Our Summary

This study investigated the accuracy of two types of biopsies used in diagnosing and staging prostate cancer: the classic systemic biopsy and the newer targeted biopsy guided by magnetic resonance imaging (MRI). The researchers examined the medical records of 112 patients who had radical prostatectomy (surgical removal of the prostate) at their institution between January and June 2021. They found that 17.7% of patients who had the classic biopsy and 12% of those who had the MRI-guided biopsy had their cancer severity underestimated (undergraded) in the initial biopsy compared to the final pathology report after surgery. No cases of overgrading (overestimating cancer severity) were found. The study suggests that MRI-guided biopsies are more accurate than classic systemic biopsies, as they target the tumor itself rather than the areas where tumors are most often found. This reduces the likelihood of sampling error, where only a low-grade part of the tumor is biopsied and the cancer’s severity is underestimated.

FAQs

  1. What are the two types of biopsies used in diagnosing and staging prostate cancer according to the study?
  2. How do the rates of underestimating cancer severity compare between classic systemic biopsies and MRI-guided biopsies?
  3. Why are MRI-guided biopsies suggested to be more accurate than classic systemic biopsies in diagnosing prostate cancer?

Doctor’s Tip

A helpful tip a doctor might tell a patient about prostate biopsy is to consider asking for a targeted biopsy guided by MRI, as it may provide more accurate results compared to a traditional systemic biopsy. This can help ensure a more precise diagnosis and staging of prostate cancer, leading to better treatment decisions.

Suitable For

Patients who are typically recommended for a prostate biopsy include those with elevated levels of prostate-specific antigen (PSA) in their blood, abnormal digital rectal exam findings, or other risk factors for prostate cancer. Additionally, patients with a family history of prostate cancer or those who are experiencing symptoms such as frequent urination, difficulty urinating, or blood in the urine may also be recommended for a biopsy. The findings of this study suggest that patients who are undergoing a prostate biopsy may benefit from having an MRI-guided biopsy to improve the accuracy of diagnosing and staging prostate cancer.

Timeline

Before the prostate biopsy:

  1. Patient presents with symptoms such as frequent urination, difficulty urinating, blood in urine, or elevated PSA levels.
  2. Patient undergoes a digital rectal exam and PSA test to assess prostate health.
  3. If abnormalities are found, the patient may be recommended for a prostate biopsy to further investigate potential cancer.

During the prostate biopsy:

  1. Patient undergoes a transrectal ultrasound-guided biopsy, where a needle is inserted into the prostate to collect tissue samples for analysis.
  2. The biopsy samples are sent to a pathology lab for examination to determine if cancer cells are present and to assess the aggressiveness of the cancer.

After the prostate biopsy:

  1. Results of the biopsy are typically available within a few days to a week.
  2. Depending on the results, further tests or treatments may be recommended, such as additional imaging tests, active surveillance, radiation therapy, or surgery.
  3. If cancer is confirmed, the patient may undergo counseling to discuss treatment options and potential side effects.
  4. Follow-up appointments will be scheduled to monitor the patient’s condition and response to treatment.

Overall, the timeline of a prostate biopsy involves initial screening and evaluation, the biopsy procedure itself, and post-biopsy follow-up to determine the best course of action for the patient’s prostate health.

What to Ask Your Doctor

Some questions a patient should ask their doctor about prostate biopsy include:

  1. What type of biopsy do you recommend for me - a classic systemic biopsy or an MRI-guided biopsy?
  2. How accurate is the biopsy in determining the severity of my prostate cancer?
  3. What are the potential risks and side effects of the biopsy procedure?
  4. How will the biopsy results impact my treatment options?
  5. How long will it take to receive the biopsy results?
  6. Will I need additional biopsies or tests after the initial biopsy?
  7. What are the chances of the biopsy underestimating or overestimating the severity of my cancer?
  8. Are there any alternative diagnostic tests or procedures that I should consider?
  9. How experienced is the healthcare team in performing prostate biopsies?
  10. What should I expect before, during, and after the biopsy procedure?

Reference

Authors: Pezelj I, Pirša M, Svaguša I, Nikles S, Tomić M, Knežević M, Tomašković I, Krušlin B. Journal: Acta Clin Croat. 2022 Oct;61(Suppl 3):28-31. doi: 10.20471/acc.2022.61.s3.4. PMID: 36938557