left: Andres Bodewig, M.D.
This is a great article by Dr. Bert Vorstman clearly outlining the facts about prostate cancer diagnosis and the essential need for a biopsy. Needle tracking or spread has never been documented by any urologist or pathologist in the world. There may be the rare single physician that may be an advocate if this concept. But there is no science merit to this. This concept just is not true. The reason that a biopsy is essential is that it provides hugely valuable information as to the Gleason score and the aggressiveness of the cancer. We as urologist depend on this information for planing the appropriate treatment for that individual. As well as obtaining additional information on the prognosis of the cancer. Unfortunately, there are no imaging (x-ray studies) with capabilities to determine the presence or absence of prostate cancer without a biopsy. Similar to breast cancer, no women would have their breast removed by a diagnosis based on a mammogram without having confirmation by biopsy. Like wise, no man should undergo treatment of his prostate without a biopsy.
Dr. Vorstman makes a very valid point in that the one or two urologist in America that relay on MRI, as opposed to a biopsy, are the same doctor's recommending post treatment MRI's. As well as the same physicians' that have a personal interest and ownership in the MRI equipment. As pointed out by Dr. Vorstman, there is no scientific proof or merit for a post treatment MRI. The best parameter to measure the clinical outcome of prostate cancer treatment is by periodically following the PSA.
There are three elements that are important in selecting a physician: 1) Is he board certified in his specialty?, 2) How often has he performed the recommended procedure? 3) How will the information will the test he is recommending impact on the proposed treatment? And if he is recommending a prostate MRI over a biopsy, ask for medical peer review literature to confirm that this has scientific merit,
I welcome the comments of my colleagues that treat prostate cancer on a regular basis. Can anyone them really say that they can diagnose prostate cancer with an MRI ?Can anyone of them in their professional conduct recommend an MRI over a biopsy and treat prostate cancer as such...without biopsy?
Do Prostate Needle Biopsies Spread Cancer Cells? – NO THEY DO NOT!
Posted by admin in Uncategorized on September 20, 2010 no responses
Prostate needle biopsies and needle tracking marks DO NOT spread cancer cells. Furthermore,the inflammation that brings about healing of the needle track DOES NOT cause cancer.
There are purveyors of pseudo science even in the world of urology who repeatedly offer false science that is peppered with irrelevant references and non sequitur arguments to present their case.
The sole purpose for perpetuating these untruths is to confound a vulnerable target (men who have or are at risk of having prostate cancer) and steering them towards evaluations that are self serving. Invariably,this disordered rhetoric is generated and encouraged by those physicians and organizations that have most to gain. In this regard,in-house imaging equipment such as MRI’s are well known to be potential instruments for financial abuse. Therefore, at risk patients are easily encouraged to undergo needless and expensive in-house MRI studies. This convenient arrangement and investment by owner physicians, represents a huge potential conflict of interest in managing prostate cancer patients.
There simply is NO reliable evidence to support the notion that MRI with or without spectroscopy will ever dispense with needle biopsies of the prostate.
Imaging studies are unable to definitively diagnose a prostate cancer let alone make determinations on a Gleason grade and score.
No man should ever consider treatment of his alleged prostate cancer based solely on the dubious images generated by an MRI.
Even benign lesions may mimic a prostate cancer and the only reliable method for detecting a prostate cancer is based upon a needle biopsy.
Similarly,there is no evidence that “scientific” targeted biopsies of suspicious areas provides any benefits over the standard needle biopsy without the expensive MRI. In fact,using the targeted MRI approach to the prostate may detect very early low grade,low volume cancers that are usually clinically insignificant and can be managed by active surveillance.
In addition,the questionable practice of recommending routine post HIFU MRI studies on the pretext of early recognition of incompletely treated men simply represents a further shameless and unadulterated assault on the wallets of patients and insurance companies.
Only a well designed and executed trans rectal ultrasound and needle biopsy of the prostate by an experienced urologist can answer all of the questions as to the true nature of a man’s prostate cancer.
The unabashed, pseudo intellectual and illogical recycling of these myths about prostate needle biopsies spreading cancer cells
by physicians is unfounded,unconscionable and malicious.
Certainly,those urologists that are board certified are required to practice by an ethical and scientific standard. Others,however,appear to practice the peddling of half truths and this non Hippocratic behavior taints all physicians and may be considered malpractice.