Prostate Biopsies

I recently heard an interesting talk given by my local urologist in which he traced the history of prostate biopsies to detect cancers.  I’d like to share a couple of insights that I learned.  When my own cancer was first detected in 1995, the surgeons collected six samples via the trans-rectal route.  I assume that at that time, this was the standard protocol.  Currently, I understand twelve samples is the norm.  However, my urologist stated that the trans-rectal route can easily miss cancers located in the anterior tissues of the prostate gland.  Therefore, he recommended that the best route for biopsies is trans-perineal, i.e., the genital area between the scrotum and anus.  This route provides better access to the anterior prostate.  He also mentioned that a value called PSA-density, i.e. the amount of PSA produced per volume of gland, continues to be a useful indicator of possible malignancy.  PSA density values have been used since the 1990’s.  In fact, without realizing it personally, I had used it in my own case in 1995.  An ultrasound had revealed that my prostate was not especially enlarged yet my PSA was consistently somewhat high in the 4.o ng/ml range.  Naively, I reasoned that if a smaller gland was producing a higher than normal amount of PSA, something might be wrong.  I was correct.  Numerical guidelines for PSA densities are available though I don’t have that information at hand.  My urologist also discussed the increasing use of magnetic resonance imaging (MRI) in guiding biopsies and delineating the prostate and surrounding tissues.  An excellent overview of prostate MRI was written by UCLA Radiologist Dr. Daniel Margolis and published in the November, 2010 issue of the Prostate Cancer Research Institute (PCRI) Insights.  An on-going clinical trial at the National Cancer Institute using MRI-guided focal therapy to treat low-risk, localized prostate cancer was also posted on this website on July 11th, 2012.

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