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Posted 5/30/2013 1:51 AM (GMT 0)
The AUA white paper on biopsy complications says it "carries a very low risk of mortality" (p.12). They site studies that show mortality within 30 days of a biopsy range from about 1 in 1000 to 3 in 1000, but those rates may actually be lower than expected from a similar non-biopsied control population.

But there are risks of infection (up to 7%, up to 4% may require hospitalization), significant bleeding (1-4%) and urinary retention (up to 1%).

I don't consider any of those risks large enough to rule out a biopsy for me if one is indicated, but it better be indicated.

AUA/SUNA White Paper on the Incidence, Prevention and Treatment of Complications Related to Prostate Needle Biopsy

- Allen
Posted 5/30/2013 2:13 AM (GMT 0)
Someone made the observation here some time ago that "Life is Terminal". I had a few-months old baby die in my hands at the scene of a car accident back in the days that us Red Cross volunteers stopped to help at accidents, before there were EMTs. Everything we do every day has the potential of being fatal.

Look at the kids who went to school in Oklahoma. For some, it was a fatal choice.

Get over the percentages. Do you want to know? Take the risk. Otherwise go home and do something else.

Maybe I was lucky. My GP will not do a DRE. He says he is not comfortable making those calls. He sent me to a good uro. The uro decided a biopsy was appropriate. It was 9 of 12 positive with 3+4, 4+3, and 4+4.

Risks. Argh.

Anybody gone out and gotten a copy of "A Private Battle" yet? I keep suggesting you read it.

 

Posted 5/30/2013 2:15 AM (GMT 0)
how do you get over something like that? Poor baby and poor you for having to experience that.
Posted 5/30/2013 2:17 AM (GMT 0)
You got the same risks if you go to the ER to have a bad cut on your finger stitched up. I think talking about any physical risk to avoid or discourage a prostate biopsy is a cop out in my opinion. Seems like the one side is bent on destroying the gains that have been made the past 10 years in promoting men's health issues. Still asking, what is the real, real motivation for this. It's got to be somewhere in the money trail, its always about money in the end. I was in the upper end of Finance and Accounting for most of my working career, and at the end of the day, its always about the bottom line.

david in sc
Posted 5/30/2013 2:25 AM (GMT 0)
davidg,
I had 13 biopsies and wish I knew then what I know now. It was apparent after 3 years and 14 psa and free psa data points that there was only one cause of my elevated psa, and that was prostate cancer. Yet it took 7 more years and 10 more biopsies. I wish I had read Strum then rather than 8 years later. I wish I knew that prostate oncologists existed. I wish I knew about Color Doppler or even saturation biopsies. I'll never make that mistake again regarding this disease and will know how to intelligently question my doctors and be my own best advocate.
If I were going on AS it would be with Dr Bahn and the Color Doppler. Once a baseline is established he will take no more than three cores and only if the tumor shows growth.
Posted 5/30/2013 2:30 AM (GMT 0)
look, it's about not testing ( this will rule out a lot of AS), not doing biopsies, and not treating/Managing. That's what all this spin is about lately.

There is only one group that benefits financially form that chain of events.

The AUA guidelines are much better than the Otis Brawley crap but it so looks like a poor compromise, specially the part for 40-54 year old men. So I wonder how much of it is a political compromise.

It's a shame
Posted 5/30/2013 2:31 AM (GMT 0)

John T said...
davidg,
I had 13 biopsies and wish I knew then what I know now. It was apparent after 3 years and 14 psa and free psa data points that there was only one cause of my elevated psa, and that was prostate cancer. Yet it took 7 more years and 10 more biopsies. I wish I had read Strum then rather than 8 years later. I wish I knew that prostate oncologists existed. I wish I knew about Color Doppler or even saturation biopsies. I'll never make that mistake again regarding this disease and will know how to intelligently question my doctors and be my own best advocate.
If I were going on AS it would be with Dr Bahn and the Color Doppler. Once a baseline is established he will take no more than three cores and only if the tumor shows growth.

All that technology was available then?

I know how you feel, my mother had her third biopsy in 2 weeks in same spot yesterday.
Posted 5/30/2013 2:55 AM (GMT 0)
JohnT

Thanks for the factual reply, wouldn't have expected any less from you. However, and I am not disputing your source of information, but, it sounds like a "plugged" number. Like certain financial reports I was auditing over the years, where the originator of a certain report used a pre-determined bottom line number to prove a point, and simply adjusted or plugged the other numbers in the formula to make the final answer come out to a pre-determined answer. Coming back to topic, I simply don't believe there would be that substantial an increase in suicide rate based on men having prostate biopsy. Now if someone had a pancreatic biopsy, and it came back showing advanced pancreatic cancer in its last stage, I could almost believe somewhere in the country, 1 or 2 people that couldn't handle the news could possibly go over the deep end, out of fear of dying a quick and painful death. However, that would never be the case normally from the results of a prostate biopsy.

