10. Prostate needle biopsies damage the prostate:
A prostate biopsy is the most common method to diagnose prostate cancer. Patients are sometimes concerned that when conducted with a needle, the biopsy could damage the prostate. However with preparation, patients do not suffer from a prostate needle biopsy, which also has low rate of infection or other urinary problems.
11. Prostate needle biopsies can spread the cancer:
Prostate cancer can spread to other parts of the body, but there is no scientific evidence that needle biopsies can cause metastatic spread. In fact, the biopsy is performed using an 18g spring-loaded biopsy needle, which is removed with the sample tissue and stored when the trocar is taken from the prostate. This means that the diseased tissue never touches other healthy tissue.
12. Prostate cancer grows slowly and does not need to be treated:
There are different types of prostate cancer–some of them grow slowly and others grow and spread aggressively. In fact, there are cases in which treatment may not be required but it depends on many factors and needs to be decided by both patient and physician. However, prostate cancer is the second most deadly type of cancer among men in the U.S.A. This is why it’s important to be followed by a specialized physician, who will evaluate the tumor volumes, the Gleason scores and the regions of the prostate involved, as well as recommend the best course of action.
“total PSA only may not be cost effective, evaluation of individual men with the PSA as well as the %free PSA may be”
May be but no one knows yet.
So it’s still the same as PSA screening in general. No-one has ever shown that PSA screening, or even PSA screening of a chosen risk group, leads to an overall saving of lives.
It’s about time someone showed that PSA screening of any risk group at all leads to an overall saving of lives.
Regarding your statement:
“An imaging study including an MRI, CAT scan, or ultrasound is not used to diagnose prostate cancer. They may be requested by the physician to evaluate the presence of suspicious areas to be targeted during a biopsy or to evaluate the extent of the cancer. However, it’s a myth that an MRI can substitute a prostate biopsy.”
I would take major exception with your statement. Imaging before biopsy should become standard of care, the same as it is for women suspected of having breast cancer. What woman do you know who would submit to having 150 needles stuck in her breast to see if maybe they hit something and then go get a mammogram to see if they see something? Urologists have this entirely backwards. Random TRUS biopsies should be relegated to some dark closet of the past. TRUS biopsies regularly miss 40% of clinically significant cancer. Modern mp MRI scans have both a negative and positive predictive value of over 90% for prostate cancer. When a man is suspected of having prostate cancer the first step should be an mp MRI scan. If an area suspicious for clinically significant cancer is found, then an MRI guided biopsy targeting the suspicious area is warranted.
Standard TRUS biopsies regularly cause swelling and inflammation in the prostate which often results in a rise in PSA leading to more unnecessary biopsies. Erectile Dysfunction as a result of biopsy is not uncommon. The infection rate of TRUS biopsies is up to 4.5% and often results in hospitalization.
While a biopsy is the only way to diagnose prostate cancer, it should be a targeted, MRI guided or MRI/US fusion guided biopsy, not a TRUS biopsy.