Are Prostate Biopsies Completely Safe? - Prostate Cancer N...

Prostate Cancer Network

3,303 members1,875 posts

Are Prostate Biopsies Completely Safe?

Murph256 profile image

Is there any medical evidence that prostate biopsies can spread the disease? Just from an intuitive standpoint, it seems as if piercing the prostate capsule 12 or 13 times with a needle, in order to collect cancer cells, could spread those cells outside the prostate.

39 Replies

Here's what we know:

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

It seems to be very rare. Most prostatte cancer cells in the prostate can't live outside of the prostate. If they can, they're probably already there. It's not a good reason to avoid a biopsy if you need one, but biopsies should only be given when really needed.

Allen - this appears to be a link to a Vitamin D study - at least when I click it.

Murph256 profile image
Murph256 in reply to Hindemith1

If you move over to the index on the right, scan down to labels and click on “biopsy”, the pertinent information comes up.

Woops, here it is:

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

Murph256 profile image
Murph256 in reply to Tall_Allen

One would think/hope that in this day and age of advanced imaging and blood tests that the medical community could find a less invasive way of diagnosing prostate cancer.

From that blog post, it seems as if there multiple examples of biopsies spreading cancer cell systemically, or at least just spreading the cancer within the prostate.

In hindsight, I should have forgone the biopsy and undergone the surgery much sooner.

Godblessus profile image
Godblessus in reply to Murph256

They have PMSA prostate membrane specifics antigen is a contrast that is accurate to 90-95% of pc tumors for imaging... several blood tests one is PCA3 ... different tools ... notthe standard in USA yet... too bad

Unfortunately, PSMA expression doesn't appear until later in the game.

Tall_Allen profile image
Tall_Allen in reply to Murph256

Considering all the biopsies that are done, there are very few documented cases of spreading from biopsies. There are some liquid biopsies, but they have to be validated on larger samples.

bhayes84 profile image
bhayes84 in reply to Murph256

I was told that insurance wouldn’t cover surgery w/o a biopsy to prove it was needed.

Darryl profile image
DarrylAdministrator

I think there is a larger risk of death or poor health from biopsy introduced infection. Neither are deal-killers (except, perhaps, after the fact) , but, they should be discussed with your doctor prior to biopsy.

pisdov profile image
pisdov in reply to Darryl

Absolutely! 22 days in hospital, plus 60 days at home with an IV to get rid of an infection from a biopsy. If you must have a biopsy (one of the most over ordered tests in the entire medical field), opt for a transperineal biopsy. MUCH SAFER!!

Godblessus profile image
Godblessus in reply to pisdov

Yup 3 weeks on antibiotics ... never had any pain until the biopsy...

Currumpaw profile image
Currumpaw in reply to pisdov

Hey pisdov,

An in bore, real time biopsy, using the mp 3.0T is the most accurate. Every time a core is taken the chances of damage and infection increase.

drelist.com/blog/erectile-d...

I have had three saturation biopsies given to me by the same urologist.

Currumpaw

pisdov profile image
pisdov in reply to Currumpaw

I'm sure it's me, but I don't follow you. You are saying it is more accurate but also more dangerous? I'm not well versed in the lingo, could you please explain?

Currumpaw profile image
Currumpaw in reply to pisdov

Hey pisdov,

Every time that needle punctures your colon during a transrectal prostate biopsy to extract a core from your prostate your chances of infection increase.

The TRUS biopsy should probably be put aside.

Prior to an Artemis biopsy that fused an image from a 1.5 T MRI with contrast to an ultrasound screen to guide the biopsy needle my urologist told me to my face that he was unable to tell the difference between a scar and a lesion. I had had 12 core TRUS, a 27 core Artemis and an ablation prior to this biopsy. Because of that do you think there might have been some scaring on my prostate? That turned into a 32 core biopsy, no cancer detected. The pathologist noted that one core contained seminal vesicle--thank you--not! My stable PSA began to destabilize after that biopsy!

The following year I was given a mp 3.0T MRI. The radiologist that read the MRI reported that there was on cancer in my prostate, bladder, kidneys, lymph, colon rectum --whatever was in the MRI's field got a clean bill of health.

13 months later against my objections I agreed to an Artemis biopsy where "only Levaquin" would be used. Not a combination of Cipro and Levaquin. Well, there were twenty possible sites that needed to be biopsied by once again, using a 1.5 T MRI.

Do you see the difference? The uros doing biopsies using the mp 3.0 T MRI in bore, real time, have a huge advantage. Where someone else might do a saturation biopsy because "this looks like it might be" these Docs are looking and seeing what is there with a much higher degree of accuracy. There is a radiologist, a Dr. Busch, who is incredibly skilled from all that I have read about him and heard from men who have been to him. He is known for being correct about the Gleason grade before the pathology result is in. Very skilled at reading and he biopsies in bore, real time. Very accurate and what is important, the chances of missing "something" are reduced with this type of biopsy. This type of biopsy and high definition enhancing the view of a prostate eliminates the need for the 20 core and up saturation type of biopsy.

