What men should consider before getting a prostate biopsy

Prostate cancer has become a confusing diagnosis in recent years. The mainstream medical community is desperate to treat it like an emergency, when, for many years, it was largely considered a fairly benign “side effect” of getting older.

Yes, men do indeed die from prostate cancer. But usually, they live with it… and often, for a very long time.

Still, the debate on how to approach a positive diagnosis rages on. And as screening becomes more aggressive and overtreatment more commonplace, it’s had plenty of unfortunate consequences. (A lot of mutilated men, for one. And a subsequent misguided crusade against PSA testing, for another.)

That’s why I wanted to share these latest findings with you today.

According to a recent study, factoring in a couple of specific MRI findings into a patient’s risk assessment can cut the number of unnecessary biopsies in men with high PSA blood test scores — while still pinpointing potentially lethal prostate cancers. (This is a good thing, because as I’ve said before, it’s not the PSA that’s dangerous — it’s what your doctor wants to do, based on the results.)

These MRI-based findings are prostate volume and a relatively new test called the Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2).

This study featured more than 651 patients — all of whom had either high PSA or an abnormal digital rectal exam. And all of whom had at least one lesion identified via MRI.

After this MRI, the men received a PI-RADSv2 category assignment. Patients with lesions that were category 3 or higher received MRI-guided biopsy, as well as a systematic biopsy taking 12 different samples.

Results showed that just over 48 percent of one cohort and 38 percent of the other had what the researchers classified as “clinically significant” prostate cancer. (That is, their Gleason score was 7 or higher.)

Just as a brief refresher, your Gleason score is calculated based on how abnormal your cells appear under a microscope. Pathologists will analyze the tumor’s tissue and assign numbers based on how much the cells in the cancerous tissue look like normal prostate tissue.

If the cancerous tissue appears to portray normal prostate tissue, it’s assigned a grade 1.
If the growth patterns of the cancer cells in the tissue appear abnormal, a grade 5 is assigned.
Scores between 2 and 4 exhibit features in between the two extremes.
Traditionally, the higher the Gleason score, the likelier it is that your cancer will grow and spread quickly. But the trouble is, as men grow older, their Gleason scores can get higher — without it necessarily signifying aggressive cancer.

Which is why, as I’ve always said, it’s time to do away with blanket diagnoses and treat the individual. And when it comes to prostate cancer, many different factors should be considered, especially age.

Treatment is a shot in the dark

Recommending a course of action for older men with a high Gleason score is a whole different problem entirely. This study was dealing with biopsies — and specifically, the fact that there isn’t much guidance for helping doctors or patients decide when they’re worth performing. Up to this point, the decision has essentially been a crap shoot.

And that’s what makes this finding newsworthy. The total reduction in false positives among men biopsied according to the MRI model — and not just based on a high PSA — would be enough to spare 18 fewer men out of every 100 from unnecessary biopsies.

That’s about 20 percent. And given the problems we still have with prostate cancer overtreatment today, I’ll take it. It sure beats ditching a potentially valuable test like the PSA, despite mainstream medicine’s ignorant belief that we could do without it. An option like this helps doctors use the information they gain from the PSA in a smarter way.

At last, we’re looking at a pragmatic approach that makes some sense. Just take a guess where this research started… in Europe. It only recently received attention in this country after a few American researchers hopped on board.  Currently, doctors all over the world are working together to make this a globally-acceptable scoring system.

This is exactly why the U.S. ranks so low in most health parameters, while somehow spending the most money on health care. Our health care system lets corporate interest — instead of the best interest of the patient — run the show, especially in the fight against cancer.

Here’s my advice to you:

Until this screening approach catches wind as the go-to approach, seek out a doctor who can provide you with your PI-RADSv2 score following your prostate MRI. To find an accredited imaging facility near you, try using the search tool provided by the American Society for Radiation Oncology or visit the Resources section on the Prostate Cancer Foundation’s website.

As for testing guidelines, you should absolutely get screened for prostate cancer (and that definitely should include routine PSA testing). You should have at least a baseline PSA test at some point by the time you’re 50 (it could cut your risk of prostate cancer death in half).

If you receive a high PSA result, active monitoring of your levels over time is ideal. In most cases, prostate cancer is not something that must be removed from your body immediately. Often times, simple lifestyle changes (such as healthy diet and exercise) can keep it at bay.  However, if there’s a sharp rise in your PSA within a three-month span, it can indicate an aggressive cancer, thus a more aggressive treatment.

At any rate, it’s imperative you work with your doctor to create a proactive prostate health plan that’s right for you based on your lifestyle and family history.

And remember, although prostate cancer is a scary situation, be sure to take a step back and weigh your options. Don’t let fear push you into an aggressive, immediate treatment — it may not be necessary.

For more in-depth recommendation on prostate health, I’ve written a great deal on the subject. I recommend searching my website archives via www.DrPescatore.com.