While a prostate biopsy can be an important diagnostic tool, it's not always necessary, especially if other tests suggest the cancer is unlikely to be aggressive. A prostate biopsy can provide valuable information, but it also has risks and disadvantages.
It’s essential to decide whether to have a biopsy in consultation with your healthcare professional. Understanding the pros and cons can help with that choice.
How is a prostate biopsy done?
A prostate biopsy is usually performed by a urologist, who inserts fine needles into the prostate gland to collect tissue samples. A pathologist then examines the samples for prostate cancer cells.
Prostate biopsies are done under a local or general anaesthetic and take about 20 to 40 minutes. Most people can go home the same day.
Is a prostate biopsy painful?
Prostate biopsies are not pleasant. You may experience pain or discomfort for days or weeks afterwards, along with blood in your urine and ejaculate1.
What are the downsides of prostate biopsy?
A prostate biopsy is necessary to confirm prostate cancer, but the decision to proceed should be made with as much information as possible. Here are some reasons why you may want to avoid one.
Risk of overdiagnosis and overtreatment
Some prostate cancers – known as non-aggressive cancers – are slow-growing and unlikely to spread or become life-threatening. A biopsy could diagnose a non-aggressive cancer, which means you may have had an unnecessary procedure.
In a recent US study, approximately half of biopsies had prostate cancer: 33% of them were non-aggressive and 66% were of concern2.
PSA testing can lead to a needless biopsy
Sometimes a biopsy is recommended based on PSA test results, but several things other than cancer can cause your PSA levels to rise, including benign prostatic hyperplasia (enlarged prostate), prostatitis, or recent ejaculation3. Relying solely on PSA levels can therefore lead to an unnecessary biopsy.
One study found that while PSA screening may lower the risk of a prostate cancer spreading, problems such as false positive results, over-diagnosis and biopsy complications occurred in 20% to 50% of cases when a cancer was detected4.
Prostate biopsy risks
As with any invasive procedure, there are risks associated with prostate biopsy. About one in five men may experience some form of complication5, such as:
- infection
- blood in the urine or sperm
- pain.
Unnecessary worry and hassle
One study found one in 20 men regretted having a biopsy6. The need to go to hospital for a procedure can understandably cause some anxiety. It also means taking time out of your schedule for the procedure and the recovery.
Are there any alternatives to prostate biopsy?
Depending on your situation, there may be alternative ways to evaluate your prostate cancer. For some low-risk prostate cancers, your urologist might recommend active surveillance. This involves monitoring your PSA levels and imaging results (and sometimes biopsies) to avoid or delay the need for treatment.
Advanced imaging techniques can assist with prostate cancer diagnosis. An MRI scan, for example, uses radiofrequency pulses and a magnetic field to create images of the prostate.
Advances in biotechnology have also brought a whole new dimension to prostate cancer evaluation.
Advanced testing methods for prostate cancer are now available, specifically designed to guide decisions about whether to proceed to a prostate biopsy. Unlike a biopsy, which is invasive and carries risks, these advanced testing methods use information from a simple blood test to determine whether you have an increased risk of aggressive prostate cancer, making them safer and more convenient option in many cases.
The results from these advanced screening tests can help you and your doctor decide whether you would truly benefit from a prostate biopsy. If your cancer is not likely to be aggressive, you might be able to avoid an unnecessary procedure and the potential harms associated with overdiagnosis, surgical complications and needless worry.
And if it is, you can move forward knowing decisions have been made with as much information as possible. Discover if this test is right for you here.
References
- Rosario D J, Lane J A, Metcalfe C, Donovan J L, Doble A, Goodwin L et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study BMJ 2012; 344 :d7894 doi:10.1136/bmj.d7894
- Ref: Shore, ND, Polikarpov, D, Pieczonka, CM, Henderson, RJ, Bailen, JL, Saltzstein, DR, Concepcion, RS, Beebe-Dimmer JL, Ruterbusch JJ, Levin RA, Wissmueller S, Ho Le T, Gillatt, DA, Chan, DW, Deng N, Siddireddy, J, Lu Y, Campbell, DH, & Walsh, BJ 2022, ‘Development and evaluation of the MiCheck® prostate blood test for clinically significant prostate cancer. , (E-pub ahead of print) In: Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2023.08.005
- National Cancer Institute. Prostate-Specific Antigen (PSA) Test. Available at https://www.cancer.gov/types/prostate/psa-fact-sheet. Accessed 21 Aug 2024.
- Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. Prostate-Specific Antigen-Based Screening for Prostate Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); May 2018.
- Bokhorst LP, Lepistö I, Kakehi, Y, et al (2016), Complications after prostate biopsies in men on active surveillance and its effects on receiving further biopsies in the Prostate cancer Research International: Active Surveillance (PRIAS) study. BJU Int, 118: 366-371. https://doi.org/10.1111/bju.13410
- Coyle C, Morgan E, Drummond FJ. et al. Do men regret prostate biopsy: Results from the PiCTure study. BMC Urol 17, 11 (2017). https://doi.org/10.1186/s12894-016-0194-
