Prostate Cancer

Diagnosing Prostate Cancer – Transrectal Ultrasound & Biopsy

According to the American Cancer Society, other than skin cancer, prostate cancer is the most common cancer in American men, with about 192,000 cases predicted for 2020. They also predict about 33,000 prostate cancer deaths for 2020.

The above statistics are typically stated at or near the top of virtually every article about prostate cancer, setting a tone of “doom and gloom” for the unwary reader upfront.

There are many different ways to diagnose prostate cancer, but the most common method used by most urologists today remains the transrectal ultrasound (TRUS) guided prostate biopsy.

The ultrasound is used to guide the device containing the biopsy needles to take samples of prostate tissue.

The TRUS guided biopsy has been in use for many years, but it does have some serious drawbacks. While it is undoubtedly the most used procedure today, it is not the most definitive, nor the most effective for diagnosing prostate cancer.

It is typically ordered when a man undergoes a yearly physical exam that includes a PSA blood test, and the test result comes back greater than the established limit of 4.0.

This usually results in a referral to a urologist that, in turn, recommends a transrectal ultrasound (TRUS) guided prostate biopsy to determine if prostate cancer is present.

Doctors agree that the prostate-specific antigen (PSA) blood test is not accurate. Still, it, along with a digital rectal exam (DRE), is generally the starting point for finding prostate cancer. While the TRUS itself is a non-aggressive procedure, the associated biopsy is not.

The TRUS simply creates images of the prostate using sound waves. These images are used to guide the biopsy needles to take a sample tissue from suspicious areas of the man′s prostate.

The combination of a PSA blood test followed by a TRUS guided biopsy is, in most cases, the standard used for the initial diagnosis of prostate cancer in the US. However, while it is the most used protocol, it can easily miss some cancers, as well as find insignificant cancer that probably will never need to be treated.

The balance of this article explicitly describes the details of the transrectal ultrasound (TRUS) guided prostate biopsy procedure. This is not a recommendation for this procedure since we do consider it obsolete as well as side effect-laden and dangerous. There are far better procedures available.

With that said, this article is provided for informational purposes specifically for those that want to know more about the procedure. For more prostate screening information see:

https://www.bensnaturalhealth.com/blog/prostate-cancer-screening/

What is a Transrectal Ultrasound (TRUS) Guided Prostate Biopsy?

A prostate biopsy is a procedure by which samples or prostate tissue are taken for examination in a laboratory for the presence of prostate cancer cells.

The samples are taken by puncturing the prostate using small hollow needles. The needles are often part of a spring-loaded sound transducer inserted into the rectum so that it is in close proximity to the prostate.

The doctor performing the procedure can then position the device towards a suspicious area of the prostate to capture a core of tissue within the needle. Typically, about 10 to 12 tissue samples are taken.

The entire procedure is quick and generally takes less than 15 to 20 minutes.

While the procedure is not considered painful (by doctors), most urologists today introduce a Lidocaine gel into the rectum to reduce the sensations of pain and discomfort.

The tissue samples are then removed from the needle cores and sent to a laboratory for examination. The procedure is typically performed when results from a PSA blood test are above the normal range, or a digital rectal examination is deemed to be suspicious by the performing doctor.

Prior to the procedure, the patient is usually asked to use a cleansing sodium phosphate enema at home (typically known as a “Fleets Enema”) and is started on a course of antibiotics as a preventative measure to help prevent infection from the procedure.

Potential Side Effects and Complications of a TRUS Biopsy

The TRUS biopsy procedure is performed by passing the sound transducer probe and needles through the rectum to be in close proximity to the prostate. Even though a preceding Fleets enema causes a nearly complete bowel evacuation, there is always a possibility that rectal bacteria is still present.

The procedure, especially the puncturing of the needles into the prostate, can force fecal bacteria into the prostate, causing an infection. This is one of the major side effects of a prostate biopsy.

Other side effects such as; bleeding, pain, sexual problems, and urinary retention are also common. Learn more about biopsy side effects here:

https://www.bensnaturalhealth.com/blog/side-effects-prostate-biopsy/

The latest research today indicates that about two percent of prostate biopsies result in a subsequent infection. While two percent is a relatively small number, some of these infections can result in sepsis and can be quite serious and sometimes life-threatening.

In addition, there is a danger that one or more of the biopsy needles passes through a cancerous tumor in the process of removing a core of prostate tissue. This leads to the possibility that cancer cells from the tumor can be seeded into the bloodstream.

On this last point, urologists that perform prostate biopsies tend to disparage the theory that a prostatic biopsy can seed cancer cells into the bloodstream for migration to a remote site in the body. However, researchers that generally study cancer often disagree.

It may take several years for a few cancer cells seeded to a remote location to develop into a big enough tumor to be diagnosable. Considering this as a practical point, it is exceedingly difficult to determine the source of such cancer accurately.

Alternatives to a Biopsy

A TRUS guided prostate biopsy is the most common diagnostic tool used by doctors to detect prostate cancer. However, it should be used only in cases where a patient is suspected of suffering from prostate cancer. And it also should be used judiciously.

A TRUS, guided prostate biopsy is an invasive test! The tissue is being removed fro the body, and the method of performance is prone to side effects. Thus, a test such as this should only be employed on a patient that might get significant benefit from further treatment if cancer is found.

Thus, patients with a limited life expectancy due to age or other co-morbidities should not be subject to such an invasive test. However, this is not a universal case. I have seen many men in their mid-eighties that have been subject to aggressive biopsies.

This begs the question of whether or not further treatment would improve the patient′s survival potential or just destroy his current quality of life.
When a definitive result is needed regarding prostate cancer, there are many alternative methods of detection that do not involve such high risks.

