[FuzzyUK (OP)]

If you don't know if you have prostate cancer then a biopsy seems to be one way of telling, since from what I can make out a Prostate-Specific Antigen (PSA) test is an unreliable way of telling. But puncturing the prostate gland with a needle might push cancer cells into adjacent tissue if one has the disease?

[RD]

Regarding this frequently asked question about spreading prostate cancer, Dr. Jones maintains that needle biopsy does not pose significant risk. "This is primarily based on old wives' tales," he said. "Since metastasis occurs when cells break off and spread through the bloodstream, it makes sense that a needle placed through cancerous tissue might break off some cells. But in fact, this occurs only rarely, with certain types of high-grade cancers such as kidney cancer. Prostate cancer is not one of those types." Dr. Jones told me that he does not know of a single case reported where this occurred following a transrectal biopsy.

A DIFFERENT BIOPSY THAT SHOULD BE AVOIDED

On the other hand, there is another type of biopsy for prostate cancer called a transperineal biopsy, that in a very few instances, has been associated with cases of spreading cancer, Dr. Jones acknowledged, noting that this is rare. "The only data that has ever shown that a prostate biopsy may pose a risk are associated with transperineal biopsies, in which tissue is collected by a thin needle that is inserted through the skin between the scrotum and rectum and into the prostate," explained Dr. Jones. This procedure is more common in Italy, where there have been occasional reports of needle tracking cancer spread. Some doctors believe this type of biopsy provides better information on the location of the cancer than the transrectal approach, but this is controversial, Dr. Jones said. While the transperineal approach remains very uncommon in this country {USA}, Dr. Jones said this procedure may be seeing a small resurgence in the US based on this potential benefit.

J. Stephen Jones, MD, is chairman of the department of regional urology at the Cleveland Clinic Glickman Urological and Kidney Institute, and is associate professor of surgery (urology) at Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.

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