Does puncturing the prostate capsule spread cancer

Your concerns regarding a biopsy to potentially cause cancer cells to spread are not supported by the data. What’s called “needle track seeding” is extremely rare. Though not a zero chance, this paper from 2015 points out how rare it is: https://pubmed.ncbi.nlm.nih.gov/24958224/

If you wanted a zero chance of any risks, you’d never leave your house…..and even that has risks.

I just read that short paper. It's a paper on reviewing other papers. No description of the method used on the original studies at all. Granted, I didn't read all the supporting papers.

My question would be "How could you possibly know how many incidents of seeding occurred?" What did they use to deterimine this?

I do still agree with the conclusion statement "we do not advocate avoidance of biopsies as the benefits of appropriate cancer diagnosis and management outweigh any potential risks from seeding." I think that's valid until there is a way to say with some greater confidence when this does or does not happen.

In the PCRI conference this statement was made “ Seeds for metastasis were already there when surgery was done, waited to grow.” You want to kill those seeds With radiation and ADT if you can.

If it goes beyond the capsule, yes it can cause spread elsewhere.

@web265 That’s what “literature searches” do; they search for all literature mentioning (in this case) prostate cancer needle track seeding.
From those literature they have insight into “…incidence, clinical presentation, risk factors, type of needle used, transrectal vs transperineal approach, as well as tumour grade and stage.”
They even provided links to the literature they searched so that anyone interested in further details could investigate for themselves (if wanting to know for example, when this does or does not happen), though that was not the purpose of this literature review.

What was more interesting to me was their reporting that “… In most cases (33), seeding was reported after transperineal biopsy of the prostate, while 9 cases occurred after transrectal biopsy.” This at a time when transperineal biopsies were relatively rare.

What would be interesting to me is how it was determinined that "seeding" took place in any of these cases.

To me the possibility of spread via biopsy is intuitively obvious. We have an organ that is highly vascularized that is punctured multiple times. There's blood in the urine. Blood gets picked up from the prostate and recirculates through the body. The only way to end the debate would be to tag and track individual cancer cells at the time of biopsy. Now that would be interesting.

@callibaetis I had similar thoughts when seeing that blood!