Over a million men get a prostate biopsy every year and quite often, in fact almost always, they are unaware of how dangerous a biopsy can be. It’s a well established fact that over 100,000 men every year in the United States get unnecessary treatment for their prostate cancer. Unnecessary because they have small low grade disease that never would hurt them.
HOW DOES THAT HAPPEN?
It starts with the prostate biopsy. Instead of targeting an abnormality within the gland, random biopsies with 12 different cores are used and small amounts of low grade prostate cancer are routinely discovered in about 25% of people that have a biopsy. So any man over age 50, even with a normal PSA, harbors what we call low risk or low grade prostate cancer. When people hear the word cancer, of course that precipitates action and they are being managed by a very aggressive group of doctors — urologists who are trained as surgeons and whose typical stance is to do something about it, rather than monitor.
All this starts with the prostate biopsy and a lot of the problems have been blamed on PSA testing, but it’s really not the PSA that’s the causing the problem, it’s what we’re doing with the PSA information. This information is leading to random biopsies, which is considered the standard of care in the United States right now.
ALTERNATIVES TO RANDOM BIOPSY?
It’s so important to think in terms of a prostate imaging study (Multiparametric MRI or Color Doppler Ultrasound) rather than a random biopsy.