Can a prostate biopsy potentially release malignant cells that may otherwise be contained in the prostate?
Question Regarding Biopsy: Can a... - Advanced Prostate...
Question Regarding Biopsy
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Abraxis49
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Yes, it potentially can do so. However, the tumor in the prostate keeps releasing cells all the time trying to seed metastases. So do not worry about the biopsy releasing cells.
Even if the "lesion" is confined prior to biopsy? Sorry, just trying to get my head around this. Thank you for your help.
Potentially means it cannot be ruled out completely. Nobody has canceled a biopsy because of this yet.
There is blood flowing through your prostate and this allows the lesions to spread cells. Only a very tiny fraction of these cells will be able to grow to metastases, the rest will die sooner or later.
Understood. I can't thank you enough for taking the time to respond. I'm still getting my head around this and am still working on getting a handle on my stress level. It is decreasing as I am gaining knowledge and this group has been a huge help. I have an mri guided biopsy scheduled in 4 weeks. I guess they target the lesion area discovered on my mri. Should result in fewer samples I would think.
I would prefer more samples. The prostate will contain several lesions and if they miss the most aggressive one you get a Gleason score that is too low. Your doctor will plan the therapy based on the Gleason score, so it is important to determine the right score.
I have canceled a biopsy because of this. That falsifies your assertion.
I will write "almost nobody" next time.
You don't have the evidence to support that assertion either.
Dismissing the inflammation, wound healing, and metastatic invasion that has been observed in the tumor area surrounding the needle channel after biopsy in patients with breast cancer because "there is blood flowing through your prostate and this allows the lesions to spread cells." borders on magical thinking.
A prostate cancer tumor inside an intact capsule does not shed many cells. Poke 18-30 holes in it with needles, draw those needles back out through the rectum, and you have a completely different problem. It is inflamed (promotes cancer), bleeding (carries cancer cells), provokes a significant healing response (which encourages cancer growth), and has all those holes to shed cancer cells where it has none before.
To the extent that there is risk from intact prostate tumors shedding cells, a biopsy at a minimum adds an entire new kind of risk, and very possibly multiplies the original risk.
Well sh_ t..........now I'm really confused (despite the fact that I appreciate the input).
Would these MRI findings change the complexion of this discussion in your opinion?
FINDINGS:
Prostate Size: 4.7 x 3.5 x 4.5 cm.
Central Gland: Heterogeneous signal with no high-grade malignancy by MRI. PI-RADS 2.
Peripheral Zone: There is a PI-RADS 4 lesion measuring 10 mm left posterior peripheral zone at the 5 o’clock location at the apex.
Seminal Vesicles: Normal.
Extracapsular Extension: None.
Urinary Bladder: Normal.
Lymph Nodes: No lymphadenopathy in the visualized pelvis by MRI. Bones: No abnormal marrow signal in the visualized pelvis. Miscellaneous: Small right inguinal hernia containing fat and no bowel.
Thanks again for your input, I'm just trying to sort this out while I have time.
The primary question is whether a biopsy will change your decisions regarding treatment.
You report one modest-sized legion that is well visualized by MRI. PIRADS-4 means it is likely but not certainly a tumor. All of my MRI readings these days are PIRADS-5. When I first started this journey they thought I was crazy to ask for an MRI instead of submitting to a biopsy. Maybe I am, but I'm still here.
The main thing you learn from a biopsy that isn't reported in an MRI is the Gleason score. If it is 6, leave it alone, aka watchful waiting, but no biopsies. If it is 8 or above it is more dangerous and should probably be excised while still contained in the prostate.
There are 3 ways to get proxy information for Gleason score without submitting to a biopsy.
1) There are MRI techniques that measure the diffusion rate of water through the tissues. These correlate remarkably well to Gleason grade. Not perfect, but pretty close. I learned this from a lecture by a Dana Farber surgeon. He admitted that urologists make so much money off biopsies that most MRI providers don't offer the new technique to avoid trouble.
2) Circulating Tumor Cells (CTC) This was far-out stuff when I first had such a test in 2008. Now it's approaching mainstream but found mostly in advanced clinical settings. They are getting very good at determining both Gleason grade and specific biochemical or genetic markers that may point the way towards the most effective treatments.