For more information, see:

https://www.bensnaturalhealth.com/blog/prostate-biopsy-alternatives/

Tests to Diagnose and Stage Prostate Cancer: https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html/

Discussion

According to most experts, prostate cancer is generally a slow-growing disease that is highly over diagnosed and over treated in the US compared to several other Western countries. There are several reasons for this.

Cultural issues: Fear is a huge motivator. When a man hears about a friend or relative getting treated or dying of prostate cancer, fear sets in, driving him to get tested and, if necessary, treated.

Myths and false information: Like other cancers, the cultural norm is that “if you get it early, you can cure it successfully.” With prostate cancer, curing it early generally means surgery to remove the prostate gland or radiation to it. Both carry side effects that many men deem to be worse than the illness.

The cultural issue is difficult to define. Still, as a long-term natural health professional, I have seen many cases of men whose knowledge of prostate issues was limited to what they got from their peers at the gym. Then when presented with a cancer diagnosis, all reason is thrown out, and they succumb to whatever treatment their doctor proposes. This is a major factor leading to over-treatment.

Finally, regarding prostate cancer, myths, and false information rule. While every article on prostate cancer (including this one), begins with statistics of the number of cases and number of deaths found yearly, few articles go on to state that according to the American Cancer Society, the 10-year survival rate for most prostate cancer diagnosed today is 98 percent.

This begs the question of whether we are seriously over-diagnosing and over-treating men in the US by aggressively looking to diagnose and treat every case of prostate cancer.

As a natural health practitioner for many years, I have interfaced with many men that have had aggressive treatment for their prostate problems. The almost universal request is that I help them regain the sexual abilities lost due to treatment. Also, they almost universally regret having the procedure.

Depending on the treatment they had, I can help some of them, but I turn away far more men that I cannot help. This is debilitating for both of us.

Personally, in my opinion, men do not understand the sexual side effects of prostate treatment, especially a prostatectomy. Also, urologists tend to be in denial about the extent of the side effects of the procedures (and medications) they provide. They often minimize or do not discuss side effects at length with the patient. Unfortunately, this leaves many men with residual treatment side effects that they were not expecting.

I have not kept detailed data on the number of men that I have interfaced with that have expressed concerns to their doctors about the possibility of erectile dysfunction or other side effects of a procedure. But, I have been told many times that patient concerns were minimized or side effects not communicated fully or accurately.

The most common side effect of a prostatectomy is erectile dysfunction. Telling a patient that it is easily fixed with Viagra or one of the other ED medications, is, in itself, is a huge chunk of misinformation. A high percentage of men that have had pelvic surgery or radiation will suffer from permanent ED that will not resolve with medication.

In my experience, I have found that many men do not really understand what this means. There is a huge difference between ED for an intact male and surgically induced ED.

A normal man might get sexually aroused and not be able to get an erection sufficient for sexual intercourse. However, he can still have a feeling of arousal in his organ, even though it is insufficient for normal intercourse.

With surgically induced ED, the erectile nerves are damaged or destroyed, and the effect is as if the penis has been totally disconnected from the system.

Of course, if the man was never very active sexually, he may not think that this is a very negative side effect. But, for most men, the thought of never being able to get any feeling of having an erection again is debilitating!

Conclusion

Much of the writings about prostate cancer revolve around methods to detect it or treat it when it is found. However, such articles rarely discuss conditions where there is no need to seriously investigate the potential for prostate disease in a patient that is not going to treat it.

The lead author of one recent study was asked if an 80-year-old with recently detected prostate cancer should be treated. She replied jokingly with, “If he comes with his parents, it’s a good idea.”

This again begs the question of subjecting a patient to multiple debilitating procedures to find a cancer that he will not be able to, or not want to, treat, or that, if treated for it, he may not survive the treatment.

Simply living with the fact that you have cancer in your prostate can cause stress and increase the possibility of other illnesses. Thus, knowing cancer is present may or may not be a good idea.

The value of such knowledge depends on a person′s age, mental discipline, and co-morbidities. Some men will accept they have cancer in their prostates; others are totally debilitated by the idea.

Goals must be set different for a healthy 60 YO man than they are for an 80 YO man with several co-morbidities. This is not always the case, and many practitioners work using a “cookie-cutter” approach.

There is much new research being performed today. If treatment is being considered or if a man has significant symptoms, this report has considerable information:
https://www.cancer.org/cancer/prostate-cancer/about/new-research.html

Unfortunately, many urologists treating prostate cancer patients today are using the paradigms and procedures they learned about in medical school many years ago. If a doctor is using older diagnostic or treatment procedures when newer, proven effective, procedures are available, that doctor is doing a disservice to his patients.

This is especially true if the older procedure carries more risks and/or side effects that a newer, proven, effective procedure. And, even more, true when the older procedure causes a much higher deterioration of a patient′s quality of life that the newer procedure.

Sources

  1. A Guide to Prostate Cancer Screening, Bensnaturalhealth.com/blog, Oct 2019
  2. Prostate Biopsy: Risks And Side Effects, Bensnaturalhealth.com/blog, May 2019
  3. Alternatives To A Prostate Biopsy, Bensnaturalhealth.com/blog, Jan 2020
  4. Tests to Diagnose and Stage Prostate Cancer. American Cancer Society, Jan 2020
  5. Prostate Cancer: Statistics, Cancer.Net Editorial Board, Jan 2020
  6. Anna Bill-Axelson, M.D., Ph.D., et al, Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up, N Engl J Med 2018; 379:2319-2329, December 13, 2018
  7. What’s New in Prostate Cancer Research?, Cancer.org,Aug 2019

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