Minimally Invasive Prostate Biopsy for Men in NYC with Elevated PSA and Abnormal Prostate Exam (DRE)

 

When Should a Prostate Biopsy be Performed?

A number of factors going to a decision whether or not a prostate biopsy should be performed. 

Prostate exam, prostate size, PSA levels, family history of prostate or breast cancer as well as findings on prostate imaging and serum tests such as 4K score help urologist to decide whether or not to recommend a prostate biopsy.  Patient’s age and life expectancy should also be taken into consideration in combination with previously mentioned factors.

Should Another Biopsy Be Performed if I Had a Previous Biopsy that Showed No Prostate Cancer?

While prostate biopsies are generally safe, a small number of men experience significant adverse side effects from prostate biopsy including infection and bleeding.  A urologist is faced with a need to minimize the number of unnecessary biopsies and to maximize the chances that dangerous cancer does not get overlooked.

There are a number of tools urologists use to help us to decide whether or not to recommend a second biopsy.  Certainly, the progression of symptoms and change in PSA levels can tip us one way or another in terms of recommending a repeat prostate biopsy.  Timeframe or time from a prior biopsy is also taken into consideration. 

Studies such as prostate MRI can help stratify the risk of having prostate cancer in the context of other clinical factors such as baseline risk for prostate cancer based on age, PSA level, and family history.

It is important to recognize that even with all the refinements that we have today including prostate MRI, 4K score, and PHI test, 15-30% of men will harbor prostate cancer that is not picked up by prostate biopsy.  Fortunately, diligent urological follow-up usually identifies these men for repeat prostate biopsy and eventual diagnosis which allows timely initiation of treatment.

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