3) Watch and wait. Get another MRI in 3 or 6 months. Prostate cancer is almost never an emergency. You can take time to study, learn of the options, learn of the very serious side effects of most treatments. Most importantly, you can get over the shock of a new diagnosis and think a bit more calmly and rationally.
If the tumor grows in 6 months, that tells you something. If it doesn't grow, that tells you something different - it is slow growing and less likely to cause a problem in the future. It might even shrink - it happens.
After my diagnosis, my first thought on waking in the morning was "I have cancer." When store clerks would ask me how I was doing, I bit back the temptation to respond "I have cancer. How are you doing?" That stage lasted about 3 months, then I got over the shock and was able to think more carefully about my knowledge and my choices.
That was 12 years ago. Now I am learning to manage my prostate cancer as a chronic disease rather than try to cure it, which invariably wrecks your quality of life and often makes the cancer worse. I'll be quite happy if I die someday with prostate cancer and not of it.
Good luck to you. Nothing is certain, including what I have written. You have to figure out what is best for you - not what some other guy did or wants you to do.
Thank you very much for taking the time to share you thoughts and your journey. It gives me a much broader perspective and options i didnt know i had. Greatly appreciated.... and congrats on your 12 years!!!
All the best
Thats a way to look at it. People dont think that way. They think everything is fine and dandy until they make a decision to do something.This "do something" is inevitably wrong and realizing if a choice is made, they have elected to commit suicide. They dont think that PCa is a systemic disease even though its organ confined. It remains organ confined because certain conditions havent been established which tell it to be otherwise.... the least of which is the possible end result of a needle biopsy.
Are the billions of cells already in the prostate going to be materially affected by the 100,000 involved in a biopsy? I am gusssing at the numbers but billions of cells are invisible by any known instrument we have...thats why bone scans and ct scans are useless.
Of course cells that are cancerous can be non metastatic. I think most of them tend to be reticent.Even weird looking ones dont go metastic. If you can change their look you can prevent them from becoming metastatic but you have to do it carefully.We dont want to wait to get a solid tumor going.
They can only survive in their usual environment because they have all they need there to grow and be nourished. In a new environment they need a blood supply to continue their existence. Cancer cells are not meant to exist indefinitely.They are destined to die normally through a process called apoptosis.
Actually they commit suicide. This whole cancer thing goes bluey when this planned death is denied. Their aggressiveness is needed to accomplish important beneficial goals required of them so they are the DELTA force needed to take out a rogue regime. What if they decide to become the rogue regime they take out? Who gets sent in then to take care of them?
The first rule in a robots program..." I cant harm a HUMAN!!!!!!"
Tropoblasts (sp) are needed in the uterus endometrial lining to attach the placenta of an embryo. After these cancer cells do this they die.
Yes. But not all "malignant" cells are "metastatic" or have potential to become metastatic. Once cells have changed so they can travel and survive outside the prostate environment, they do so with or without a biopsy. Here's an article about it:
pcnrv.blogspot.com/2016/08/...
Thanks for the great info! I appreciate you taking the time to respond. At the end of the day, it would seem at this point that the value of obtaining a gleason score via biopsy is certainly worth the %of possible risk involved from the procedure.
I think we should look at what a malignant cell really is and define metastatic.
We worry about a malignant cell because we know it has the inherent ability to change in a bad way.Even if it doesnt move which many do not, their growth can irreparably auger to prevent normal bodily functions from happening.These structures,masses or tumors... can crush a bile duct and is a tiny example almost not worth discussing.
So we have to say malignancy is not some second cousin to metatasis.
These malignant cells are a prerequsite to metastasis. So now we know they are both equally dangerous. If you can kill them in place its easier and more predictable of a good outcome. However, since we really dont know precisely where they are or where they will go we are disadvantaged .However,thats the challenge we are stuck with.
Yes. Urologists vehemently deny this, but it has been demonstrated in breast cancer.