A 12 core TRUS or other type of biopsy that might miss cancer or an in bore mp 3.0T MRI where few cores are taken and they are focused right on the cancer.

Dr. Busch recently opened a new facility and his prices increased quite a bit. Some of his patients are concerned that he may have priced himself out of their market.

Use your search bar and look around about the in bore biopsies.

Which biopsy would you choose?

Currumpaw

just a comment -

the biopsy that I got was one of the most painful procedures I have ever experienced - absolutely vicious. The Dr claimed to have used a local anesthetic

and my comment to him was - it didn't work

I am not a sissy or weenie but that hurt - a lot ...

btw I m no longer with that Dr

P

Tall_Allen profile image
Tall_Allen in reply to pjd55d

It's not just a local anesthetic. It should be done with a nerve block. That means finding the nerve that innervates the prostate on the ultrasound and injecting the lidocaine directly into that nerve. Not all urologists are capable of doing this.

NOW ya tells me! Would you happen to know if the block is administered trans-rectally or trans-perineally? I'm pretty sure any anesthetic I got was transrectal. I don't know that the pain was the worst I ever felt, but it wasn't good. A year later, I'm thinking I should have said something. Maybe I did.

There are two nerve blocks used: periprostatic or pelvic plexus. I would guess that the pelvic plexus block is more complete and can be accessed transperineally.

Thanks. I'm no stoic when it comes to pain, but I know what good local anesthesia (infiltration or nerve block) is like, and I don't think that was it.

ncbi.nlm.nih.gov/pmc/articl...

Fortunately, we've come a long way since the days of the Prostascint scan, and our knowledge of the natural history has changed since 2004.

Hey Murph256!

Biopsies can cause ED!

sciencedirect.com/science/a...

Is your Doc prescribing and using fluoroquinolones to prevent infection exposing you to the risk of an aortic aneurysm and joint, ligament and tendon damage? Rocephin and Cefdinir are safe alternatives to the fluoroquinolones which the FDA has issued much more stringent warnings about recently. The aortic aneurysms? In our age group how many men have had an aortic aneurysm in the past that was attributed to their "age" rather than the use of fluoroquinolones? Convenient?

Currumpaw

dentaltwin profile image
dentaltwin in reply to Currumpaw

Yes, they're somewhat risky drugs, and I'm as concerned about antibiotic stewardship as the next guy. But short-term fluoroquinolones for prophylaxis (as in this indication) is certainly safer than longer-term use in infected cases. Do they do prophylactically what they're supposed to? That's another story--and prophylactic use of antibiotics is something I've had to grapple with in dentistry. Unfortunately, in these cases attorneys sometimes get involved, and that distorts the clinical picture.

Currumpaw profile image
Currumpaw in reply to dentaltwin

Somewhat risky? The FDA issued stronger warnings and I believe advised doctors to use something different. My damaged shoulders and back which were long forgotten as they had healed in the 80's came back with a vengeance from Cipro and Levaquin. Short term? A timeline?

I had a TRUS in July of 2013, a 27 core Artemis in September of 2013, a HIFU ablation in October 2013 and a prescription for Levaquin 6 days after the ablation. Had trouble with an old triceps tweak in March 2014, an old hip injury in May 2014 and-----in August while just un racking 145 lbs., my warm up weight for incline presses -- I never let the weight down--MY SHOULDER SHREDDED! I could hear the tissue ripping and let bar fall on me to prevent more damage. It was only a light weight.

I was diagnosed by a chiropractor as having an adverse reaction to the fluoroquinolones. She has extensive, decades long experience.

About a year ago I asked my oncologist when I could expect the damage from the fluoroquinolones to heal. He down loaded the results of my bone from August 2013 and February 28, 2017 onto my patient records. He told me to log on when I got home. The 2013 scan showed a bit of inflammation in my lower back. The 2017 scan showed deterioration of both shoulders and my lower back. That is the result of repeated use of the fluoroquinolones. Not continuing use but repeated. That cannot be argued with.

Just one exposure to these drugs has resulted in life altering consequences for many, hence, the FDA's stronger warnings. These drugs aren't like ibuprofen, they have killed people.

Currumpaw

dentaltwin profile image
dentaltwin in reply to Currumpaw

Your point is taken. There are in fact multiple FDA warnings re: fluoroquinolones. They are serious drugs, and should be used (as with any medication) in situations in which the expected benefit is greater than the documented risk. Some of the warnings are here:

fda.gov/news-events/fda-bri...

...and links to previous warnings are linked in the text.

