Question: My PSA test results came back high and my doctor wants to send me for a biopsy. But a friend told me a biopsy can make prostate cancer spread. Is this true?
Dr. Hibberd's answer:
Your doctor is right. Biopsies are minimally invasive and are not a big deal. Your friend may be theoretically correct but from a practical viewpoint is misguided. Biopsies are most often performed under ultrasound guidance into suspicious areas and usually are done with a fine needle that extracts a core of tissue enabling almost no down time after the procedure.
Excisional biopsies for diagnosis are usually unnecessarily aggressive. Concerns regarding spread of cancer cells by biopsy have been debated for years, but the alternative is no biopsy — not always a good idea. But delaying a biopsy, while tracking PSA trends over time — to see if they are rising or holding steady — may be acceptable in some circumstances, especially if a conservative treatment plan is anticipated.
But a sample for tissue analysis is the only sure way of identifying aggressive prostate cancers, so doctors can come up with a reasonable treatment plan that is conservative or aggressive, as necessary. If you are not a candidate for surgery to remove your prostate, it is not unreasonable to ask your urologist if a biopsy can be delayed without adversely affecting your treatment plan.
We do not usually move to biopsy with a single elevated PSA reading unless a rectal exam reveals a firm nodule on your prostate, or an ultrasound suggests a mass or isolated suspicious area. Remember, an elevated PSA does not always mean cancer.
Elevations of PSA can occur with infection, and can be very high in the presence of prostate stones, giving rise to PSA levels as high as 50-100 times normal
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