I know you are not guilty of this (would never think or accuse you), but in these many, many reports an studies that are constantly being analyzed and even over analyzed here, there just isn't any easy or sure way to prove or disprove some of the numbers, let alone the conclusions that are being made. I don't see them as being so exact as some interpret them to be.

david in sc
Posted 5/30/2013 2:57 AM (GMT 0)
It is less that the tests exist than that someone can pay.

My (big national brags a lot) insurance company only pays for 6-core biopsies. My uro ignored that, and did 12. My first introduction to the twilight zone of payments.

The uro was smart enough not to detail the number of cores, so that part went through. Bostwick, after some phone calls, wrote off the "extra" 6. Bless those folks. I'll always have good things to say about them.

If the uro had told me there would be a fight over payment, I would have asked for 6 cores, and would have been under-diagnosed. You don't know all this crap at the beginning, when it is important. I'm happy that my uro/surgeon did what needed to be done rather than what the insurance would approve.

Davidg,

I have nightmares about the folks I did not save 40 years later. I don't stop anymore. It helps avoid more failures.

Posted 5/30/2013 2:58 AM (GMT 0)
Tony,
You ask, what do I think about those two studies? If true and accurate the urology profession should be embarrassed that in trying to save lives they kill that high number of men by doing prostate biopsies. I have no access to the one published full study. The other is just a new paper to be presented at the ASCO meeting later this week. Abstracts are too short on information to be able to do a fair review.

For years we have read about the comorbidities of prostate biopsies and death from the procedure is seldom mentioned or reported extremely low. If a prostate biopsy can kill a man in 120 days at the rate reported, it should have been known years ago when millions of biopsies have been done throughout the last 20 years.

What a bad omen for active surveillance that depends on biopsy to observe occult progression. Need better imaging pronto to say the least…

RalphV
Posted 5/30/2013 3:07 AM (GMT 0)
142, and I say this purely in jest. how dare you imply you might have been under diagnosed. that would be a novel subject here, I thought the pet subject was over diagnosis, so please don't muddle the waters.

on the serious side, can't imagine an insurance company squabbling over a 6 or 12 core biopsy, that's really nit picking and trying to doctor the patient. but I believe you

david in sc
Posted 5/30/2013 3:10 AM (GMT 0)
Ralph we are in 100% agreement about embarrassment on the part of the AUA. I agree! But now they are goats trying ti curb things and they cant win either way. I hope they err in the future on the safest way...

I'll be in Chitown this weekend and will round up the full paper. But this goes beyond active surveillance!

Tony
Posted 5/30/2013 3:14 AM (GMT 0)
I can't remember all the names of the websites that let users post reviews of products and services, there are many, Angie’s List comes to mind.

Anywho,
There has been some speculation (and some proven) for many years, that these type of websites are littered with so called "positive glowing reviews" or "competitor slander", coming from what appears to be legitimate consumers who are actually employees, or friends of, and people with vested interest in these reviews.

...just sayin'
Posted 5/30/2013 3:15 AM (GMT 0)
I got a "not covered, excessive" denial for cores 7-12. Still have the paperwork.

The collections lady from Bostwick was an angel. She went over everything, then finally said "You have cancer. The next few weeks and months are going to be hell. You don't need this to worry about." And she wrote them off. I'll remember that as one of the very few positive notes about this journey (along side the help from Sonny, Purg, and English Alf).

Posted 5/30/2013 3:17 AM (GMT 0)
I tried the list that you mentioned above there, James. For one month, as I was looking for a good roofer, and was amazed at 2 of the highest rated ones on that list are well known crooks in my area, anyone around here would agree. The glowing reviews you mentioned seem entirely made up. I canceled immediately, knew it was going to be a waste of time

david
Posted 5/30/2013 3:21 AM (GMT 0)
James you don't know me. I wish you would take your time deciding whom I represent. I assure as a man that has been around this block and seen a lot I'm on your side.

Tony
Posted 5/30/2013 3:31 AM (GMT 0)
Exactly Purg!

