Don’t you dare let that mean ole urologist biopsy your prostate for profit!


a wise man doesn't need advice...a fool won't take it
It’s funny… Richard Ablin  kept on referring to all the money that urologists make doing biopsies and PSAs. When people start striking right at the money that ” those rich doctors” make, I’m sorry, I just tune out. To me this mindset has a preconceived notion that then flavors and influences that person’s view of the whole subject. I believe it taints it.  I received a delightful comment earlier today and in it there was mention ” tumor seeding.” It is a very common question and concern of patients of mine. The correct answer to the question is that tumor seeding from the prostate at the time of prostate biopsy has not been proven or shown to occur. Does that mean it hasn’t happened? No. Maybe it has.  It took about two seconds to find a discussion on seeding and how bad the urologist is for not telling everybody that he could spread their cancer. Here’s the deal. How will we get the specimen to see if there is cancer? We got to get it somehow. So… is  the risk of having undiagnosed cancer less than the risk of seeding the biopsy track or vice versa. I don’t know. In my 24 years I have never seen or heard of any patient having an issue with seeding. Look at it this way and remember this as you read the remarks from below, by the way this debate must have been going on in 2002 also, but then consider this. You have voluntarily gone to a urologist and now you have taken the time out of your schedule, you’ve had a PSA which is high, and exam by your family doctor, and now you are there with the “specialist.” What do you do?  Well, go prepared, ask a bunch of questions, determine if the doctor is reasonable, likable and competent, discuss the deal with the doctor and your family and friends and make a decision.  Note the angst in the piece below and in Ablin’s op- piece. You’ll see what I mean. Also see how I got a little testy in my response  to his letter that was written to but not accepted by the NYTs.
 

Re: Re: Prostate Biopsy — Spread Cancer Cells??

Post a new topicby Guest on Sun May 12, 2002 11:36 am

You and other urologists appear to be oblivious to this risk. There is much anacdotal evidence posted on the Internet about this risk under “needle tract seeding” and “needle tract metastasis”. One study puts the risk of needle tract seeding (spreading the cancer) at 0.5% (1 in 200) and another at 5.0% (1 in 20). FYI, theses studies are not prostate biopsy studies but have examined the needle biopsy seeding risk from adrenal, liver and carcenoma biopsies. Also, check out the newsgroup sci.med.diseases.cancer.

If the odds of needle tract seeding are .5% to 5.0%, this suggests that prostate biopsies should be used VERY SPARINGLY. Since PSA test results lead to many unnecessary biopsies being performed, many men are exposed to this risk.

In my case, it appears that my prostate cancer would still be confined to the prostate capsule, except that I had the prostate biopsy three years ago. Of course, the only way to prove that needle tract seeding occured is via an autopsy. That’s the interesting thing about proving that needle tract seeding occurs: the evidence is destroyed during surgical removal. And I doubt that many autopsies look for needle tract seeding. Be assured, mine will.

Why do you think urologists turn a blind eye to this risk? Could it be that without PSA tests and needle biopsies showing that men have prostate cancer, they would lose a lot of cash flow business in the form of radical prostatectomies? BTW, only 3% of men die of prostate cancer because it is usually confined to the prostate capsule and very slow-growing.

The medical community needs to rethink the needle tract seeding risk in the context of prostate cancer and the characteristics of prostate cancer. I only wish that my urologist had told me about this risk. FYI, I asked and got the same answer that you gave me on the Internet, i.e. the wrong answer.

2 Replies to “Don’t you dare let that mean ole urologist biopsy your prostate for profit!”

  1. For what it’s worth, I had a urologist actually admit to me that a lot of “testing” is “revenue driven.” A multi-parametric MRI might achieve same results as biopsy. Your thoughts on that appreciated.

    In my case, I had a “regular” biopsy, then a saturation biopsy from another urologist (2nd opinion). Was treated and “cured” with NanoKnife, then PSA started rising, and again “cured” by radiation. Result of my “cures” is metastatic prostate cancer in my bones. I have no idea if all the needle insertions (including the marker seed implants prior to radiation) had anything to do with the spread, but think some clinical research on the issue is worthwhile. Strongly suggest anyone considering radiation INSIST on a bone or PET/CT prior to and/or during radiation treatment. Scan was done before the initial NanoKnife (no spread) but was not done before radiation. Had the metastasis been discovered earlier it might have been treated and “cured” before spreading. I suspect there will be no third “cure” and hope this will be of help to those of you recently diagnosed.

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