does prostate biopsy spread cancer?

[notme]

I just heard a MRI technician say that if you get a biopsy and the needle hits cancer that it's 100% certain that your cancer will spread to outside the gland. read for yourself at www.mrisusa.com

do you believe this?

of course he is trying to sell MRIs instead of biopsy, and I agree ~ a MRI doesn't hurt. So what is the reason doctors all want a biopsy? $$?

If you have cancer of-- say the bones, they give MRIs to locate it.

[Replicant]

MRI does not diagnose prostate cancer. A pathologist needs to look at the cells under a microscope. MRIs can be used to look for spread outside the prostate, and there may be a role in using it to do targeted needle biopsies.

My reading of the literature (on the National Library of Science's PubMed, for example) is that the risk of a biopsy needle tracking tumor cells into healthy tissue is not zero, but it is on the order of a few percent. A 1991 study by Walsh and Epstein at Johns Hopkins found that 2% or so of their biopsies showed evidence of this--but this was back when needles were bigger.

There is also the risk of infection, even though this risk is mitigated by antibiotics. (A friend of our family had a quite serious infection from a prostate biopsy).

Therefore, prostate biopsies should not be done without reasonable suspicion. The risk needs to be balanced against the benefit of the information gained.

Just my non-qualified view on the matter.

[Replicant]

notme,
from the website you linked to, I went into the diagnosis section. Indeed, this site is NOT claiming that MRI can diagnose prostate cancer. As I wrote in the other response, the site is talking about using MRI to avoid blind biopsies, to target where the needle goes.

Quote from site (emphasis supplied by me)
Diagnosis
Prostate cancer is most often discovered by physical examination or by screening blood tests, such as the PSA (prostate specific antigen) test. Suspected prostate cancer is typically confirmed by removing a piece of the prostate (biopsy) and examining it under a microscope. However, blind needle biopsies spread cancer cells and only yield a 25 % success rate in finding cancer. Recent advancements in imaging technology such as prostate 3.0 Tesla MRI with Spectroscopy allow physicians to locate suspicious areas of disease and then performed targeted biopsies improving diagnostic outcomes by up to 40%. In addition to locating suspicious lesions, 3.0 Tesla with Spectroscopy can determine whether prostate cancer has spread beyond the capsule.
http://www.mrisusa.com/Prostate%20Cancer.html

[Replicant]

Walsh, in his book on pages 178-179, addresses the question of needle tracking of tumor cells. He says "This is an excellent question and a very common fear", but basically if it were a serious risk, then "the whole concept of early diagnosis and treatment wouldn't work. But many thousands of people--all of whom had initial biopsies to confirm what they had--have been cured of cancer."

He goes on to say that sometimes cancer cells may escape into the bloodstream, and that the "circulation of cancer cells in the blood is probably a common event, even in cancers that are curable. And it's not unreasonable to assume that a few more cells may find their way into the bloodstream when the tumor is manipulated, as it is during a biopsy. The key is the stage of your cancer. When cancer is confined to the prostate, even if a few cells escape into the blood, they won't survive. This is because they haven't yet got the hang of living outside the area where they developed." A few sentences later: "So there are two different issues. One is the presence of cancer cells in the blood.; the other is the survival of these cells in distant locations. Prostate cancer cells are simply unable to live outside their normal environment until they develop this ability, called metastatic capability."

[Hawk]

A couple thoughts on this topic:

My Conversation with Dr. Bertrand Guillonneau who performed my surgery at Sloan-Kettering

Question: "At what point does this cancer start throwing cells out into my blood stream?"

Answer: "Oh, you have cancer cells in your blood stream. That does not mean they are capable of establishing themselves and surviving. No one can tell what moment that may happen."

I am not suggesting this is the last word. As Dr. Guillonneau himself says at times, "What do I know, I am only a surgeon"
albeit a world renown surgeon.

