Prostate biopsy     

 

       Dr Gonzalo E. Díaz M  - Ultrasound - Telemedicine             

 
     

 

Prostate

Avoid the Prostate Biopsy
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Prostate Biopsy

Prostate biopsy: 18 reasons to avoid it    

 
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Prostatitis                                                        

Prostatitis is a common disease that consists of the inflammation of the prostate usually as a result of infection. It can cause complications for neighboring structures and affect the kidneys and seminal vesicles. It is diagnosed by means of the prostate C.M.P. just like seminal vesiculitis. A sample of prostatic liquid is acquired through prostatic massage and a culture is done to determine the germ that is causing the infection. However, this should not be done until it has been determined by a C.M.P. that there are no contraindications since this could aggravate some diseases. It is usually treated with antibiotics and anti-inflammatories. If it is not treated, it could cause sterility and chronic urinary problems.

A rectal digital examination cannot be used to detect prostatitis since the only thing that can be done through it is to determine the shape and consistency of the posterior aspect of the prostate. It cannot detect the signs of prostatitis. The PSA usually rises when there is prostatitis.


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)

 

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.

 

 


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