14 November 2017

Do you need a prostate biopsy?

Prostate biopsy (taking and examining a fragment of tissue) is a painful and insufficiently informative procedure, it is performed annually by more than a million men around the world. In most cases, cancer is not confirmed.

There are other diagnostic procedures that are less costly and painful, but which can help specialists suspect prostate cancer at the earliest stage.


Most often, prostate cancer screening begins with a blood test for PSA (prostate-specific antigen). Elevated PSA levels may indicate the likelihood of prostate disease.

Determination of the PSA level in combination with the results of finger and ultrasound rectal examination can help the doctor to suspect prostate cancer.

The most common diagnostic test for suspected prostate cancer is a biopsy: a doctor, under ultrasound control, takes a piece of prostate tissue with a small needle, which is then examined under a microscope for the presence of cancer cells.

A biopsy can not only show the presence or absence of cancer, but also determine its stage.

The patient should talk to the doctor whether a prostate biopsy is necessary in this case or there is an alternative.

It is better to give preference to a biopsy in the following cases:

  • The PSA level is significantly higher than normal, the prostate is sharply enlarged during finger examination.

  • The data of imaging methods indicate the likelihood of an aggressive form of cancer.

  • The patient is at risk of prostate cancer.

Three alternatives to biopsy

Laboratory diagnostic methods

There are a number of tests that determine the presence of enzymes synthesized by cancer cells in the blood. One of these tests is the 4Kscore analysis, a relatively new way to diagnose prostate cancer. It does not replace a biopsy, but it can "weed out" those who do not need a biopsy.

The method of determining enzymes in the blood cannot be used as the only one, it can complement other studies.

Observation in dynamics

Most often, after detecting high PSA numbers in the blood, the doctor immediately prescribes a prostate biopsy. However, it is equally important to know whether the PSA changes over time. So, for example, if the PSA level is high, but does not change for a certain time, then there is most likely no prostate cancer.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is an imaging technique that uses a magnetic field and radio frequency pulses. Just like a biopsy, MRI can give false results, but its accuracy is 98%.

There are different variants of MRI:

  • Diffusion MRI – assessment of water absorption by molecules.

  • MRI with contrast – assessment of blood flow in and around the prostate.

  • Magnetic resonance spectroscopy – allows you to distinguish cancer from other causes of prostate enlargement (for example, infectious diseases).

Each MRI technique has its advantages and disadvantages. The combination of two different techniques is optimal, then the picture will become more complete.

Advantages and disadvantages of prostate biopsy

Prostate biopsy, like any other research method, has its own characteristics.

The advantages are:

  • Getting accurate information about the aggressiveness of cancer.

  • Confirmation of cancer if there is evidence to suspect it.

  • The ability to start treatment immediately after a biopsy.

The issue of early diagnosis of prostate cancer is very relevant, since the five-year survival rate with timely detection and treatment is 99%.

Disadvantages of prostate biopsy

  • Discomfort. The biopsy material is taken under local anesthesia, but pain may occur in the first days after the procedure.

  • Insufficient information content. The probability of not finding cancer in its presence is about 20%. There is also a risk of false positive results. This means that some patients will have to perform a biopsy several times.

  • The risk of hospitalization. The invasiveness of the procedure implies the likelihood of complications, primarily infectious. A 2011 study showed that within 30 days after a prostate biopsy, 6.9% of men were hospitalized. In addition, there is a risk of bleeding during the first days after the procedure.

Prostate Cancer Risk Factors

Elevated PSA levels in the blood are an important risk factor for prostate cancer.

Other factors include:

  • age;

  • burdened heredity (the presence of prostate cancer in blood relatives);

  • the presence of mutations in the BRCA1 and BRCA2 genes;

  • the presence of Lynch syndrome (hereditary colon cancer);

  • eating red meat and dairy products with high fat content;

  • fatness;

  • smoking;

  • inflammatory diseases of the prostate in the anamnesis;

  • a history of sexually transmitted infections;

  • exposure to certain toxic chemicals.

Some studies show that vasectomy also increases the risk of prostate cancer.

What questions should I ask the doctor?

Below is a list of some questions that you can ask the doctor who prescribed you a prostate biopsy.

  • Am I at risk of prostate cancer?

  • What are the methods of prostate cancer treatment?

  • Are there other, more accurate and safer methods of prostate cancer diagnosis?

  • Will I need a second biopsy?

  • How high is the PSA level in my blood?

  • What are the results of finger and ultrasound rectal examination of the prostate?


The diagnosis of prostate cancer often scares patients, but in fact this disease is treatable and has a favorable prognosis with early detection. This does not mean that all men should undergo all kinds of diagnostic procedures. It is necessary to consult with a competent specialist who will prescribe the most appropriate methods.

Aminat Adzhieva, portal "Eternal Youth" http://vechnayamolodost.ru according to Medical News Today: Are there any alternatives to a prostate biopsy?

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