Author’s reply to StainsbyBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e1030 (Published 14 February 2012) Cite this as: BMJ 2012;344:e1030
- Bob Djavan, professor of urology1
- 1Department of Urology, New York University School of Medicine, New York University, New York, NY 10016, USA
Evaluation and analysis of complications of prostate needle biopsy are certainly crucial when discussing benefits and harms of biopsy in times of increasing numbers of biopsies and biopsy cores. Stainsby’s suggestions may seem attractive but do not reflect our current understanding and are not supported by the current literature.1
All studies quoted were performed before or in the early days of prostate specific antigen (PSA) testing, and patients are not comparable with those of today, who usually present with early prostate cancer. Pathological analysis has evolved too, and the authors of the 1991 study do not criticise or refute the validity and necessity of prostate biopsies today.2
In their study, most patients underwent biopsy with a 16 gauge needle, not the thinner 18 gauge needle currently used, and case numbers were too low to identify significant differences or similarities.
In the early 1990s it was commonly thought that perineal biopsies might be associated with increased tumour tracking and eventually seeding. However, a literature review reported only a “third case” of tumour seeding in patients undergoing transperineal biopsies of the prostate.3
We reviewed the morbidity of prostate biopsies in the Early Prostate Cancer Detection Study and found no evidence of tumour seeding.4 Although this was not a specific end point of the study, no clinical or pathological correlation was identified. Similarly, an analysis of 10 474 prostate needle biopsies, performed between 1993 and 2011, found no evidence of tumour seeding or tracking.5
In summary, screening adversaries will always try to identify harms and drawbacks of PSA or the biopsy procedure. Most critics focus on PSA, not the biopsy procedure. The current discussion on tumour seeding and tracking lacks scientific evidence, especially with our current knowledge of the harms associated with prostate biopsies.
Cite this as: BMJ 2012;344:e1030
Competing interests: None declared.