I do not use fluoroquinolones in my practice, and I certainly have no standing to speak for what urologists may use in practice, nor if there are viable alternatives to fluoroquinolones for this purpose. I'm also not thrilled with the microbiology of trans-rectal biopsy. It certainly makes sense that if transperineal biopsy was as effective it would be the preferred method; my understanding is that it is NOT as effective.

Certainly I'm in favor of safer, less invasive procedures and medications being used whenever possible.

BTW, ibuprofen ain't candy either; while its risk is not in the same category as most antibiotics, it confers significant renal and cardiac risk--especially when used long-term, as it often is.

Currumpaw profile image
Currumpaw in reply to dentaltwin

Hey Doc!

There are viable alternatives use by urologists. Friends on another site informed me that urologists use Cefdinir and Rocephin without the damage that has been irrevocably done to me.

In the 80's when the fluoroquinolones first came out and the pharmaceutical reps were making the rounds with free samples for the doctors a friend had a cold. His doctor prescribed one of the first generation of fluoroquinolones. No one knew what was happening to him. He would begin to shake and have to hold onto something to prevent himself from falling. He lost so much of his vision that he was unable to drive. He lost much of the feeling in his hands. At first it was thought he might have MS. Then this and that and the other thing!

I should keep a log on info and sources about fluoroquinolones but I believe that if you look you will find a warning about using the fluoroquinolones in the 2005 edition of "The Physician's Desk Reference". It was known back then that some people had serious adverse reactions.

Currumpaw

dentaltwin profile image
dentaltwin in reply to Currumpaw

This ain't my wheelhouse, but cephtriaxone and cefdinir are cephalosporins--they have a very different antimicrobial profile. Not saying they wouldn't work, and great if they do. I see some references to them being used for infections caused by coliform bacteria, but mostly I'm seeing references to resistance to them. Again, that doesn't mean they can't work--maybe someone could comment.

Currumpaw profile image
Currumpaw in reply to dentaltwin

Hey dentaltwin,

I never speak or write without knowledge. If I am expressing an opinion I say so.

Below are some warnings about the fluoros by the FDA in 2016! Note --potentially, permanent side effects--or damage to muscles, tendons, joints, nerves--

FDA warns about increased risk of ruptures or tears in the ...

fda.gov/Drugs/DrugSafety/uc...

Excerpts:

[12-20-2018] A U.S. Food and Drug Administration (FDA) review found that fluoroquinolone antibiotics can increase the occurrence of rare but serious events of ruptures or tears in the main artery of the body, called the aorta. These tears, called aortic dissections, or ruptures of an aortic aneurysm can lead to dangerous bleeding or even death. They can occur with fluoroquinolones for systemic use given by mouth or through an injection.

Fluoroquinolones should not be used in patients at increased risk unless there are no other treatment options available.

Because multiple studies showed higher rates of about twice the risk of aortic aneurysm rupture and dissection in those taking fluoroquinolones, FDA determined the warnings were warranted to alert health care professionals and patients.

Duh---I can hear it now when a guy has an aortic aneurysm months after being dosed with fluoros!

“When they get old, (those in our age group with prostate cancer or suspected cancer), it isn’t uncommon for them to have an aortic aneurysm”

So a man’s life is chalked up to a tissue failure rather than poisoning by a drug?

FDA updates warnings for fluoroquinolone antibiotics on ...

fda.gov/news-events/press-a......

In 2016, the FDA enhanced warnings about the association of fluoroquinolones with disabling and potentially permanent side effects involving tendons, muscles, …

Dr. Gary Onik, a urologist pioneering a new way to use cryo uses Cefdinir for his patients. I have spoken with and "friended" one of his patients for whom Dr. Onik used Cefdinir rather than fluoros effectively and without incident. The man is an athlete and Dr. Onik knew he would be putting his patient at risk one of the potentially, permanent side effects--which are crippling.

As for Rocephin, I have had several conversations with someone who has interviewed some of the top uros including Dr. Klotz. He told me that Rocephin is a viable alternative.

Currumpaw

dentaltwin profile image
dentaltwin in reply to Currumpaw

In fact, I did find one paper that advocated use of newer cephalosporins for prophylaxis for TRUS biopsies. So there is some support. It is a small, retrospective study.

Thanks for pointing this out to me.

ncbi.nlm.nih.gov/pmc/articl...

dadzone43 profile image
dadzone43 in reply to Currumpaw

right on, brother!

Tall Allen has the pertinent information. Reckoning also the potential complications of bleeding, infection, risk from fluoroquinolone antibiotics that the urologists insist of giving us, it is still a "safe" procedure. One of the short comings of biostatistics is the impossibility of "proving" something is entirely safe. There is an irony there.

Currumpaw profile image
Currumpaw in reply to dadzone43

Hey dadzone43,

Speaking of infection, I pulled up some info--

ncbi.nlm.nih.gov/pmc/articl...