One other point. I can easily see how MRI can guide a biopsy and increase the odds of not missing a small tumor. It would have possibly spared me 3 biopsies if I had my endo rectal coil MRI earlier on. What makes no sense to me is how it can reduce one bit the slim risk of tracking cancer during a biopsy. A biopsy needle is still inserted into the tumor and extracted exactly like any biopsy. They obviously use a fresh needle with each core taken so the needles that miss the cancer are no risk and that is all the MRI is designed to reduce. That is unless they imply they can do the job with one or two needles because they now they hit the tumor. Even in that scenario, I only had two needles hit my tumor.

[brainman]

Notme, I have never heard or read any legitimate site (JAMA, NEJM...) that says that needle biopsy can spread cancer. I have heard about full surgery having the danger of sloffing off cancer cells. I do not have a reference for this... I am not sure this is true, it just is something that is in the back of my mind as something that I have heard.

[notme]

Thanks for all your replys

It occurred to me that doctors order a MRI to locate the suspicious site of cancer, but then, yes they always follow with a biopsy, except in the brain.
My experience with this was the MRI was always correct, it was indeed cancer, so I still wonder if the biopsy is really needed.

yes, brainman, I remember hearing of surgery leaving behind cells...

"What do I know, I am only a surgeon" (:

Replicant, agreed, we all sure hope: "many thousands of people--all of whom had initial biopsies to confirm what they had--have been cured of cancer."

[Hawk]

The bottom line is that an MRI can identify a mass or density change in the tissue. Only a trained pathologist with a microscopic study of cell structure can tell if it is cancer. Additionally, only a pathologist can give the much needed information on the Gleason grade of cancer.


PS: I loved Dr. G's "what do I know, I am only a surgeon" remark. He was highly specialized and humble about what he did not know (nutrition etc). Some doctors try to fill in the blanks by guessing with the sound of authority.

[notme]

The guy from that web site, mrsiusa, wrote on another forum "it's not what I believe, it's a fact...Prostate Biopsies do spread Prostate Cancer. If a Doctor hits Prostate Cancer during a Biopsy, The chance of needle tracking (spreading the cancer) is close to 100%!!!"

He certainly was clear when writing off the books.....that is, IF it is indeed him, but it certainly sounds like it is.

[brainman]

notme, I am do not agree with that guy you are quoting... no matter how confined he sounds. Everyone who has had or currently has prostate cancer has had at least one needle biopsy including Hawk, Replicant, and many others. They show no signs that the needle biopsy has spread their cancers. As Replicant quoted, if the danger was indeed 100%, there is no way the medical professionals would continue to use needle biopsies.

[Replicant]

They're big on selling proprietary herbal/vitamin supplements (click on Peenuts.com at the bottom of mrisusa.com -- the websites are nearly identical and both registered to Wheeler's medical practice).

They have yet another website, same registration, same design, PanAmHIFU.com, with a section "Why HIFU Fails" which argues that you should have a biopsy using their special MRI equipment for targeting, before getting HIFU. They also want you to come to them for imaging if your PSA fails to nadir below 0.5 ng/ml, or if your PSA rises after HIFU.
http://panamhifu.com/why_hifu_fails.html

notme, is Dr. Wheeler "the guy" to whom you refer?

[notme]

No, it's the MRI technician who is writing. Yes, he sites all of the web sites you mention and touts Peenuts.
Thing is, if he is right then I think we should warn others...yes, it's too late for me as well. I don't like the fact that he is selling so much, but if he is correct.... Here's a part of what he says....