Manipulation of the Primary Breast Tumor and the Incidence of Sentinel Node Metastases From Invasive Breast Cancer
ncbi.nlm.nih.gov/pubmed/?te...
from the full text of the paper:
"Conclusions: Manipulation of an intact tumor by FNA (fine needle aspiration) or large-gauge needle core biopsy is associated with an increase in the incidence of SN (sentinel node) metastases, perhaps due in part to the mechanical disruption of the tumor by the needle."
A newer paper
Core-Needle Biopsy of Breast Cancer Is Associated With a Higher Rate of Distant Metastases 5 to 15 Years After Diagnosis Than FNA Biopsy
ncbi.nlm.nih.gov/pubmed/?te...
"CONCLUSIONS: At 5 to 15 years after diagnosis of the primary tumor, CNB diagnosed
patients had significantly higher rates of distant metastases than FNAB-diagnosed patients."
citing a previous study:
"inflammation, wound healing, and metastatic invasion were observed in the
tumor area surrounding the needle channel after CNB in patients with breast cancer."
I was in your same predicament end of 2017, and early 2018. The decision to get a biopsy became a serious one once I read up on its' invasiveness. I google'd a lot, so that I could learn more. I also am aware that you can't believe everything you read on the internet.
I stumbled across the term 'needle tracing', and found this scary. This is reportedly when bio-matter can escape along with extraction of a biopsy needle. Damn! If this were true, wouldn't biopsies present a means for localized cancer to escape and become metastatic? (now realize, I know nothing about medicine. I'm a computer geek).
When I brought this up with my urologist/surgeon, he mentioned in all his years he never encountered a report of this happening. I may add, my urologist has been in practice many many years, has ties UW Medical Center and Medical Research, Fred Hutch and the Seattle Cancer Care Alliance. He is one of the best in this area!
Ok, enough praise. He explained to me the process, how the biopsy needles work to encapsulate tissue samples prior to needle extraction. He talked of the prostate surface and mechanics of needle insertion/extraction, etc. After the discussion, I was no longer concerned (worried) about stuff I read about needle-tracing.
Now there are side-effects from getting a biopsy. They are not fun, but you can recover from them. So from what I've learned from my experience, this site, and others, is that if you find symptoms which indicate accelerated growth of cancer you need to act soon. This could be a doctor observing a nodule during a D.R.E. and its' growth over time. It could also be a PSA test score that's risen over 4 and has doubled in the last year.
So like many others have said on this site, early detection is important. It may turn out your cancer is slow-growing, so Active Surveillance may called out. Yet if it takes off, take care of it early. You will be provided more options in care, with better chances in outcome. I wish you best of health going forward. You'll be ok, just take it day at time.
Thank you so much! I have to tell you that when I woke this morning after a rather sleepless night this was what was on my mind. The information that you shared has helped me. Just a bit of background to throw in the mix. My PSA was 2.03 5 years ago. I am now 69 years old. I opted to not have a PSA during that time because of a large majority of organizations that were saying that it caused so many needless procedures etc. I discussed this with my family doc when I was having some routine blood work done in December of last year and he said it might be a good idea to check. My PSA was 4.3 in December. As a result, he recommended that I see a urologist, which I did...negative DRE and he suggested that I get another PSA in 3 months. In march I went back and did another PSA...last reading was 4.47. My urologist suggested an MRI......following are the results that prompted my urologist to recommend an mri guided biospsy, scheduled in 4 weeks:
PROCEDURE: Prostate protocol MRI Pelvis without and with IV contrast.
INDICATION: Elevated PSA of 4.47 on 03/20/2019. No biopsy.
TECHNIQUE: Prostate protocol multisequence, multiplanar MRI of the pelvis without and with IV contrast. Using a phased array coil small field-of-view imaging of the prostate was performed using the following sequences; axial T1-weighted, axial T2-weighted, sagittal T2-weighted, oblique coronal T2-weighted, diffusion-weighted. Dynamic post-contrast imaging was performed. Post-processing with CADStream software.
COMPARISON: None.
FINDINGS:
Prostate Size: 4.7 x 3.5 x 4.5 cm.
Central Gland: Heterogeneous signal with no high-grade malignancy by MRI. PI-RADS 2.
