Prostate Biopsy- Is it a Perfect Procedure?

Joseph C. Presti Jr. says in "Prostate Cancer: Principles and Practice" (page 23):

"...needle biopsy of the prostate represents a sampling of the gland, and accurate prediction of tumor grade within the prostate may be hindered by sampling error. In general, in several series correlating tumor grade on the biopsy with the grade of tumor in the radical prostatectomy specimen, needle biopsies exactly correlate with the prostatectomy in 31% to 59% of cases. The magnitude of this grading error is greater than or equal to 2 points in the Gleason sum in 26% to 38% of cases, with the needle biopsy more likely underestimating the tumor grade in comparison to the radical prostatectomy specimen."

In the book "Prostate Cancer", by Sylvan Meyer and Dr. Seymour C. Nash (page 55), Dr. Nash says:

"Why are so many prostate cancers understaged, some 50% of the cases we operate on? Because we got them tardily. Because PCa is a multifocal disease. It may not just be in one spot. It hides. In a rectal exam, there are multiple areas you can't feel. I'd say half the cases are multifocal and not in one area. That's why if you biopsy one area and the cells are well differentiated, another area could be totally undifferentiated. So, what you get in tests may not be what's there. "

In Ferris Clinical Advisor 2004-6th Ed (page 491), we read the following:

"The use of serum-free PSA for prostate screening has been proposed by some urologists as a means to decrease unwarranted biopsies without missing a significant number of prostate cancers. This approach is based on the higher free PSA in men with benign prostatic hyperplasia and the higher protein-bound PSA levels in men with prostate cancer. For example, in men with total PSA levels of 4 to 10 ng/ml, the cancer probability is 0.25, but if the percent free PSA is =17%, the probability of cancer increases to 0.45."

So unfortunately no, it's not perfect. The tumor is a compact mass of cells and that is what is normally felt during a DRE. Some cancers are already in an advanced stage, and only few biopsy samples are needed. But we should not forget that "cancer" means "crab". This gives us a clue of its possible complexity: it can have many small legs, spreading throughout the prostate and even worse, metastasizing throughout the body. Which is why sometimes, "more" is "better" as far as prostatic samples are concerned.

Someone compared a prostate biopsy to chasing a worm inside an apple, with a needle: there's a possibility you won't get it the first time.

But it is extremely useful in many cases...

Related prostate health articles:

• The Prostate Biopsy: The prostate biopsy is an important part of the diagnosis because an accurate and early estimation of tumor grade significantly helps prostate cancer patients in their management of prostate disorders.
• Prostate Biopsy Evaluation & Results: Tissues are graded according to their ability to retain their normal appearance. The more disrupted the normal glandular architecture, the higher the grade of tumor and the poorer the prognosis…
• Prostate Biopsy- How is it done? Procedure…: There is an ongoing refinment of the prostate biopsy process, adapting it to prostates of different sizes and shapes.
• Prostate Biopsy- How does it feel?: Most people only feel a slight sting, while others accuse very bad consequences (such as prostatitis) following prostate biopsy.
• Prostate Biopsy Risks & Side-effects- Are there any?: Sometimes people ask about prostate biopsy side effects, or about prostate biopsy risks . The greatest risk is not getting accurate prostate samples, that is not making correct conclusions as a result of the biopsy.

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