Prostate biopsies have
been recommended when the PSA (Prostatic Specific Antigen)
gets up. However, there are many conditions besides prostate
cancer that heighten the PSA, being the most frequent
urinary infections, tumors, cysts, stones, sexual activity,
transrectal exams and mainly the prostate biopsy.
WHAT IS A PROSTATE BIOPSY?
A prostate biopsy is a surgical procedure in which the
prostate is perforated generally through the rectum to
obtain prostate tissue for examination by the pathologist
looking for cancer.
HOW IS IT DONE?
There are two methods to do a prostate biopsy and both use a
needle made up of a section ending in a point which slides
inside a thin cylinder. On turning or returning the internal
segment within the cylinder produces an incision and cut.
The most common technique is to use a flexible needle
attached to an ultrasound probe through the anus and go
through the rectum wall with the needle until reaching the
prostate. The other method uses a rigid needle perforating
from the space between the scrotum and the anus, going
through the tissue until reaching the prostate, using the
guide of an ultrasound probe introduced in the rectum and
parallel to the needle.
In both cases a spring pistol is used which shuts the
internal part of the needle ahead to later retreat and cut
prostate tissue during the retraction. It is common for
biopsies to involve 24 or more shots, each of which is very
IS IT PAINFUL?
It is painful unless general or regional anesthesia is used,
regional (spinal), as local anesthesia is inadequate.
WHAT IS A PROSTATE BIOPSY GOOD FOR?
A prostate biopsy is useful for classifying the tumor,
principally through theGleason Technique, which is
very subjective and depends heavily on the ability of the
pathologist, as the tissue sample is minimal and often is
useless for the diagnosis, which explains why almost all the
biopsies show nothing unusual.
CAN THE BIOPSY POSITIVELY ASSURE THAT THERE IS NOT ANY
No, as less than1% of the prostate tissue
is examined in each biopsy, which means that more than
99% of the gland is without examining, which also
explains why almost all the biopsies show nothing abnormal.
For example in the case of a prostate of 90 cc and a tumor
with the diameter of 12 mm- see illustration, it is almost
impossible to detect.
No technique can exclude the possibility of cancer. The
biopsy can only detect cancer when this is detected in the
tissue sample taken. A study of Dr. Roehl published in the
Journal of Urology says that only 29% of the cases of cancer
could be detected in the first biopsy.
WHY CAN´T A BIOPSY EXCLUDE THE POSIBILITY OF PROSTATE
1. Only 1% of the gland is examined in each
biopsy. That means that the possibility of not
detecting the cancer is 99%
2. If the cancer is very small, for sure it will
not be detected
3. If the cancer is located in a part of
difficult access it probably won’t be detected
4. If the pathological exam is superficial or
done in a hurry, for sure it won’t be detected
5. Prostate cancer has a hard consistency and it
is easy for this hardness in the tumor to deflect
the needle especially in the technique using a
6. When needles are reused they lose their sharp
edge and thus don’t cut well. This makes the biopsy
even more painful (there are between 7 and 24 shots)
and this reduces the amount of adequate tissue for
the pathologist to examine. The reuse of the pistols
reduces the effectiveness of the springs, making the
cut less effective and more painful. The more the
spring is used, the more fatigue it suffers.
Before a prostate biopsy is taken, the patient must sign
a written consent where he is informed about the risks
involved and also about the possibility of the test not
detecting cancer even if it is present. The list of
complications is shown below:
PROSTATE BIOPSY COMPLICATIONS
a- Septicemia which is a severe infection of the
blood which gets worse rapidly until septic shock is
produced and is potentially deadly. It can cause circulatory
problems, kidney failure, abdominal lung, bone, and
b- Infections transmitted such as hepatitis and AIDS
as well as abbesses in the punctured area and urinary
c- Hemorrhages and hematomas, blood in the urine,
abundant bleeding from the anus and in the semen.
d- Arteriovenous Fistula
e- Tumor dissemination as cancer cells are released
and travel through the blood
f- Bladder perforation
g- Urinary obstruction, caused by inflammation as a
result of the biopsy
h- Severe pain i- Strokes (we knew of this from several of the
persons who consulted us by email and in person, who did not
follow our advice and had a biopsy
j- Perineum abscesses, which may appear later (2
months or more)
k- Erectile dysfunction sexual relations deteriorate
or become more difficult
l- Loss of desire and reduced sexual activity which
may be permanent
CAN THE PROSTATE BIOPSY BE AVOIDED? It is possible to avoid a prostate biopsy if a Prostate- C.M.P. can be performed, along with a prostate
specific antigen (PSA).
The principal use of a prostate biopsy is to classify the
tumor but this can also be done during surgery. In other
cases the seriousness of the situation makes the biopsy
unnecessary, for example when there are metastases (the
spread of the cancer in the body) or when a person for one
reason or another can’t, or doesn’t want to be operated on
or receive treatment reducing their quality of their life.
