Prostate biopsy alternatives: Three options

A prostate biopsy can be painful and stressful and will not catch all cases of prostate cancer. Even so,
more than a million men undergo prostate biopsies each year. Most do not have prostate cancer.

A number of alternatives to a biopsy can help men assess their risk for prostate cancer, decide whether they should be screened, and test for prostate cancer. In this article, we look at three of these options.

Overview

Microscope used to check prostate biopsy

A prostate biopsy sample will be viewed under a microscope to check for abnormal cell growth.

For most men, testing for prostate cancer includes a blood test for prostate-specific antigen (PSA). Higher-than-normal PSA scores may suggest a problem with the prostate.

If a PSA test or a digital rectal exam of the prostate shows a possible prostate irregularity, a doctor may suggest someone has further testing. 

One of the most common tests for prostate cancer is a prostate biopsy. During the biopsy, a doctor uses an ultrasound machine to look at the prostate. A small device is inserted into the rectum to perform the ultrasound.

Using a small hollow needle, the doctor removes a tissue sample from the prostate. The sample is then viewed under a microscope to check for abnormal cell growth. Several samples of prostrate tissue may be taken during the procedure.

A prostate biopsy can also help to decide the stage of prostate cancer if it is present. Discovering how advanced the disease is can help a doctor determine the best treatment. 






Three alternatives to prostate biopsy

Men should discuss with their doctors whether a prostate biopsy or an alternative is best. A biopsy may be the best option when:

  • PSA levels are high, or significantly higher than the size of the prostate suggests they should be. 
  • Imaging of the prostate suggests the man might have an aggressive form of cancer
  • The person being examined has a raised risk for prostate cancer.

Three of the possible alternatives to a prostate biopsy are:

Prostate cancer enzyme tests

Some tests look for enzymes produced by prostate cancer to assess whether the condition is present, and whether it may be aggressive or fast growing. These tests use either blood or urine samples to assess a man’s risk.

Doctors normally recommend these tests for men who have high PSA scores or whose doctors find abnormalities during a digital prostate exam. 

One new blood test is the 4Kscore test, which measures a man’s risk of prostate cancer. This test does not replace a biopsy, but it can help identify which men should have one. As a result, it may help reduce the total number of men who undergo biopsies. 

Enzyme tests cannot identify every case of prostate cancer but neither can biopsies. Instead, blood and urine screenings find the most aggressive cases of the disease.

Some forms of prostate cancer are slow-growing rather than aggressive. These forms are unlikely to be fatal. 

Watchful waiting 

In most cases, a doctor will recommend a prostate biopsy based on a high PSA score. However, other issues can cause a high PSA score and a PSA score also tends to rise with age.

Waiting and testing PSA levels again can provide useful information. A man whose score remains high but has not changed since the last test may not have prostate cancer. 

Magnetic resonance imaging

Magnetic resonance imaging (MRI) uses a magnetic field and radio frequency pulses to help a doctor view the prostate. 

Similarly to biopsies, MRIs can sometimes produce an incorrect result, but they also detect up to 98 percent of prostate cancers.

An MRI scanner being used to detect prostate cancer

An MRI scanner may be used to detect prostate cancer.

Doctors use a variety of techniques to look for cancer with an MRI. The options include:

  • Diffusion-weighted imaging: This looks at how the prostate absorbs water. 
  • Contrast imaging: Blood flow in and around the prostate is observed with the help of a dye. 
  • Spectroscopic imaging: This aims to distinguish prostate cancer from other causes of prostate enlargement, such as infection.

Each technique has its strengths and weaknesses, and the ability of each approach to detect a given type of prostate cancer varies. The most effective MRI methods combine several of these imaging techniques.

Benefits and drawbacks of a prostate biopsy

A prostate biopsy is a routine procedure. Some of the benefits of choosing this option include:

  • getting accurate information about how aggressive the cancer is 
  • confirming a diagnosis of suspected prostate cancer 
  • being able to treat prostate cancer promptly

When caught early and treated correctly, prostate cancer has a five-year survival rate of 99 percent.

The drawbacks to a prostate biopsy include:

  • Discomfort: Most people receive pain medication to reduce discomfort during the procedure. However, it is common to experience bleeding and pain in the days following a biopsy. 
  • Inaccurate or incomplete results: Prostate biopsies miss about 20 percent of cancer cases. They can also produce false positive results. This means some people may need to undergo multiple biopsies. 
  • Risk of hospitalization: This can be due to infection and other prostate issues. A 2011 study found that in the 30 days following a prostate biopsy, 6.9 percent of men were hospitalized. Just 2.7 percent of men who did not undergo a biopsy ended up in the hospital.






Risk factors for prostate cancer

Men who have a high risk of developing prostate cancer may consider having a prostate biopsy if their PSA is elevated.

The risk of developing prostate cancer increases with age. Other risk factors include:

variety of red meats

A diet high in red meat is a risk factor for prostate cancer.
  • a family history of prostate cancer
  • having genetic mutations, including the BRCA1 and BRCA2 genes 
  • having Lynch syndrome
  • eating a diet high in fatty dairy products or red meat 
  • being obese 
  • smoking 
  • a history of sexually transmitted infections (STIs) or prostate inflammation 
  • exposure to certain toxic chemicals

Some research suggests that a vasectomy may slightly elevate the risk of prostate cancer. 

What to ask the doctor 

Some questions people can ask their doctor to help decide whether to undergo a prostate biopsy include:

  • Do I have a higher-than-usual risk for prostate cancer? 
  • What treatment options are available for prostate cancer? 
  • Is there another test that is safer or more accurate?
  • Will I need a repeat biopsy?
  • How high is my PSA reading? 
  • Was my digital rectal exam normal? 
  • What are the cancer screening guidelines for my age and risk factors?






Conclusion 

Prostate cancer can be a frightening diagnosis, but the disease is also highly treatable. That does not mean that men must undergo every conceivable test for prostate cancer. 

Not all prostate cancers require treatment. Men should consult with their doctors to determine the best preventative checks for them. 

Courtesy: Medical News Today