Peripheral Zone: There is a PI-RADS 4 lesion measuring 10 mm left posterior peripheral zone at the 5 o’clock location at the apex.
Seminal Vesicles: Normal.
Extracapsular Extension: None.
Urinary Bladder: Normal.
Lymph Nodes: No lymphadenopathy in the visualized pelvis by MRI. Bones: No abnormal marrow signal in the visualized pelvis. Miscellaneous: Small right inguinal hernia containing fat and no bowel.
Any further thoughts would be greatly appreciated.
Thanks again for taking the time to respond.
All the best!!
"When I brought this up with my urologist/surgeon, he mentioned in all his years he never encountered a report of this happening. "
That's because he avoids the issue. If he's never encountered a report he not only hasn't been looking, he has averted his gaze. Every biopsy he performs puts roughly $1000 in his pocket, you think that might influence his behavior?
There are literally thousands of reports of seeding, rectal cancers showing up 2 years after a prostate biopsy, etc. There are dozens of medical papers on this issue. I listed two in a response above this one. It would seem that this exalted urologist doesn't keep up with his reading.
To be fair, there is not a strong consensus about biopsies causing cancer, but science isn't about consensus, it is about truth. The truth is that women with breast cancer have been reporting tumors on the needle track for decades; it is now recommended practice to excise the needle track during lumpectomies. Men with prostate cancer have received multiple negative biopsy results, but after 3 or 5 and having upwards of a hundred wounds to the gland and surrounding tissue, they get cancer.
No, he did not avoid the issue. You don't know him, and believe you have characterized him incorrectly (based on your experiences perhaps?).
What he did do is weigh in on the serious of my condition. He noted the risks in the biopsy procedure were minimal, compared to that of the seriousness of my condition. (Risks in needle-tracing, infection, etc. versus what my DRE and PSA was telling him).
To be fair, I know there 'are' urologists as you indicate. I did not stay with the first (PCP referred) urologist I visited. It may of been due to the stereotype you outlined, as I did not feel comfortable with him. I felt he may of liked to add a notch on his belt. I could be his next candidate for surgery perhaps? I realize young surgeons need to gain experience, however I wished to place confidence in someone seasoned with more years of experience.
I did my due diligence and found a urologist/surgeon that was well reviewed and had a lifetime of experience. I found he specialized in nerve-sparing techniques and was tied to the UW School of Medicine. He was also well connected with cancer research centers in the Seattle area. In his years, he had performed many multitudes of both open and robotic surgeries.
All this, yet he was very humble. If you met him on the street, you would never know he was at the top of his profession. He was definitely not after money, as he is consistently booked out over 6+ months. When I tried to book, his office suggested referrals to other urologists in the area. It took pro-active efforts on my part to get my first appt. with him. From then on, I've had excellent care on a timely schedule!
I feel fortunate every day that I'm under his care. He's proved to be that doctor that has pride in his work, and finds reward in helping his patients. Hopefully others on this site are as fortunate with choices in doctors, as I was in mine. Take care, I wish all who read this best of health!!
I'm very glad you found a good urologist. It is important to have trust in your doctors.
I'll stand by my conclusion that if he has never encountered a report of this happening then he is averting his gaze. This issue is complex and there have been many papers, often contradictory, published about it.
It would be one thing if he told you he had reviewed the literature and found the evidence not convincing. But to deny it outright, to base his argument on his ignorance of the issues is incredibly weak. "I've never seen it so it can't happen." Really??? That's not logic talking, that's just using his authority to bully. The argument from authority is a classic logical error. It tells me he wasn't looking.
That doesn't mean he's not a good doctor. No one is perfect. It does mean that he avoids certain topics, and abandons logic and evidence when he wants/needs to bully you. There really isn't another explanation.
I went back and reread what I initially wrote. I was not clear. Sorry, I misspoke. It has been over a years since this visit with him.
I didn't mean to imply he said he had not seen any report of this. What I intended to get across to the OP was that my doctor felt risks associated with the biopsy were minimal, and that he recommended I undergo a biopsy considering growth in a nodule and double of PSA score. Basically, don't let the fear of having a biopsy take precedence over what could be much worse, not catching advanced cancer early when it's still localized.
