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Herbert Ruckle, MD, FACS, chair of urology, delves into the process and implications of prostate biopsies

As Prostate Cancer Awareness Month approaches, gaining a deeper understanding of prostate biopsies is crucial for early detection and management of prostate cancer. Herbert Ruckle, MD, FACS, chair of urology, provides valuable insights into the biopsy process and its implications, especially following abnormal PSA levels.

"PSA, or Prostate-Specific Antigen, is a protein produced by both normal and malignant prostate gland cells," Ruckle says. "PSA levels are measured by a blood test and are a critical marker in detecting and following prostate issues. When elevated, they can indicate prostate cancer or other prostate conditions, such as benign prostatic hyperplasia or prostatitis."

Ruckle advises that men should begin PSA testing at age 45 or 40 for those with a family history of prostate cancer or African American ancestry. "If the PSA level is elevated, typically above 4.0 ng/mL, further investigation with a prostate biopsy may be warranted."

Read: My PSA is elevated – what happens next?

The Prostate Biopsy Procedure

During a prostate biopsy, patients are not typically under general anesthesia but are usually given a local anesthetic and often a light sedative to help them remain in a relaxed, dazed state. Although slightly uncomfortable, the process is usually quick, and patients can return home the same day.

A prostate biopsy involves removing small samples of prostate tissue to examine for cancer cells. The most common method is the transrectal ultrasound-guided biopsy, where a probe is inserted into the rectum to visualize the prostate and guide the biopsy needle. Other types of biopsies, like transperineal biopsy, access the prostate through the skin between the scrotum and the anus or ocassionally transurethral.

Why a Biopsy Might Be Needed

Biopsies are recommended when other tests suggest there might be a problem with the prostate. These tests include:

  • Blood Test Results: Persistently high PSA levels shown from a blood test can indicate the presence of cancer, prompting further investigation.
  • Abnormal Digital Rectal Exam (DRE): If a DRE reveals irregularities such as lumps or hard areas on the prostate, a biopsy may be needed.
  • MRI Findings: An MRI scan might reveal areas of the prostate that look suspicious and require further examination.

Risks and Complications

While prostate biopsies are generally safe, they are not without risks. "Common complications include infection, bleeding, and urinary retention," Ruckle acknowledges. "We take several steps to mitigate these risks, including administering antibiotics before and after the procedure and advising patients on managing post-biopsy discomfort."

Interpreting Biopsy Results

After the biopsy, the samples are examined under a microscope to determine the presence of cancer cells. "Results can be benign, indicating no cancer; atypical, suggesting abnormal cells that may require further investigation; or malignant, confirming cancer, Ruckle says. "We ensure that patients understand their results and the implications for their health."

Treatment Options

If cancer is detected, the course of action depends on various factors, including the cancer's stage, grade, and patient age, condition, and preferences. Treatment options include:

  • Active Surveillance: Suitable for low-risk, slow-growing cancers. Regular monitoring is done with PSA tests, DREs, and periodic biopsies.
  • Surgery: Radical prostatectomy, a robotic procedure, involves the removal of the prostate gland and some surrounding tissue. It is often recommended for localized cancer.
  • Radiation Therapy: High-energy rays or particles kill cancer cells. Proton radiation can be delivered externally or through brachytherapy, where radioactive seeds are placed inside the prostate.
  • Hormone Therapy: Also known as androgen deprivation therapy (ADT), it reduces the levels of male hormones that can fuel cancer growth and can be used to increase the effectiveness of radiation or to treat advanced cancers.
  • Chemotherapy: Uses drugs to kill rapidly growing cells, including cancer cells. It's typically used with ADT for advanced prostate cancer.
  • Immunotherapy: Helps the immune system recognize and attack cancer cells.

"PSA testing and timely biopsies have led to an overall decrease in the prostate cancer death rate and numerous personal success stories where early detection and treatment have significantly improved patient outcomes," Ruckle says.

Statistics and Outcomes

Prostate cancer is one of the most common cancers among men. According to the American Cancer Society:

  • About 1 in 8 men will be diagnosed with prostate cancer during their lifetime.
  • Prostate cancer is the second leading cause of cancer death in American men, behind lung cancer.
  • Approximately 1 in 41 men will die from prostate cancer.

However, prostate cancer is often slow-growing. Many men diagnosed with prostate cancer will not die from it but from other causes. Early detection through biopsies can significantly improve survival rates. The five-year relative survival rate for localized prostate cancer is nearly 100%, according to the American Cancer Society.

"Prostate biopsies are critical in detecting cancer early when it is most treatable. Don't let fear delay seeking the necessary diagnostic steps," Ruckle says.

Experts at Loma Linda University Health are committed to providing compassionate, comprehensive, and personalized care throughout your prostate cancer screening journey. Make an appointment for a prostate cancer screening for you or a loved one today.