Another thing I would like to mention in regards to the 2 in 1000 thing.
How many of those deaths were because the patient failed to follow the instructions prior to biopsy? The antibiotics, the enemas, etc;
Don't know if they can find that out, their patients are dead.

Patients have to realize the risks involved. If they are that naive about it, then this country is in worse shape than I thought.
Posted 5/30/2013 3:36 AM (GMT 0)

TC-LasVegas said...
James you don't know me. I wish you would take your time deciding whom I represent. I assure as a man that has been around this block and seen a lot I'm on your side.

Tony

I didn't name anyone. However, if you feel compelled to reply as such, then I suppose my post struck a nerve.
Posted 5/30/2013 3:49 AM (GMT 0)
The wire is alive tonight by many including a known group of doctors whom think that indeed screening and the net saving of lives is in fact a new possibility a net LOSS of lives delivered by screening.

I do not agree with this part, I still see a benefit, but that the fact that continuously flowing new data is rolling in making the promotion of screening and treating a dangerous paradigm. We need better data and as Ralph said, we need better tests whether it's imaging, which I seriously doubt, or genetic which I think the future of screening lies with.

I think it is imperative that advocates put down the studies and lobby harder for better testing. Better screening. More research and most of all better evidence.

I don't think we are going to clean up biopsies to fix this problem. These results are what they are. Better screening tools can help offset the morbidity of biopsy and improve the bigger picture.

Tony
Posted 5/30/2013 3:52 AM (GMT 0)
James, that's why I think its almost silly to even discuss the risk of a prostate biopsy other than for malpractice reasons or honesty in disclosure. Gee, I had dental surgery a couple of months back, and had to sign waivers and such, as there were risks that when I was put under, that I might not wake up, and that there would be post dental surgery risks in the procedure itself. Life is too short to worry about these things in my opinion. You do what you have to do. There was more risk at me leaving in the two bad teeth from future infection than from having them removed.

I am sensing a direction going on here, just by a few, that are slowly trying to twist things around from being pro in the best interest of the patient, to some other agenda. Again, motivation is the key to all decisions, I am watching carefully to see where all this is leading, with regards to supposed over screening, over diagnosis, and over treatment.

david
Posted 5/30/2013 3:59 AM (GMT 0)
David (Purg)
"James, that's why I think its almost silly to even discuss the risk of a prostate biopsy other than for malpractice reasons..."

David, how much do you think you can sue for if you died of a biopsy?

Tony
Posted 5/30/2013 4:00 AM (GMT 0)
I know about the dental aspect/side of things Purg, I referenced it in a post earlier today somewhere.
I am a dental laboratory technician by trade.
Posted 5/30/2013 4:06 AM (GMT 0)
tony, not even going to take the bait on that one, that was too easy, you are slipping

you know perfectly well that, my wife or other family members could sue for malpractice on my behalf if I had died from a biopsy. pretty basic legal stuff.

david
Posted 5/30/2013 4:12 AM (GMT 0)
Tony, if 2 in 1,000 men truly die as a result of a prostate biopsy, I'm standing by to learn more.  Exactly what aspect of the procedure caused these deaths?  Was it infection, sepsis, or that sort of thing?  Did the procedure actually directly cause their deaths, or did the patients have such a degree of anxiety that they brought on a heart attack or a stroke?

Are these deaths somehow related to the anesthesia that's used in some cases?  I know that some uros use the "twilight" type of anesthesia, and then of course there's the local anesthetic that's applied at the site.

Seriously, though, someone's going to have to show me how a prostate biopsy "causes" death, unless we're using the word "causes" very loosely.  Deaths may be associated with the procedure, but causation has a specific meaning.....as if the biopsy needle were two feet long and punctured the heart. 

Posted 5/30/2013 4:18 AM (GMT 0)
Haha,
Fair enough, David (Purg). But I am not an attorney either so I don't know darn well if after all the paper work one signed going into one's biopsy if one's family could sue for anything.

As an advocate I just raise the question if the appropriate risk/reward factors are being applied. And remember, 1,000,000 biopsies per year are performed and with 2 in 1000 dying, according to these studies, it's a staggering thing to allow 2000 possible deaths per year associated with the diagnosis testing and treatment never even being started. Of course we can easily forget about the 4000 to 6000 men per year whom just go to the hospital and are dealing with infection.

But you are right about the future of litigation here. I bet there are eager lawyers getting ready already.

Tony

Post Edited (TC-LasVegas) : 5/29/2013 10:22:51 PM (GMT-6)

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