"I'm the MRI Technologist here at the Diagnostic Center for Disease. For the past 2 years I've been fortunate enough to have my eyes opened to this horrific disease that plagues all men and their families. I have dedicated my life and career to working exclusively with patients that have Prostate disease. Helping to educate, as well as being educated by more than 400 patients that I have personally performed MRI's of their Prostates. Realizing how barbaric and ludicrous traditional Urologists in are diagnosing and treating people every day. Traditional Urologists usually don't even begin to intervene until the PSA goes above 4.0. Why, because that's been the "GOLD STANDARD". Well, I think it's time we update that Gold Standard. I've personally performed MRI's on several people with low PSA's less then 2.0, the lowest being 0.7. All of these men were positive for Prostate Cancer on MRI and were then confirmed with a targeted focal biopsy of only the area in question. Had these men, gone the traditional route, they first would have first waited for their PSA's to go up, which would have caused their Cancer to grow. Then, when their PSA was around that MAGIC number(4.0), the Urologist would do a blind biopsy and might get lucky enough to stick one of his 6-12 needles in the area where the Cancer was. If not and the results were negative would that mean that the patient was cancer free or the Doctor who he trusted might have missed. Then, when he has a follow up PSA in 6-12 months and he sees it's gone up what does he do? Have another BLIND Biopsy, only this time the Urologist ups his odds and uses 12-20 needles. This barbaric inhuman process continues until the Urologist finally hits the Cancer. Here's a fact for you: 30% of 30 year old men have Prostate Cancer. Unfortunately for them, According traditional Urology guidelines, these men probably won't get a PSA till they're 50. Now let's take that "GOLD STANDARD" of Urology one step further. The DREADED BLIND PROSTATE BIOPSY... Why is it that every other organ in the human body is first studied through some form of imaging and then biopsied. EXCEPT the Prostate? Think of it like this. A patient goes to his Doctor with all the signs and symptoms of possible Brain Cancer. Does his Doctor arbitrarily stick 6-12 needles in his brain to see if the symptoms are correct. No, he sends the patient for a CT Scan or MRI of the Brain. If the results shows a suspicious area, then a Targeted Guided Biopsy done and ONLY in that region. Barbaric or not, you decide?

You say Dr. Scionti told you that biopsy does not cause cancer to spread except in the rarest of occasions. He's absolutely correct since most Urologists only yield cancer 20-30% of the time and patient's are rarely studied after their treatment. There was an article published by a Urologist on Needle Tracking in The Journal of Urology, November 2002. "

[Replicant]

I can find you many, many such people who are utterly convinced--there was a guy on the Usenet prostate cancer support group who drank his own urine (as you might imagine, it didn't work) , another guy who showed up there who was convinced if you drank this kind of milk and not that kind of milk, it would cure you ( http://www.endcancernow.org/ ); someone showed up here, on HealingWell.com, and other places shouting that hot peppers had definitely cured him...after a few months of proclaiming his cure, he mysteriously vanished ( http://www.cancerforums.net/about8898.html ).

What matters is science, not stories; studies, not anecdotes.


I see no need to pay any attention to the technician in question.

"Convictions are more dangerous enemies of truth than lies."
--Friedrich Nietzsche

[Hawk]

Hogwash to the technician out to save men from a barbaric life.

I think he is out to assure he has enough money that he does not live a barbaric life (at any gullible man's expense).

[Joe Hutt]

This is what Dr. Ben L. Pfeifer, M.D. Ph.D. has to say on this subject

I want to leave a message for you to take home. It is more for the lay man than doctors who won't often listen to the message I have spent ten years trying to get through and I call this rocking the boat: We know that any bioscopy or any surgery or prostate brachytherapy where you put radioactive seeds into the prostate to carry out radiotherapy " any or those therapeutic or diagnostic measures involving mechanical intrusion with a sharp needle in to the tumour " we know this will cause iatrogenic (caused by doctor's measures) shedding of cancer cells into blood stream which may " I must stress may " lead to early metastases. These diagnostic biopsies are a dangerous tool. The person has to be fit for it, the immune system needs to be strong to cope with the cancer cells- this is the same with breast biopsy.

10 years ago when I first talked about this in Germany at a conference attended by 2000 urologists, I was invited without their knowing I would bring this up. I was booed at which wasn't a very pleasant situation. At time we didn't have any proof it was just a hypothesis. Now in 1996 a method came out called Reverse transcriptase polymerase chain reaction test " a molecular test capable of finding one prostate cancer cell among 10,000,000 blood cells. This is a very highly sensitive test used to quantify how many prostate cancer cells would be found in a man's peripheral blood after a biopsy. There is method for doing this which will find from 0 -14,000 cells in 1 millilitre.

In patients with BPH (enlarged prostate) we don't find cancer cells 4 weeks after the biopsy.
Here you see after 2 weeks of biopsy a patient in which the needle identified cancer: in 1 millilitre of blood there are now 12,000 copies of tumour cells. That means in 5 litres- 5,000 x 12,000 that is 60 million. No urologists would like to have that injected.