Before a prostate biopsy should be programmed, a complete
evaluation of the body should be done to know if there
are metastases and the size of the tumor.
The biopsy might be of help but it also can extend the
tumor and cause serious complications mentioned previously.
has a sensitivity of 99.8% (it
detects 5 times more diseases than conventional tests)
thanks to the color processing after the exam. Its
precision is also greater thanks to C.A.D. (computer
aided diagnosis). Because of this, it usually does not
require biopsies. (In contrast if a malignant tumor is small
the biopsy is usually negative as the needle rarely
penetrates it). If a tumor is not visible in ultrasound
the biopsy will result negative for sure.
THE RISK OF SPREADING PROSTATE CANCER WITH BIOPSIES
Normally the body tries to isolate that which is causing
harm, including malignant tissue around which the organism
usually builds an isolating wall. The more malignant the
tumor, the weaker the wall.
When this wall is penetrated by an instrument, for
example the needle for the biopsy, a hemorrhage is produced
and the cells previously enclosed by the wall are released
into the bloodstream and transported all over the body,
facilitating metastasis, which are secondary points of tumor
tissue outside of the original tumor.
The immune system usually protects from the invasion of
tumor cells the same way it protects against infections. But
when the immune system isn’t enough, metastasis occurs. When
the tumor is perforated, tumor cells are released into the
bloodstreem, increasing the possibility of metastasis. In
the case of the prostate, the metastases usually appear in
In summary: a small, slow growing cancerous tumor
subjected to a biopsy may spread more rapidly all over the
body, invade the bones, other organs and lead to death.
A prostate biopsy usually consists of at least 7 shots
with the needle and because of this, the possibility of
metastasis increases considerably. No prostate biopsy (or
any biopsy) should be taken lightly. There are other
advanced diagnostic methods which provide much more
information such as
Most prostate biopsies are very painful and can have
severe complication, among these being the spread of the
tumor if this exists, infections and hemorrhaging. Biopsies
frequently are negative but this does not mean that there
is no cancer.
Additionally the trauma of the biopsy produces swelling.
Repeating the biopsy can result in chronic inflammation and
there is clear evidence relating chronic inflammation with
the appearance of cancer.
EXPERIMENT SHOWING THE DANGER OF BIOPSIES
A simply experiment shows us how living tissue loses
resistance and deteriorates when it is perforated. The
damage is directly proportional to the diameter, thickness
and depth of the perforation, to the contamination of the
perforation and to the number of perforations, and is
inversely proportional to the distance between the
The experiment requires:
1. A large needle at least 80 mm long, and a
maximum of 1 mm diameter and slightly contaminated
with dirt similar to the contamination of the
2. Two identical apples ( o pears, or similarly
firm fruit) similarly ripe not too hard and not too
soft, the size of a medium orange, and ideally still
attached to the plant for the greatest similitude to
the prostate, but also loose fruit can be used.
3. A sharp knife
Perforate with the dirty needle one of the pieces of
fruit 10 times in different directions (the biopsy requires
between 7 and 24 perforations) but all from an area with a
diameter of at the most 15 mm (to be similar to the
perforations in the prostate biopsy). Move the needle in and
out several times and turn it to be like the shots during
Don’t do anything to the other piece of fruit.
Leave both pieces of fruit in observation for 10 days.
Then cut both pieces in 3 or 4 parallel circular sections
and observe them.
Compare the condition of the two pieces of fruit. Observe
how the piece that was perforated suffered much more than
the piece not subjected to the perforations.
If by chance the perforated fruit contained a worm
(analogous to cancer) and this was perforated by the needle,
the tissue and the liquids of the worm would be spread by
the perforations in the fruit accelerating the rotting
process. The possibilities of perforating the worm are
similar to those of perforating the cancer.
The results don’t require more explanation. Both the
fruit and the prostate are living tissue and behave
similarly though naturally the deterioration of the fruit is
more rapid as its life cycle is considerably shorter.
UNIVERSITY OF CALIFORNIA, SAN DIEGO STUDY
In a study carried out at UCSD more evidence was
discovered related with the inflammation reaction and the
The study says textually "Our results suggest that
stimulating the inflammation of cancerous tissue, for
example in prostate biopsies, may, ironically, promote
The first tumor confined to the prostate can be treated,
but this is not the same after metastasis.
This study was sponsored by the National Institute of
Health, the U.S. Army Medical Research and Material Command,
the Prostate Cancer Foundation, the Aventis-UICC
Translational Cancer Research Fellowship, the Lopiccola
Fellowship of the UCSD Moores Cancer Center and the Life
Sciencse Research Fellowship.
The study was published March 19/07 and with the
permission of the author Debra Kain, the original study than
can be read following
Though ideally the prostate biopsy should
be avoided, many patients feel intimidated by professionals
who insist on it and they end up subjecting themselves to
Their frequent complications can be fatal
and one of the most common and dangerous is septicemia,
which can cause neurological problems from embolism and
thrombosis as a result of the infection. It is indispensable
that those who decide to accept the risks of biopsies take
the following precautions:
1. Before the biopsy they should
buy a good thermometer
2. They should learn to take
their pulse and verify it for several days, noting
3. Plan on staying near a good
hospital with an intensive care unit (ICU) and
microbiology laboratory open 24 hours a day for 2 or
3 days after the biopsy.
4. After the biopsy they should
take their temperature every hour and if it exceeds
99.5 Fahrenheit (37.5 centigrade), go to the
emergency room of the hospital
5. Not take antibiotics not
prescribed by their doctor.
6. Not take any medicine for
fever as it may hide the symptoms of septicemia.
This includes many pain killers.
7. If the pain increases, go to
the emergency room
8. If they can not urinate they
should immediately go to the emergency room as an
abscess may be blocking the urinary duct and the use
of a catheter may puncture it and result in
9. Request that they measure the
pulse every hour. If it goes up more than 35% over
their normal pulse, go to the emergency room.
10. If they feel weak or
neurological symptoms, they should go immediately to
the emergency room.
11. Not wait, as proper care of
any of the symptoms mentioned may make the
difference between life and death
Ideally the procedure should be performed
by qualified personnel and you should stay at the hospital
at least 2 or 3 days after the biopsy. But as this almost
never happens, it would be good to print this guide and
follow the instructions if you choose to have a biopsy.
The best thing to do is avoid it. There
are much better alternatives completely safe as follows:
HOW TO AVOID A PROSTATE
You can avoid the prostate biopsy with the following
results negative for
biopsy is necessary
2. If the
Prostate- C.M.P. is
suspicious, have a bone scan and color CAD prostate
ultrasound after also having the prostate antigen,
biopsy is necessary
3. If the
Prostate- C.M.P. is
positive for prostate CA have a bone scan taken. If
it is positive for metastasis, you have a prostate
biopsy is not necessary
4. If the bone scan is negative for metastasis
Prostate- C.M.P. is positive
for prostate CA you should consider how your health
is in general and that of your prostate to decide if
you need the operation, and if surgery is performed
a frozen section examination should be done during
the surgery to determine the size and
characteristics of the tumor and be able to decide
on the type of surgery to be done, after previously
considering other treatment options:
no biopsy is necessary
5. If the PSADI is going down (the speed of the
PSADI is negative)
no biopsy is necessary
6. If the PSADI is going up (the speed of the
PSADI is positive) and the bone scan is negative
you can discuss the possibility of a biopsy
considering its advantages, risks, and
disadvantages, remembering that most biopsies result
negative even when there is cancer, and many times
diagnose cancer when there isn’t any. A
negative biopsy does not rule out cancer. You should
also remember that prostate cancer is one of the
slowest growing cancers and thus does not require
urgent treatment, and usually doesn’t require
anything at all, thus
biopsy is necessary.
Therefore, only in a small fraction of the cases could
the possibility of cancer be considered: When the
PSADI is increasing.
Summary: The indiscriminate practice of prostate biopsies
is unnecessary and dangerous. There are methods with a
better relation of risk/cost/benefit such as Prostate- C.M.P.
Cancer diagnosis through biopsies is not infallible, as
most of the time it doesn’t detect even if the cancer is
present. Sometimes there are wrong diagnoses of cancer even
if there is nothing, as other factors cause similar tissue
changes. For example the following cause histopathologies
easily confused with prostate cancer: Atrophy, Mucinous
Metaplasia, Cowper gland infections, Post-atrophic
hyperplasia of the prostate, Prostate Sclerosing adenosis,
Prostate Xanthoma (see link).
The dangers of prostate biopsy are real and for that
reason each patient having one needs to sign a waiver
releasing those who perform it of any responsibility. The
consequences of the biopsy can be fatal.
Having a high PSA does not justify a prostate biopsy as
there are many causes which can raise this and cancer is
only one of them.
As most biopsies are negative, patients are often
subjected to several, which increases the possibilities of
developing cancer because of the repeated inflammatory
reaction and there is also the risk of spreading it (see
The biopsy is not a treatment. It is only a diagnostic
tool which has limited probability of success and should be
left as the very last resource and only for a reduced number
Questions that the person receiving the biopsy should
1. Is the biopsy painful?
2. What risks does the biopsy have?
3. If the biopsy is negative does that guarantee
that I don’t have cancer?
4. is there any risk of spreading the cancer with
5. What secondary effects does the biopsy have?
6. If the biopsy is negative, will they repeat it
7. Why should I sign a waiver relieving those who
practice the biopsy of any responsibility?
Answers to expect from the above questions:
1. It is very painful
2. There is risk of: death, septicemia, stroke,
prostatitis, urinary infections, and erectile
3. There is no guarantee. You can have prostate
cancer even if the biopsy is negative
4. There is a risk of spreading cancer cells if
there is prostate cancer (see
5. Pain, impotence, fever, difficulty urinating,
blood in the urine, blood in the semen, erectile
dysfuntion, prostatitis, elevated PSA, etc.
6. Yes, unless you refuse to repeat
7. Because the possibilities of causing serious
secondary effects are very high and can be fatal
If prostate biopsies are so dangerous, why do they
continue performing them?
Because the number of fatalities is not high enough yet
to call the attention of the media.
The same goes for the medicines taken off the market due
to their serious side effects such as thalidomide; tobacco,
cocaine introduced in the USA to treat morphine addiction,
etc. Unfortunately the voices of the “experts” prevail over
In the mean time, patients subjected to
prostate biopsies will continue suffering the consequences
as confirmed by those who have acceded to it.
A biopsy is not indispensable nor is it even
an urgent surgical procedure
A prostate biopsy is extremely painful
It cannot confirm if there is cancer or not
with any certainty
It can cause an infection in the blood
(septicemia) and even death
It can cause strokes and even death
It generally causes serious infections
It causes hemorrhaging into the urine
It causes bleeding into the semen
It causes bleeding into the rectum
It can cause arteriovenous fistulas (A
connection between a vein and artery. The blood
from the two gets mixed.)
It can cause existing cancer to spread
It facilitates the appearance of cancer in
proportion to the number of perforations and
repetitions because the inflammation caused by a
biopsy can result in cancer
It can cause perforation of the bladder
It can cause urine retention
It can cause a perineal abscess (in the
It usually causes sexual dysfunction and
It reduces sexual desire
It will almost never show cancer but most
doctors will have it repeated until cancer does
The biopsy is not indispensable and is not
an urgent intervention
The prostate biopsy can be
Prostate biopsies are usually
requested when the PSA goes up. But the PSA can go
up for many reasons besides cancer.
One of these reasons is precisely
the prostate biopsy. Each time the biopsy is
performed, the PSA goes up much more.
If instead of a biopsy of the
prostate, a Prostate- C.M.P. is performed,
which includes a color CAD ultrasound of the
prostate, bladder, ureters, seminal vesicles,
testicles, etc., the cause of the elevated PSA will
be found including cancer.
Once the cause is known, and if
no cancer is suspected, it can be corrected with
adequate treatment and the PSA will go down making
as biopsy unnecessary.
for the Prostate C.M.P.
Be in Bogotá from the night before the exam
Eat a bland diet the night before the exam
The day of the exam, not consume anything except
for a liter of water which should be drunk 10
minutes before the exam, without urinating until
after the examination of the bladder.
Not take any medicine the day of the exam unless
it is indispensable (Ask if it can be taken
Have a travad (or similar) intrarectal enema
(not oral) of 1 liter 3 hours before the
appointment, holding it 15 minutes before
Immediately after releasing the enema a thorough
cleaning of the anus with abundant soap and
water, preferably showering. If evacuation is
repeated, a cleaning of the anus with soap and
water should be repeated. There should be no
remains of fecal material or toilet paper.
If the patient uses contact lenses, they should
bring the case and liquid as they may need to
remove them briefly.
Not use talcum powder or cologne except for
Trim the hair in genital area with scissors
10.Bring any imaging exams carried out in the
last year (older than that are useless)
11.Bring laboratory exams carried out in the
previous month (older than that are no good)
Ries LAG, Eisner MP,
Kosary CL, et al. (eds). SEER Cancer Statistics Review,
1975–2001, National Cancer Institute. Bethesda, MD, 2004
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of
prostate cancer among men with a prostate-specific antigen
level 4.0 ng per milliliter. The New England Journal of
Medicine 2004; 350(22):2239–2246.
Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies
in men with persistently elevated serum prostate specific
antigen values. The Journal of Urology 1994;
Biopsy can distinguish
cancer from non-cancer just when they puncture the
cancer. Statistics show that for any reason most
Biopsies do not puncture cancer
Biopsy is not infallible
Biopsy has important
Biopsy can spread cancer
Biopsy is expensive
(about USA $1000=)
There are safer
alternatives with different approaches
Conclusion: The PSA gets
higher because of many conditions besides prostate
cancer. If they want you to have a prostate biopsy taken
because your PSA is high you should first find out what is
heightening your PSA and try solve it. If they can solve it
and the PSA normalizes, there will be no need to perform any
Prostate Ultrasound with Urosonography detects most
conditions heightening the PSA and makes the prostate biopsy