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how many biopsy samples is the norm?

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Posted 1/4/2013 3:42 PM (GMT 0)
does it depend on your psa level? if they say the prostate is the size of a walnut, why so many samples??
Posted 1/4/2013 3:49 PM (GMT 0)
The biopsies I have gotten at the VA Hospital have been 12-core biopsies. The reason they take as many as they do is they are only getting about 1/1000th of the prostate during a biopsy and the more samples they get the better the accuracy. Think of it as a bucket of marbles with about five gold ones in it. One handful might not get any golden ones but if you had two handfuls you would increase your odd of getting a golden one. More handfuls (samples) the more accurate the diagnosis. Granted you are not discovering gold during a biopsy (quite the opposite) but the theory is the same.

David
Posted 1/4/2013 3:51 PM (GMT 0)
12 samples is the norm with some doctors using 16. The saturation biopsy takes usually 60 samples. Since each needle, and thus biopsy core is so thin, very little of the prostate is actually sampled. That is why many biopsies miss the cancer. Also the location of the cancer can be an issue such as the transition zone cancer that is never found by the traditional biopsy. By its nature, the basic biopsy is very random and thus needs suffecient number of needles to take enough samlpes to be valid. Even then a very small area f the prostate is sampled. A negative biopsy doesn't confirm that no cancer exists, just that no cancer was found. Many men have muptiple negative biopsies while PSA rises until finally cancer is detected. One person on the forum had 13 biopsies and PSA rose to 40 before a large transition tumor was found.
Posted 1/4/2013 3:59 PM (GMT 0)
JNF did a great job with his explanation including the saturation biopsy approach. I would also encourage you to do some research into Transperineal Prostate Biopsy, another approach that takes ~40 samples and has some decided advantages to the standard transrectal approach.

This link does a good overview of this approach:

http://www.prostateimplant.com/STPB-stereotactic-biopsy.html

The Mayo Clinic also has some good information on this approach:

http://mayoresearch.mayo.edu/mayo/research/parker_lab/transperineal_template_biopsy.cfm

Keep them questions coming!!!!! Way to go with your approach to becoming more educated about this beast!!!!!
Posted 1/4/2013 4:12 PM (GMT 0)
First of all all saturation/mapping biopsies are transperineal. The rectum can't take that many needles. I had 45 but have heard as many as 90 samples being taken. Below is a video link not for the squeamish illustrating such.

http://3dprostate.com/videos/mapping-biopsy.html
Posted 1/4/2013 5:29 PM (GMT 0)
I had 16, but as JNF stated...12 appears to be the norm.
Posted 1/4/2013 5:37 PM (GMT 0)
I had 12, but it caused insurance issues, with big out-of-pockets created for me in the process. My big national insurance company only pays for 6. So what is "standard" and what may be "covered" can be completely different. As in all things medical, confirm coverage for any procedure, no matter how "standard" anyone tells you it is.
Posted 1/4/2013 8:36 PM (GMT 0)
first one -12, second one - 12, third one - 7 - targeted into suspicous shadows found on scan - hit pay dirt with all 7 being positive
Posted 1/4/2013 9:24 PM (GMT 0)
My uro was pretty confident and only took 6. My bucket had a lot of gold marbles.
Posted 1/4/2013 9:30 PM (GMT 0)
Urologists are looking harder and harder to find smaller and smaller amounts of PC...and if they look hard enough in men aged 50 and older, there is likely to be at least trace amounts of what pathologists today call "cancer"...although increasingly some of the most PC experienced pathologists and urologists are seeking to rename the very low-risk findings to something other than "cancer" so that we can help get away from the gross over-treatment epidemic which continues, sadly, to grip this country.

So, today 12 samples is typical, but only 20 years ago 6 was the typical sample size. As datadavid correctly pointed out, each individual sample is only about 1/1000th of the total prostate material.
Posted 1/4/2013 9:36 PM (GMT 0)
12 for the "standard" trans-rectal and 40 or more with the Transperineal..

