Our Summary

This research paper reviews recent developments in diagnosing prostate cancer. It highlights the use of multiparametric MRI (mpMRI) as a pre-biopsy screening tool. The paper suggests that this MRI technique, especially when combined with ultrasound-targeted biopsy, has a higher accuracy in detecting cancer than traditional methods. The study also mentions that testing urine for RNA biomarkers and examining biopsy samples genetically can also contribute to deciding whether a patient needs a (re)biopsy. These techniques are not without flaws, but they can enhance diagnosis when used cautiously. The ultimate goal is to avoid unnecessary biopsies and the potential risks and side effects associated with over-treatment.

FAQs

  1. How does the use of multiparametric MRI (mpMRI) improve the accuracy of prostate cancer diagnosis?
  2. What are the potential benefits of testing urine for RNA biomarkers and examining biopsy samples genetically in diagnosing prostate cancer?
  3. What are the potential risks and side effects associated with unnecessary prostate biopsies and over-treatment?

Doctor’s Tip

A doctor may advise a patient undergoing a prostate biopsy to stay relaxed and breathe deeply during the procedure to help reduce discomfort. They may also recommend taking over-the-counter pain medication, such as ibuprofen, before the biopsy to help manage any post-procedure pain. Additionally, patients should follow any instructions given by their doctor regarding post-biopsy care, such as avoiding heavy lifting and strenuous activities for a few days following the procedure. It’s also important to stay hydrated and rest as needed to help the body recover.

Suitable For

Patients who are typically recommended for a prostate biopsy include those with abnormal digital rectal exam (DRE) findings, elevated prostate-specific antigen (PSA) levels, or suspicious findings on imaging studies such as mpMRI. Additionally, men with a family history of prostate cancer or other risk factors may also be recommended for a biopsy. It is important for healthcare providers to carefully assess each patient’s individual risk factors and symptoms before recommending a prostate biopsy to ensure that the benefits of the procedure outweigh the potential risks.

Timeline

Before prostate biopsy:

  1. Patient undergoes a digital rectal exam (DRE) to check for abnormalities in the prostate gland.
  2. Patient may have blood tests to measure prostate-specific antigen (PSA) levels.
  3. Patient may undergo a multiparametric MRI (mpMRI) as a pre-biopsy screening tool to identify suspicious areas in the prostate.
  4. If mpMRI shows abnormalities, patient may undergo a targeted biopsy using ultrasound guidance to sample specific areas of concern.

After prostate biopsy:

  1. Patient may experience side effects such as bleeding, pain, infection, or difficulty urinating.
  2. Biopsy samples are examined by a pathologist to determine if cancer is present and to assess the grade and stage of the cancer.
  3. Depending on the biopsy results, patient may undergo further tests or treatments such as additional biopsies, imaging studies, or prostate cancer treatment options.
  4. Patient may require regular follow-up appointments to monitor the progression of the cancer and assess the effectiveness of treatment.

What to Ask Your Doctor

  1. What are the risks and potential side effects of a prostate biopsy?
  2. How accurate is a prostate biopsy in detecting cancer?
  3. Are there alternative screening methods, such as multiparametric MRI, that can be used instead of a biopsy?
  4. What factors would indicate the need for a prostate biopsy in my specific case?
  5. How will the biopsy results be used to determine the appropriate treatment plan?
  6. Are there any specific preparations or precautions I should take before the biopsy procedure?
  7. How long will it take to receive the results of the biopsy?
  8. Are there any lifestyle changes or follow-up appointments I should consider after the biopsy?
  9. What are the potential implications of a negative biopsy result?
  10. Are there any additional tests or procedures that may be recommended based on the biopsy results?

Reference

Authors: Hübner N, Shariat S, Remzi M. Journal: Curr Opin Urol. 2018 Jul;28(4):354-359. doi: 10.1097/MOU.0000000000000510. PMID: 29847523