In my case, biopsy and scans placed me with a Dx of localized advanced G9 cancer. However pathology results from my RP surgery found that my cancer was present on the surface of my prostate (extra-capsular). Now I'm not in the field of medicine, but learned that cancer can be and stay slow growth, or it can also be slow growth and then go non-linear at any time. Hence, why they look for a doubling-factor.
I have 2 older brothers. The oldest has a low PSA. However the other has a PSA around 3.8. I have consulted with him and now he gets his PSA tested quarterly. This could end up being the best brotherly advise I'd ever given him, if he later exhibits a path similar to mine.
OP. Focus not as much on the biopsy, but the overall picture. Find providers you feel comfortable with and trust, and get the upper hand on the situation. But by no means, don't delay due to issues that may (yet most likely not) arise out of getting a biopsy. Good fortune, and hope all decisions you make get you better!
Many are not aware that there are two biopsy procedural options. One is done in the Urologist's office; not very accurate, uncomfortable, and subject to possible infection. The other is a MRI fusion guided biopsy; much more accurate, less invasive, minimal side effects. I had the latter.
Thank you! I have the latter scheduled as well in 4 weeks. You state less invasive. Isn't the technique the same with the exception of being MRI guided to match my previous MRI?
All the best!
I'm relatively new to all this too, but like the other brothers I'm taking my diagnosis in stride. I had a prostate biopsy in urologist office that found prostate cancer. He wanted to cut, burn and remove and I said I wanted second opinion. I agreed to proton radiation for the cancer but during screening ct, mri, radiation injection a spot was found in left pelvic area only. A ct guided biopsy was performed and was a cancer, but not from prostate cancer. They now want to do many other tests because they don't know where this spot came from. I've sked appt with holistic integrated oncologist for guidance in natural cures and diet. In addition to juicing, multiple vitamins & minerals, prostacaid capsules, berberine complex, turmeric, lycopene, cayenne, krill, omega-3, saw palmetto, stinging nettle, vitamins b1, b6, c, d & e and lots of water. I don't want chemo nor radiation and hormones tend to have serious side affects. looking for some -thing with minimal side affects.
The gist of this is you have two concurrent cancers. The holistic approach is a good place to start. Minimal sde effects are possible if you could define that,please?
Its possible that vegetarian approaches, and supplements may help with your overall health.If you break your arm these wont fix your broken arm. I hate to make this ridiculous comparison but its worth looking at for analytical purposes.
You may triage these two cancers but you have to know what cancer X is to treat it properly. Even if you decide you wont...thats ok but at least find out what it is.
Prostate cancer is very slow growing but the other may not be. Your body will have to directly fight these and the body should be in good shape but that alone will not be enough.
There are direct herbal remedies that will manage prostate cancer but no doctor will support their use.These herbals suppress testosterone as Rxs do and things like PSA will decline in value. If you suppress Testosterone there will be side effects but to me they are not bad. My history with your desired approach is not very good. Ive been at it since 2004 and in order to get peace of mind, a doctor is needed who will use any approach to keep you safe. I am not for RP,Radiation or chemo. Too many people fail those TXs. With hormonal TXs you can always revert to anything else.
And there is no long lasting damage.
There is a big difference between having a biopsy in your Urologist's office vs having it done in a much more sterile surgicenter environment
I have heard of several situations where patients have ended up with painful infections from biopsies done in their doctor's office.
Theoretically possible but not likely.
I'm 75 and my first biopsy of 13 cores did not reveal any positive cores. PSA was 34. My urologist was assured that there was cancer there and proceeded with MRI guided. I was on the table for about 45 minutes, took only 5 samples and he was confident that he hit the lesion. I think it was relatively new procedure for my hospital. Results gleason 4+4. I'm oligo had IMRT and SBRT to one place to the bone. On triple hormones,Metformin,Psa now 2.4 . Scheduled to have Xgeva next month and AR-V7 test. Provenge in the planning stages. I often wonder why they don't do MRI guided as first biopsy test? Best wishes .Bob
Thanks Bob. I feel better about my first biopsy being the fused MRI, but still have a lot of concerns about the side effects of the biopsy itself.
