, which profiles ctDNA for mutations and chromosomal rearrangements in 70 cancer-related genes, detected alterations in these genes at the same distribution and frequency observed in previously published genomic profiling studies that used tumor biopsy samples, including The Cancer Genome Atlas.
And, by and large, the liquid biopsy test was highly consistent with gene alteration patterns reported in traditional tumor tissue testing. For example, Guardant360 identified the same critical mutations in important cancer-related genes like EGFR, BRAF,KRAS, and PIK3CA at frequencies very similar to what had previously been identified in tumor biopsy samples, statistically correlating to 94% to 99%.
The liquid biopsy performed well even though levels of ctDNA in most samples were extremely low, often less than 0.4% of the total circulating DNA in the blood, Dr. Mack said.
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Prostate Cancer: Advancements In Screenings
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
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Are There Alternatives To A Prostate Biopsy
Certain alternatives can sometimes be used to assist in diagnosing prostate cancer. It is important to note that these alternatives will not take the place of a biopsy. In many cases, the patient will still need a biopsy.
The use of these alternative methods can still be useful. They can be used as a way to ensure a biopsy is only conducted if completely necessary.
There are cases where a tumor in the prostate may be confirmed even before a biopsy is performed.
Some of the alternative tests that can be used are discussed below.
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Overdiagnosis And Insignificant Cancer
Clearly, the critical question is whether the cancer detected in sequential biopsies or saturation biopsies with increasing numbers of cores is clinically significant. There is mounting evidence that a substantial proportion of men with screen-detected prostate cancer would otherwise have not known about the disease during life in the absence of screening. In these men cancer treatment is not beneficial. Identifying the patients with newly diagnosed prostate cancer who have indolent disease for which surveillance or expectant management may be an appropriate alternative to immediate curative intervention is a timely and important issue. There is currently no marker of biologically indolent cancer. Although life expectancy and comorbidity are as important as pathologic characteristics of the cancer, most investigators have defined indolent disease according to pathologic stage, tumor volume, and cancer grade .
Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
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Transrectal Ultrasound Scan Guided Biopsy
Your doctor takes a series of small tissue samples from the prostate to examine under a microscope. You have the biopsy through the back passage using a transrectal ultrasound scanner.
A TRUS guided biopsy can be uncomfortable. You usually have a local anaesthetic to numb the area and reduce any pain.
Prostate Biopsy Alternatives And Cancer Treatment Options
Ive been a patient of the same urologist at the nearby DuPage/Duly clinic since my vasectomy about 15 years ago. I like my physician, but the office and staff have become increasingly unresponsive in recent years. This time, it took literally a month to hear back from an assistant when I inquired multiple times about having routine testing prior to my appointment. It got worse from there, as it became clear that my only point of communication was not even familiar with relevant diagnostic technology. For example, I tried to confirm that they used the standard for prostate imaging, a multiparametric 3T MRI that would be comparable to the one used for my last MRI in 2019. She apparently had not heard of it and could only refer me to the MRI department for information.
Ultimately, I was never able to discuss my concerns with the urologist or with his colleague to whom his assistant referred me for a biopsy. Messages on MyChart and those left with the office were routinely ignored. My last interaction with the office was a call when the urologists assistant alarmingly indicated that a biopsy was urgent because the MRI showed that I still had a PIRADS 4 lesion that is almost certainly cancer. Even though the same lesion was targeted in two negative biopsy samples in 2019, she enthusiastically indicated how essential it is to biopsy it again to confirm the cancer and start a treatment plan.
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Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.
Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.
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What Side Effects Can A Prostate Biopsy Have
The possibly low rate of success in prostate biopsies is not the only concern with the procedure.
Patients have raised other concerns when they undergo this diagnostic procedure as well. This would, of course, include the potential side-effects that may occur.
Individuals suspected of prostate cancer need to realize what to expect with any advised procedure. This includes the use of a prostate biopsy to detect cancer cells in their prostate glands.
Certain risks have been associated with a prostate biopsy. Most of these risks are considered mild.
There are, however, a couple of risks that need to be taken more seriously. These risks may lead to more significant damage. The complications can also sometimes become more severe.
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More Complications With The Tp Approach
As far as complications go, one man in the TRUS group developed an infection that was treated with multiple rounds of oral antibiotics. None of the TP-biopsied men got an infection, but eight of them had other complications: one had urinary blood clots that were treated in the hospital, two were catheterized for acute urinary retention, three were medically evaluated for dizziness, and two had temporary swelling of the scrotum.
Why were the TP noninfectious complication rates higher? That’s not entirely clear. For various reasons, doctors wound up taking more prostate samples on average from men in the TP group than they did from men in the TRUS group. The authors suggest if an equivalent number of cores had been taken from men in either group, then the complication rates might have been more similar. . But doctors in the current study also had more experience with TRUS biopsies, and that might also explain the discrepancy, the authors suggest. And as doctors in general become experienced with the TP method, complication rates might fall.
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases