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Prostate biopsy:  18 reasons to avoid it                          
 
     

 

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Prostate Biopsy                                                           Free medical advice

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 painful,

IS IT PAINFUL?
It is painful unless general or regional anesthesia is used, regional (spinal), as local anesthesia is inadequate.


TRUS Prostate Biopsy: needle in red; prostate in magenta
As seen, it is easy to hurt the bladder

 

WHAT IS A PROSTATE BIOPSY GOOD FOR?
A prostate biopsy is useful for classifying the tumor, principally through the Gleason 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 PROSTATE CANCER?

No, as less than 1% 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 CANCER?

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 flexible needle

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 neurological complications.
b- Infections transmitted such as hepatitis and AIDS as well as abbesses in the punctured area and urinary infections.
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.

NON INVASIVE METHODS TO EVALUATE PROSTATE CANCER:

The Prostate- C.M.P.  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 the bones.

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 Prostate- C.M.P.

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 perforations.

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 rectum.

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 the biopsy.

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 metastasis. 

The study says textually "Our results suggest that stimulating the inflammation of cancerous tissue, for example in prostate biopsies, may, ironically, promote metastasis…”

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 this link

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 biopsies.

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 their average.

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 septicemia

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 BIOPSY

You can avoid the prostate biopsy with the following exams:

1. Prostate specific antigen (PSA)

2. Prostate- C.M.P. which detects all the known causes for the PSA to go up.

Results:

1. If the Prostate- C.M.P. results negative for prostate CA, no 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, no 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 CA and biopsy is not necessary

4. If the bone scan is negative for metastasis and the 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 no 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 this link).

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 of cases.

Questions that the person receiving the biopsy should ask:

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 the biopsy?

5. What secondary effects does the biopsy have?

6. If the biopsy is negative, will they repeat it again?

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 dysfunction, etc.

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 this link)

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 common sense.

In the mean time, patients subjected to prostate biopsies will continue suffering the consequences as confirmed by those who have acceded to it.

Prostate biopsy: 18 reasons to avoid it

  1. A biopsy is not indispensable nor is it even an urgent surgical procedure
  2. A prostate biopsy is extremely painful
  3. It cannot confirm if there is cancer or not with any certainty
  4. It can cause an infection in the blood (septicemia) and even death
  5. It can cause strokes and even death
  6. It generally causes serious infections
  7. It causes hemorrhaging into the urine
  8. It causes bleeding into the semen
  9. It causes bleeding into the rectum
  10. It can cause arteriovenous fistulas (A connection between a vein and artery. The blood from the two gets mixed.)
  11. It can cause existing cancer to spread (metastasis)
  12. 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
  13. It can cause perforation of the bladder
  14. It can cause urine retention
  15. It can cause a perineal abscess (in the crotch area)
  16. It usually causes sexual dysfunction and impotence
  17. It reduces sexual desire
  18. It will almost never show cancer but most doctors will have it repeated until cancer does appear

The biopsy is not indispensable and is not an urgent intervention

The prostate biopsy can be avoided

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.

 

 Preparation for the Prostate C.M.P.

1.   Be in Bogotá from the night before the exam

2.   Eat a bland diet the night before the exam

3.   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.

4.   Not take any medicine the day of the exam unless it is indispensable (Ask if it can be taken beforehand)

5.   Have a travad (or similar) intrarectal enema (not oral) of 1 liter 3 hours before the appointment, holding it 15 minutes before releasing.

6.   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.

7.   If the patient uses contact lenses, they should bring the case and liquid as they may need to remove them briefly.

8.   Not use talcum powder or cologne except for underarm deodorant.

9.   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)

Appointments

 

References:

Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 1975–2001, National Cancer Institute. Bethesda, MD, 2004 (http://seer.cancer.gov/csr/1975_2001).

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; 151(6):1571–1574.

Inflammation in prostate carcinogenesis. Angelo M. De Marzo1,2, Elizabeth A. Platz3, Siobhan Sutcliffe3, Jianfeng Xu4, Henrik Grönberg5, Charles G. Drake2, Yasutomo Nakai6, William B. Isaacs7 & William G. Nelson2 

University of California, San Diego research published March 19,2007

Sum up this facts:

  • 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 risks

  • Biopsy can spread cancer

  • Biopsy hurts

  • 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 biopsy.

C.A.D. Color Prostate Ultrasound with Urosonography detects most conditions heightening the PSA and makes the prostate biopsy unnecessary.

appointments

Dr. Gonzalo Díaz M. C.A.D. Color Ultrasound - Telemedicine
Cl 73 10-10 Of 404 Bogotá, Colombia
Tel (571)2487018Mobile (57)3102536047     

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Free medical advice about Prostate, Male Urinary tract and Genitalia

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