I find it interesting and concerning that in table 1, glutaraldehyde, the cold chemical sterilant, is used to disinfect reusable needle guides used for transperineal prostate biopsies between patients, however, there is no exposure to fecal matter.

Formaldehyde or a povidone iodine solution, (betadine! really!), was used to disinfect the needles used in transrectal biopsies---between patients--! Something a little stronger with the formaldehyde. Formaldehyde kills it all!

The anti-biotic used to "augment" the 6 Cipro pills for two of my biopsies was described by the nurse as a "large, intramuscular shot of Levaquin" as she inserted the needle deeply into my buttocks!

Maybe transperineal biopsy should become the standard. It greatly reduces the risk of infection.

The transperineal probably will present a "learning curve". Perhaps that is the reluctance to make it the number one type of prostate biopsy.

Currumpaw

dentaltwin profile image
dentaltwin in reply to Currumpaw

Glutaraldehyde is high-level disinfection or sterilization depending on length of immersion. We use it in the office for non-autoclavable instruments. I don't know the size of the bore of the bx needles. They would have to be large enough to have good contact with the internal surfaces. Heat/pressure sterilization is still the gold standard. I'm a bit surprised the biopsy needles are re-used at all, frankly.

Aldehydes (glut or formaldehyde) are corrosive and they must be thoroughly removed from any immersed instrument that is going to have contact with tissue.

Currumpaw profile image
Currumpaw in reply to dentaltwin

Hey dentaltwin!

I believe the needles are 20 gauge. If they take enough samples a prostate can be made from the cancer free ones. --landed with a thud huh? I was surprised too about reuse of needles-- but that was in the study. Most are disposable today I believe. In the recent past I saw a antique hypodermic, thick glass--made me think of the old movies.

From an on line vendor:

BD Westcott Fine Aspiration Biopsy Needles are high performance units, designed for maximum precision and efficiency. They feature a Westcott needle tip type, regular wall design and a polypropylene Luer hub, color coded in black. Each unit includes an aspiration needle. The Needles are CE-Market, sterile and single-use products. For exceptional quality and added patient safety they do not contain any PVC or natural rubber latex.Select Your BD Westcott Fine Aspiration Biopsy NeedlesTo meet any specific requirement and allow greater flexibility the Needles are available in a wide variety of sizes that offer a choice of gauge and length combinations. For detailed information, please see below:20G x 3" Needle20G x 5" Needle20G x 7" Needle22G x 3" Needle22G x 5" Needle22G x 7" NeedleTo purchase Aspiration Biopsy Needles of your choice, please go to the drop down menu above and complete your online order in a few easy steps.

As for the aldehydes, glutaraldehyde, formaldehyde and I are old friends as I embalmed bodies for quite a few years. The glutaraldehyde in the instrument tray would get refreshed as needed. The strength of the formalin solution I mixed in the Porti-Boy for arterial embalming would depend on the case. Interestingly, glutaraldehyde will make the same chemical bonds with protein tissue that causes preservation as formaldehyde does --but fewer of them.

dentaltwin profile image
dentaltwin in reply to Currumpaw

Ahhh...I have fond memories of the gross anatomy lab. I think they used phenolics, which weren't quite as irritating. But by the middle of the term we had maggots in the cadaver. "That's alright", Andy the embalmer said "They don't eat much!"

Currumpaw profile image
Currumpaw in reply to dentaltwin

Hey dentaltwin!

Yep! The elderly person that wasn't missed for --some time. The suicides. I remember the gent that walked in and made his arrangements. He walked in. A month later he was on the table missing a lower leg. half a foot I believe, and had had a heart operation. I found out that by dying he missed his hip replacement. I must say that I cursed at his doctors. I felt he was used as a money machine. L feel that his doc should been more upfront -- maybe the medical advice should of been something like--"Got someone you want to see, now is the time. Maybe a dinner or two with them. Food you want to eat that you haven't been eating because I told you not to, don't overdue but enjoy it. Maybe a few of your favorite drinks, bottle of wine but not all at once! A cigar, a few cigarettes maybe and would walking into a place with dancing girls holding a fistful of fives bring a smile to your face? Do it!

I have to remember my own advice.

Embalming those you know, some close to you.

Currumpaw

NO procedure is "completely safe". The risks for a prostate biopsy are low in comparison to the benefit of diagnosing cancer of the prostate. I had one and it diagnosed Gleason 7 cancer, resulting in treatment (surgery). I believe it is more accurate in diagnosing than MRI alone, but that is my opinion. It worked for me. The only side effect was blood in the urine the first time I pissed after the procedure.

Hurts.... Wish it on my ex-wife if she had one. Come to think of it I think she may have had one....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 09/05/2019 4:31 PM DST

You may also like...