FYI: Be careful when considering RX

[TWTJr]

medscape.com/viewarticle/89...

This Medscape article concerns HIFU (Hi intensity focused Ultrasound) and its use by a physician trying to get around the standard of care of prostate biopsy prior to any definitive PC treatment. (in addition to potential fraud) The MD may not follow proper standards, and apparently has written the book, "Men at Risk: The Dirty Little Secret That Prostate Biopsies Really Do Spread Prostate Cancer Cells" which I have not seen, concerning the possibility of prostate biopsy related spread of PCA. I do not endorse his book, or treatment without proven histologic diagnosis, but remain curious about the issue. Only wish research on using non-invasive MRI or PET to diagnose and grade PCA would evolve faster. This would remove the process of invasive biopsy as a potential cause of metastatic disease occurring in close proximity to the diagnostic biopsy or invasive treatment.

[Tall_Allen]

It will always be impossible to Gleason grade PC without histological analysis. spread of PC with a biopsy does not seem to be an issue for most men. It is doubtful that cells with low grade can live outside the prostatic environment. But there have been isolated cases of spread along the needle track.

pcnrv.blogspot.com/2016/08/...

[TWTJr in reply to Tall_Allen]

Development of an MR-Gleason Score for Prostate Cancer using Advanced MRI Metrics

cai2r.net/research/developm...

ascopubs.org/doi/abs/10.120...

Studies are being performed to provide non-invasive imaging-based grading that provide the same information (high grade or low grade, predictive of future treatment failure). I am not yet aware of the outcomes of these imaging studies but this is the type of approach that I believe will be most beneficial if they prove useful. PCA could be graded by a non-invasive Gleason proxy, and treatment plan made with a broad inclusion of multiple modalities without potential harm to the patient. Would not that be a superior method than 12-18 trans-rectal core bx? (a barbaric type of biopsy)

[Tall_Allen in reply to TWTJr]

Studies like that can only show correlation. Gleason score evaluates tissue architecture, which can never be seen with imaging - the voxel size is way too high. I would never be comfortable assuming that a PIRADS 5 is high grade or a PIRADS 1 isn't, for example. Perhaps someday genomic changes will be found to cause Gleason grade, but we are far from being able to say that without a biopsy.

[TWTJr in reply to Tall_Allen]

Yes, I agree that research if far away. But it should be the goal. Ideally, it should be the goal for diagnosis, grading and staging most diseases, malignant or otherwise. Medicine has come a long way since I started, and changing fairly rapidly.

And with that I wish you a Merry Christmas and Happy New Year!

[dentaltwin in reply to Tall_Allen]

I do wish it were possible to more widely adopt transperineal biopsies. Do you know if there are any disadvantages (diagnostically) compared to TRUS-biopsies?

[Tall_Allen in reply to dentaltwin]

Transperineal offers better access to the anterior.

Some find more biopsy dissemination of cancer with transperineal (a very rare phenomenon):

ncbi.nlm.nih.gov/pubmed/329...

Others find no difference:

ncbi.nlm.nih.gov/pubmed/201...

[TWTJr in reply to Tall_Allen]

Bx related tract metastasis, lymphatic vessel to lymph node and venous related metastasis (to bone via Batson's plexus and pulmonary metastasis all occur, are poorly recognized, often recognized on a delayed basis, and most difficult to study. With the tens of thousands of biopsies being done yearly, without a control group for comparison, the true incidence of biopsy related spread of all grades of PCA cannot be not known, and will remain so until a properly designed longitudinal study followed for at least 10 years is performed.

[dentaltwin in reply to TWTJr]

My last general anatomy course was about 45 years ago, so this may be beyond me, but...how can they determine that (for example) a bony metastasis was from the biopsy?

[TWTJr in reply to dentaltwin]

Not possible by direct exam, or with present standards of care. Only by comparing statistics of the natural course of disease events of two groups of patients. One group has the traditional biopsy, another group has no biopsy or surgical intervention. If the invasive biopsy group has a higher incidence of bone or other metastasis, with other pertinent varaibles (Gleason score or proxy test for such) controlled, then the logical reason would be due to the invasive biopsy or treatment.

Should note that until such time that a non-invasive process (such as MRI, blood test, or genomics) is developed that would allow the diagnosis and grading of prostate cancer using non-invasive techniques is developed, this type of study cannot be performed. Research is on going. I believe that our sons will benefit, and the diagnosis and treatment of this wicked disease will, like many other diseases, be substantially different. (Hopefully less invasive and more effective)

[dentaltwin in reply to TWTJr]

Thanks. Yeah, the ethics of that study would be difficult. Appreciate your taking the time to respond, doctor!

[dentaltwin in reply to Tall_Allen]

Thanks!

[TWTJr in reply to dentaltwin]

Trans-perineal biopsys are technically more difficult, and additonally, there is an extensive perineal nerve plexus that can, and does, become injured resulting in post biopsy pain in a few. I do not know the exact incidence, but the pain can be very debilitating and chronic in some.

[dentaltwin in reply to TWTJr]

Thanks--I guess there's a bit of a trade-off.

[NPfisherman]

Gotta watch who you deal with...reputable organizations .....MD's with a good reputation... My question is whether people who undergo prostate biopsy and end up with E coli sepsis are at higher risk for metastatic prostate cancer ??

[TWTJr in reply to NPfisherman]

No, E.Coli sepsis occurs about in 2% of transrectal biopsies, but I know of no data that suggests a correlation between biopsy related sepsis and subsequent metastatic disease.

[NPfisherman in reply to TWTJr]

No, I was not aware of any any studies/correlation of data and my question would be regarding high gleason scores from biopsy....sepsis lowers ability to make immune response making one more susceptible....

[j-o-h-n in reply to TWTJr]

Well junior, I think that for most of us you can't put the toothpaste back in the tube.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/26/2018 7:07 PM EST

[TWTJr in reply to j-o-h-n]

That is about the size of it. Happy New Year and many more!

[j-o-h-n in reply to TWTJr]

Thanks, and You Too....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/26/2018 9:34 PM EST

[Sxrxrnr1 in reply to j-o-h-n]

ucsdnews.ucsd.edu/archive/n...

I recall pulling this up a couple of years after being diagnosed. Greatly influenced my reluctance to enjoy any more biopsies,,,which I never had.

Perhaps meaningless today, but interesting.

Someone once said, forgotten who, that needle tracking metastasis was an East Coast, West Coast thing.