Can Prostate Biopsies be Deadly?
Is with good reason that men try to avoid prostate biopsies. There is nothing pleasant about them eh?
Not only is it uncomfortable, but you have to deal with the potential cause of infection and bleeding in your semen and urine that can last for weeks.
At this year’s American Society of Clinical Oncology (ASCO) meeting a disturbing scientific paper was presented. Researchers analyzed the results of the Prostate, Lung, Colorectal, and Ovarian) screening trial (PLCO) – – (DYLA – Don’t You Love Acronyms) — an showed that at 120 days after the biopsy 1.3 out of 1000 men without cancer and 3.5 out of 1000 men with prostate cancer had died (Boniol et al 2013).
This is not the first study associating prostate biopsies with mortality. A study developed in Canada observed in over 22,000 men between 1989 and 2000 and noticed a 1.3% death rate in men after a prostate biopsy within 120-days. (Gallina et al, 2008)
My take on this
The studies mentioned above do not explain why the increase in death after prostate biopsy. Also, it is not clear that the death rate was a direct result from biopsies – those that died might have already been at risk from other conditions such as heart disease.
I admit, in the 10 years I have been working with prostate patients and urologist’ I have never seen a death associated with a prostate biopsy. Hospitalization from infections? Yes. Erectile dysfunction (ED) ? Yes. Temporary ED from prostate biopsy have been reported in the scientific literature as well. (Akbal et al. 2008)
Additionally, prostate biopsies remain the gold standard for finding cancer cells in the prostate. Another words, diagnosis can only be made with a prostate biopsy.
Men with high PSA ‘s and concerns of harboring prostate cancer have no choice but to undergo screening with a prostate biopsy. The procedure is not a “walk in the park” by any means, but men at risk should not avoid a potentially life saving biopsy. Imaging’s such as MRI’s are improving, Genetic test’ are developing , but I don’t suspect any of these will replace screening with a prostate biopsy anytime soon.
Who is a candidate for a prostate biopsy? Should a PSA be used for prostate cancer screening? Can biopsies be improved? – are controversial questions and under much research.
Boniol M, Boyle P, Autier P, Perrin P. Mortality at 120 days following prostatic biopsy: analysis of data in the PLCO study. Program and abstracts of the 2013 American Society of Clinical Oncology Annual Meeting and Exposition; May 31-June 4, 2013; Chicago, Illinois. Abstract 5022.
Medscape Video with Dr. Gerald Chodak
Gallina A, Suardi N, Montorsi F, Capitanio U, Jeldres C, Saad F, Graefen M, Shariat SF, Widmer H, Arjane P, Péloquin F, Perrotte P, Karakiewicz PI. Mortality at 120 days after prostatic biopsy: a population-based study of 22,175 men. Int J Cancer. 2008 Aug 1;123(3):647-52.
Akbal C, Türker P, Tavukçu HH, Simşek F, Türkeri L.Erectile function in prostate cancer-free patients who underwent prostate saturation biopsy. Eur Urol. 2008 Mar;53(3):540-4.