IS IT POSSIBLE TO SKIP A BIOPSY?
We've been talking a lot about the different types of biopsies - targeted vs random and all these new developments. But what's really exciting is with imaging coming along so nicely in the last few years, we can talk about leaving the biopsy out of the picture altogether. We can simply rely on our imaging and PSA levels to determine if there's a significant problem. This of course avoids a lot of the problems - the discomfort, the risk of infection, and other issues that are associated with doing biopsies. How can we simply leap frog over the biopsy question, or the need for biopsies. The answer is we can trust that imaging is able to see high-grade disease. Historically, we've relied on these random biopsies to detect high-grade disease. But now that we know that imaging studies are 95-98% accurate for finding the presence of high-grade prostate cancer, we can simply do an imaging study. And if it doesn't show any high-grade prostate cancer, we don't need a biopsy. This is something quite revolutionary and exciting. Now what about that 2-4% chance that an imaging study could miss high-grade prostate cancer? The answer to that is patients should have ongoing PSA testing. If there is a continued suspicion of an underlying abnormality that may have been missed on a previous scan, then subsequent scans can be performed 6-12 months later to see if there is something brewing or growing. The good news about prostate cancer is these small tumors typically won't spread until it gets to a certain size. That gives us the luxury of monitoring the sequential scans over time. Every man with an elevated PSA, isn't required to undergo a biopsy, they can have a scan and if the scan shows no abnormality, then they can safely rely on that information.
PROSTATE IMAGING REQUIRES AN EXPERT
The technology to image the prostate gland with multi parametric MRI or color Doppler ultrasound is quite accurate and useful. But there are several caveats. The right technology is necessary - 3 Tesla MRI. We also need to have good technicians performing the scans and of course most importantly physicians that are specifically trained in how to read these scans. Unfortunately, there are doctors out there doing scans that don't know what they don't know. They will provide a scan, give you a report, but upon my expert review of some of these reports, the scans are really suboptimal. When doing prostate scanning, at least as of 2013, it's important to use selected facilities - centers of excellence, that specialize in getting optimal information.