Okay, the title of this blog is obviously a trick question. No one—I repeat, NO ONE—looks forward to the prospect of a prostate biopsy. It’s not like standing in front of the freezer section and pondering which flavor of Ben & Jerry’s ice cream you want to bring home and enjoy.
TRUS biopsy – UGH!
I once had a patient (call him Mr. R) who came in for a multiparametric MRI of his prostate. A year ago, he’d had a TRUS biopsy that was negative for cancer. Now his PSA was still rising and his urologist wanted to do a repeat biopsy. Mr. R told me, “Doc, I’ll never go through that again. There were 12 needle sticks, and by the third one I felt like I was being hit in the bottom with a baseball bat. I was brought up that men don’t cry, but I had tears running down my face. I don’t know which was worse, the pain or the embarrassment of being a sissy.” I asked if the doctor had given him a local injection to numb the area. He said the doc told him not to worry, the gel on the transrectal ultrasound wand had a numbing effect. However, in his words, it turned out to be a crock of s—t.
Some urologists do a better job of local anesthetic than others, but no patient should suffer. I get why men hear such stories and dread TRUS biopsy. There’s also a clinical reason why TRUS biopsy is to be avoided: research consistently confirms that this blind, randomized method over-detects insignificant prostate cancer (PCa) that is unlikely to be life-threatening, yet under-detects significant PCa that can ultimately take a man’s life.
The biopsy men prefer
The Sperling Prostate Center is a leader in a biopsy method called MRI-guided in-bore biopsy (MRGB). Unlike ultrasound guidance—a hit-or-miss technique that can’t distinguish the actual tumor—when we perform a biopsy under the guidance of real-time MRI, we not only distinctly see what we’re targeting, we can precisely direct a minimum number of needles into the suspicious area most likely to harbor the most aggressive cells. This gives a true picture of a patient’s risk level, which then leads to the best treatment match. Our method avoids over-detecting insignificant disease and lowers side effect risks.
Studies show that MRGB is diagnostically superior to TRUS but say little about the patients’ experience. How do know that patients would much prefer MRGB over standard 12-14 needle blind TRUS biopsies? Well, the clear answer comes from an October, 2020 published study in which a team of researchers recruited 47 men for their feedback on TRUS biopsy vs. MRGB.[i] All of them would undergo MRGB for suspected PCa. Each man had already had multiparametric MRI of the prostate; 24 had previously had TRUS biopsy. As we do at our center, all patients were injected with a local anesthetic prior to MRGB (unlike poor Mr. R and his TRUS biopsy).
After the MRGB, each participant was given a questionnaire asking them to rate 11 items on a scale from one (not at all) to ten (very much). Those who already had TRUS biopsy completed the same ratings for their earlier TRUS biopsy as well.
According to the study (the word “exam” is used to indicate the MRGB),
The set of items evaluated satisfaction with the information received and the possibility to ask questions to the staff; the tolerability of the irritation, duration and discomfort associated with the exam; their level of worry or calm before the exam; the perceived need to undergo the exam; their satisfaction with the exam and willingness to repeat it in the future; and acceptability of the exam.
It’s no surprise that the men in this study greatly preferred the MRGB. The authors write, “Overall, both the quantitative comparison of perceptions of the two techniques and explicit preference showed greater acceptability of MRGB compared to TRUS-Bx.” In fact, “…patients’ perceptions were significantly in favour of MRGB,” and of those who had previously had TRUST biopsy, 75% of them reported that if they had to have another biopsy, they would choose MRGB.
It’s not ice cream, but…
Admittedly, having a prostate biopsy is a quantum leap away from enjoying Ben & Jerry’s (not to mention that Ben & Jerry’s has a LOT more flavors!) However, it’s a fact that today, in the U.S., roughly a million prostate biopsies occur annually. The vast majority are traditional TRUS biopsies, despite the fact that they are deeply flawed, and as with Mr. R, patients’ fears are often justified.
While patients fear the embarrassment and pain, their greater fear should be the inaccuracy. The lack of precision has led to deplorable overtreatment of insignificant PCa, and countless cases of recurrence due to undertreatment of significant PCa.
On the other hand, in-bore MRGB sets the new accuracy bar, with a very slim margin of biopsy error. In addition, it generally involves fewer needles, greatly reducing side effect risks. Finally, the Sperling Prostate Center brings the advantages of leading experience plus Artificial Intelligence resources to in-bore MRGB excellence.
Contact the Sperling Prostate Center for more information.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Pizzoli SF, Marton G, Pricolo P, Oliveri S et al. Patients’ experience with MRI-guided in-bore biopsy versus TRUS-guided biopsy in prostate cancer: a pilot study. Ecancermedicalscience. 2020; 14: 1127. Published online 2020 Oct 20.