Biopsy

[ieshepherd@yahoo.co.uk]

Can the biopsy procedure affect the distribution or progression of cancer cell development?

[Mr Benjamin Challacombe]

No there is no evidence that prostate biopsy can spread or worsen prostate cancer. There have been millions of biopsies and this has never been found with standard prostate cancer

[Suresh Rambaran]

I agree with the information provided by Ben as there are no evidence to say prostate biopsy can spread cancer. For details on prostate biopsy, please check this link http://prostatecanceruk.org/information ... cer#biopsy

[tackle prostate]

Regrettably I have to disagree with the esteemed contributors before me. There IS evidence that what is called "needle track seeding", i.e. spread of the cancer as a result of biopsy, can occur. A study carried out by Vincent Gnanapragasam and reported to the Prostate Cancer Advisory Group, which looked at data over the past 20 years, found that there is a risk of such spread, and that it might be as high as 1%. The study was published in BJUI in June this year. See http://www.ncbi.nlm.nih.gov/pubmed/24958224.

[Dr Jon Rees]

I would disagree with my esteemed colleague at Tackle - having looked at the paper quoted it states 'seeding is a rare complication after prostate biopsy' and quotes incidence at '<1%' not '1%'

I personally don't think it is a complication that shopuld worry patients - it appears to happen v rarely, regardless of route of biopsy, and if you need a biopsy, you need a biopsy and this isn't enough of a risk to significantly tilt that balance.

That's my view!

[ieshepherd@yahoo.co.uk]

Many thanks to you all for an interesting and helpful debate. Apparently statistical analyses require careful consideration of the resulting probabilities. It depends on one's own interpretation of negligible risk.

[tackle prostate]

Jon is right to say it's extremely rare, but <1%, does actually mean it might be (or was historically) as high as 1% (and I've discussed this with the author of the report). So that, for what it's worth, is the "(not so) good evidence".
Personally I know of at least two cases where the urologist has explained to the patient that he felt that the cause of subsequent progression after RP was needle track seeding. But that, of course, is just anecdote.
The key point here, in my view, is that biopsy is not without risk (particularly from infection), and those risks do seem to be increasing, but are generally underplayed by surgeons who seem to think they have no choice - how else can you confirm a cancer? But they do have a choice - multiparametric MRI, and the profession should be pushing very hard indeed to use MRI in the first instance and only to use biopsy in the same way as it is used for breast cancer, i.e. to locate and stage a tumour, rather than, at random, to see if there is one.
And, of course, the same argument applies to repeat biopsies, e.g. in Active Surveillance. If I were on AS I wouldn't permit repeat biopsy unless there were clear signs of progression.

[Dr Jon Rees]

I'll leave that one to Ben to reply to, as our MRI expert...

Jon

[Mr Christopher Eden]

Pre-biopsy multiparametric MRI scanning is certainly gaining traction as it allows targeted prostate biopsy. It's the norm now in West Surrey/North Hampshire. There's now plenty of evidence to support this stance.

[Mr Benjamin Challacombe]

Yes new Gold standard for diagnostics should be MRI before any biopsy
but only 90% effective at picking up intermediate and high risk disease and less so for low risk cancer.
Clearly trans rectal biopsy of the prostate has lots of risks- infection, bleeding, temporary erectile problems but tumour seeding really not one of them. Trans perineal biopsy is much better for infection risk but worse for retention rates.
Active surveillance protocols will probably change to MRI follow up as suggested