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Great question…apparently biopsy/Decipher score is currently the best way to determine aggressiveness; but even Gleason scoring is inaccurate in 20–30% or more cases, even at Centers of Excellence, according to Dr. Matt Cooperberg.
However, once diagnosed with low risk PCa, I believe we are very close to having noninvasive tests (such as MyProstateScore 2.0 - MPS2) which will eliminate the need for follow-up biopsies for those on Active Surveillance….possibly by the end of 2025.
Regarding your other comment:
Cutting around the margins (excisional biopsy) is the gold standard for a suspected melanoma, for a variety of reasons, including “seeding”, although spreading cancer through cutting into tumors is apparently rare.
Although metastasis, due to biopsy is apparently rare, it does happen.
Hopefully, biopsy methods are ever improving; but it’s a demonstrably fact that CTC’s are elevated after prostate biopsy.
A 2014 study showed 84% of men had elevated CTC’s 30 minutes after their biopsy.
The entire point of this thread is that prostate complications (other than the well known infection complication) can happen…I’m living proof.
I don’t fault the medical establishment for my “rare” negative biopsy side effect.
Even my urologist admitted it does happen, one in half years after I asked him about my experience.
Unfortunately, “rare” side effects are not mentioned in the prebiopsy “fine print”, as the thinking goes that it will only scare and discourage men from doing the only thing the industry knows to do.
Fair enough, but I for one decided not to remain silent, regarding my biopsy experience, just because it may ruffle a few feathers and it is considered “rare”.
Information is sometimes inconvenient and there are no guarantees even for the seemingly mundane…
Replies to "Great question…apparently biopsy/Decipher score is currently the best way to determine aggressiveness; but even Gleason scoring..."
Oh boy, that’s truly a mouthful but also hitting the nail right on the head!! You must have been in the military or knew someone who had been. Cause those that truly know these need to know answers that you don’t need to know know exactly what I’m saying while not saying it. This will not make a bit of sense to most people but for those of us that it does make sense to should be very careful on expounding on this and any other issues (shall we say) and hope to live another day!)
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Yes, any time we cut into cancer the "spread" is possible but it is soooo rare. All types of a cancer are routinely cut out of the body and in a vast majority of cases it gives long term curative results. The minuscule and extremely rare cases can not determine usefulness or validity of a method. However - I agree, it would be useful if even such rare events are disclosed before surgery or biopsy. On the other hand if they would list every possible event for every procedure the consent paper would be as long as any legal document which would again require a presence of an expert "patient advocate" that would be able to explain every of those events to a patient in detail. I do not think that doctors are hiding anything, I think that they just do not have time to discuss every possible and unlikely scenario. The same applies to dental procedures, for example. All kids have their wisdom teeth removed in the USA almost routinely and nobody talks about very serious complications that can happen with nerve damage that can even cause hearing loss, and other serious possible complications. ANY time we do anything to our body or ingest any medication we can have adverse and even fatal effect.
In those mentioned studies they measured a number of "epithelial cells" which are all "epithelial" in origin and there is no way of distinguishing them by origin ( are they from prostate surface , from perineal skin region, epithelial cells from pelvic floor tissues or surrounding organs ???? ) . Even they stated this:
" It is interesting that some patients show circulating epithelial cellular material before CNB demonstrating that other causes, such as palpation, may contribute to epithelial cellular material dissemination.
"It is also interesting that some patients without PCa had epithelial cellular material, demonstrating that even nonmalignant or premalignant conditions may cause dissemination of epithelial cellular material. It is a limitation of this study that there is no molecular studies of the epithelial cellular material, except for the criteria used to identify them. "