Focusing on the most minor of this is a biopsy. The biopsy contains the least risk and provides the most benefit. The shot is milli seconds and the area microscopic. One has to ask what is the scope of this invasion?Consider the prostate may contain aberrant cells which are momentary and give false readings re GS.If the focus is hot spots how can you spread it where it already exists?Ihad 2 biopsies 3 months apart. First 3+4,
2nd 4+5. These samples were random.If you take anything hormonal your GS will change in your tissue samples.Different outcome and more tx All false. Still you have to know the parameters.I am 15 years out ADT only PSA 2.Send samples to Dr Gleason in VA.
I suggest ploidy analysis of cells and see what they are. Dont get caught up in the biopsy being the nemesis in this disease. The disease itself is the nemesis not the tool that finds it.If you are diploidal you are better off than aneuploidal. Both treatable with ADT.
Dr Stamey said its tumor size that suggests spread and establishment of blood flow to tumor. Folkman suggests a connection with primary and secondary tumor to establish blood flow.RP may not be a good thing even though tumor burden is removed.
Thanks for your wisdom & great perspective. Much appreciated!
Can a deadly germ fly into your soup and kill you dead in 30 seconds?
Understood
Hmmmm never thought of that........ will have to strain my soup from now on..... Thanks
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 05/09/2019 11:39 AM DST
If I were you I wouldnt take soup. Its too risky.
Even if I had it on a waterproof roll?
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 05/10/2019 2:55 PM DST
You are on a roll all right but its not waterproof!
Maybe an Ocelo Sponge?
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 05/10/2019 6:00 PM DST
Germs are microscopic. So small that they make a roll look like an aircraft carrier.These germs will enter your body and grow so quickly you will be a reduced to the size of a miniscule sitting upon a modicum sitting on an imperceptable dimuntive...which is a million times smaller than a quark or a neutrino.Now, do you want to pick that up with a sponge?
You mean to tell me it's smaller than a tiny weeny flea or a flea's tiny weeny?
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 05/10/2019 9:53 PM DST
How teeny is a teeney fleas teeney weeney?Divide that by the length of the universe! Thats the size of a neutrino. We are bombarded with those all day and all night and they go right through us and the teeney fleas teeny weeny.
The length of a flea's teeny weeney and a neutrino is that they are twice as long as from one end to the middle.
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 05/11/2019 11:48 AM DST
can you prove that 1=1?
This 1 or the other 1?
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 05/11/2019 6:54 PM DST
take me to your leader
That's what one ladder said to the another ladder.
Take me to your Leader Ladder...........
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 05/11/2019 6:57 PM DST
Are you sure it wasnt take me to your gutter,leader but later for the latter ladder.
That's it............. those meds really drain me..............
Happy Mother's day.
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 05/12/2019 12:04 AM DST
Happy Mothers Day to you too and feel better friend
They couldnt see the bacillus of tuberculosis so they created a dye or stain to see it Guess what... the stain was the cure they were searching for. These bacillus are called spirochete and Dr Erhlich discovered the cure by accident In Germany in the late 1800s.Its possible fleas could have done the same thing.
Circulating Tumor Cells (CTC) have been detected in my blood work, yet my immune system (or post treatment results) have put the cancer into remission (at least for now).
The CTCs are not guaranteed a free pass to maximize the potential damage. The fight continues and the healing / prognosis is stable and encouraging.
Don't quit the fight and don't assume that you are losing badly.
Stay positive, take some steps towards better overall self maintenance and liv e your life with zest.
Take 2 and call me in the morning - LOL ....
Hang in there !
Chicken or the Egg?
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 05/09/2019 11:40 AM DST
Take two and call me in the morning. Very funny. I would rather keep my two marbles. Think it is more like take two and call me in six months. Enjoy.
This may have little or nothing to do PCa; however, seven years ago a scan identified a 2.75 cm lesion in my kidney and none of the four doctors consulted recommended a biopsy for fear of 'possible' cancer spreading. All recommended a nephrectomy and I lost the kidney for nothing since it turned out to be a benign cyst.
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