It can be difficult to reach the entire prostate using the trans-rectal ultra-sound probe.. So some areas can't be sampled using that method..But it's fast and cheap compared to the 40 core transperineal approach which is done in a hospital setting under general anesthesia...

In the States, a few Uros use a color doppler ultra-sound probe which in skilled hands can sniff out cancer and guide the doctors hand to the right spot....
Posted 1/4/2013 11:32 PM (GMT 0)
Yup, 12 cores seems the norm -- at least for NORMAL SIZED prostates. A normal size is somewhere around 35 grams.

In my case, the prostate was 98 grams -- almost 3 times normal size. And, when my local urologist did my biopsy, he took TWENTY samples.

I was never so happy for a procedure to reach its conclusion! LOL

Chuck

7/11 PSA 6.41 (4.1 2009) DRE-BPH,no lumps PCa Dx 8/11 age 62 adenocarcinoma 3/20 cores,T2C Glea 3+3 DaVinci prostatectomy 11/1/11 Mayo Clinic, nerve sparing Dr. Matthew Tollefson-highly recommend! Pathology-tumor confined to prostate 5 lymph nodes, seminal vesicules, extraprostatic soft tissue negative 1x.6x.6 cm mass involving R post inferior, R post apex, L mid post prostate R post apex margin involved by tumor over .2 cm length
Catheter out 7 days, no incontinence
Post-op exams 2/13/12, 9/10/12, PSA <0.1
Posted 1/5/2013 1:42 AM (GMT 0)
I'm not sure how many samples in my first biopsy, which was negative. My second was a saturation biopsy, which had 30 samples. (Less than is being reported here.) The second time around I definitely had more junk in my juices for a longer period of time.

Michael
Posted 1/5/2013 3:07 AM (GMT 0)
They only took 8 samples from me. Luckily 2 of them hit the spot.

Mag

 

Posted 1/7/2013 8:01 PM (GMT 0)
The PA who just did mine said 14 was what was normal - 6 on each side and two in the middle - I forget what he called them as he said it just as the spring-loaded needle got me good.

My prostate was so small he could only get 12 samples.
Posted 1/8/2013 1:11 AM (GMT 0)
I got 14. Prostate was small, from what the doc said. I was surprised. I thought 12 was the norm.
Posted 1/8/2013 4:18 AM (GMT 0)
transrectal ultrasound 12 core is typical. The sample areas are miniscule. The idea is to take a small sample from each quadrant, left and right sides , lateral base, base, lateral midsection, midsection, lateral apex and apex, best shot of finding something that way, with the blind melon approach

Color doppler guided ultra sound would direct the needles right to any tumors, so if you have that available, go with that, you will not have to worry about a negative biopsy.

I had the basic one but got lucky in that my walnut was loaded, so no repeat biopsy needed, ever again, just intermediate to high risk cancer to deal with. If positive, by all means have an accredited lab do a second pathology report, as all treatment flows from that.. I was hoping they mixed up my samples and really didn't have PCa

Post Edited (Fauntleroy) : 1/7/2013 9:23:26 PM (GMT-7)

Posted 11/14/2014 2:14 PM (GMT 0)
I know this is an old thread, but just noticed a visitor reading it.

In my case and because they found no target areas on my MRI the uro guy took 40 samples.

Hope this helps the guest who was reading this thread.
Posted 11/14/2014 2:49 PM (GMT 0)
Since my Prostate had shrunk down to 33gm due to 10 yrs on avodart/ finasteride, my Uro only took six trans rectal samples and two of the six were positive with gl9. It was over very quickly and was pretty painless as the Uro used anesthetic.
Bob
Posted 11/14/2014 7:23 PM (GMT 0)
I had 5 samples taken, but color doppler ultrasound was used to guide the needels directly to the suspicious areas. 4 out of the 5 samples were positive.
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