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Optimising prostate biopsy

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.d8201 (Published 09 January 2012) Cite this as: BMJ 2012;344:d8201

Re: Optimising prostate biopsy

Evaluating and analyzing complications of prostate needle biopsies are certainly crucial when discussing benefits and harms of biopsies in times of increasing number of biopsies and biopsy cores. The suggestions made by Stainsby may sound attractive at first sight but do not reflect our current understanding , nore are they supported by the current literature.

Firstly, the studies quoted were exclusively performed in pre- or early PSA eras where cancer features were different and patient cohorts not comparable to today's average patient presenting with early prostate cancer. Pathological analysis has evolved as well and Bastacky and Epstein (1), who authored the study in 1991, certainly do not criticize or refute the validity and necessity of prostate biopsies today.

In their study , most of the patients underwent Tru Cut Needle Biopsy (16 Gauge) versus a much thiner 18 gauge needle today and case numbers were far from significant to identify differences or show similarities.

The common understanding in the early '90s was that eventually perineal biopsies may be associated with increased tumor tracking and eventually seeding. However, Ryan et al reviewing the literature, could only report a “third case” of tumor seeding in patient undergoing transperineal biopsies of the prostate (2).

We reviewed the morbidity of prostate biopsies in the early prostate cancer detection study (EPCDS) and found no evidence for tumor seeding in those patients (3). Although this was not specifically an endpoint of the study, no clinical nor pathological correlation was identified. Similarly, Loeb et al, who analysed a total of 10 474 prostate needle biopsies, performed between in 1993 and 2011 in the European Randomized Study of Screening for Prostate Cancer (Rotterdam section), did not report any evidence for tumor seeding or tracking (4).

In summary, reflections and suggestions as mentioned by Stainsby are always attractive for those screening adversaries trying to identify harms and drawbacks associated with either PSA as a marker or the biopsy procedure by itself. Whereas most of the critics focus on PSA, little has been reported regarding the biopsy procedure. Although this represents a new target and topic, the current discussion on tumor seeding and tracking lacks scientific evidence and certainly reflects even less our current understanding of the harms associated with prostate biopsies.

Literature
1. Bastack SS, Walsh PC, Epstein JI. Needle Biopsy aasociated tumor tracking of adenocarcinoma of the prostate. J Urol 1991; 145 (5): 1003-1007
2. Ryan PG, Peeling WB. Perineal prostatic tumour seedling after 'Tru-Cut' needle biopsy: case report and review of the literature. Eur Urol. 1990;17(2):189-92.
3. Djavan B, Waldert M, Zlotta A, Dobronski P, Seitz C, Remzi M, Borkowski A, Schulman C, Marberger M.
Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study.
J Urol. 2001 Sep;166(3):856-60
4. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schröder FH, Roobol MJ.
Infectious Complications and Hospital Admissions After Prostate Biopsy in a European Randomized Trial.
Eur Urol. 2012 Jan 5. [Epub ahead of print]

Competing interests: No competing interests

07 February 2012
Bob Djavan
Professor of Urology
New York University NYU
New York, NY 10016, USA