There are around One Million prostate cancer biopsies
performed each year in the USA. Many of these, as much as 75%, will be negative
for cancer. The process is reasonably, to minimally painful. It is usually
performed as an outpatient procedure. What doctors don’t often tell you is that
cancer cells can be missed even when the biopsy is guided with trans-rectal
ultrasound; that up to 4% of men who have a biopsy need hospitalization for
infections that are resistant to antibiotics; and even a single biopsy may
over time spread cancer outside the prostate, increasing the need for more drastic
treatment. As one senior oncologist put it, the biopsy process creates wounds
in the prostate. These are along the paths where needles are inserted to obtain
tissues for testing. To heal that wound the body brings in growth hormone
causing cells to grow faster. Prostate cancer loves growth hormone and when a
biopsy needle punctures a cancer cluster, the cancer cells will grow out along
the path of the wound (like little pacmen gobbling the growth hormone) until
they eventually escape from the prostate. The cancer then starts circulating
within the body looking for another place to attach and grow.
While a prostate biopsy does define the presence and severity
of any cancer it finds and may never be completely eliminated, the issue
becomes what of the approximate 75% of men where cancer is not found. Are these 750,000 biopsies putting men to unnecessary risk? What about
the prostate cancers the biopsy needles miss? Are these men missing a chance to
take early steps that might help their bodies to fend off an initial cancer attack,
or be more easily cured? Fortunately there are a few new tests promising better
reliability, and a safer process. Unfortunately some of these are so new that
they are not yet covered by insurance. They include the ONCOblot Test looking
for the ENOX2 protein, the MiPS Test looking for a specific gene fusion in
urine to define the probability of prostate cancer, and better MRI/ultrasound
imaging. Just click on these links, or go Prostate Screening Tests at the top
of this page to find out more.
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