Should men get the biopsy for prostate cancer that requires general anesthesia?

Should men get the biopsy for prostate cancer that requires general anesthesia?
By Judy Foreman
January 19, 2009

Probably not - at least not as a first step in cancer diagnosis.

In a typical office biopsy, a man is given local anesthesia and the doctor uses needles, inserted through the rectum, to take 12 samples of prostate tissue. Because the needles may miss some areas, the test may falsely say a man does not have cancer when he does.

In the new "saturation transperineal" biopsy, needles are used to take 40 samples. Doctors insert the needles through the perineum, the skin between the bottom of the scrotum and the front of the rectum. General anesthesia is used.

In a study to be published soon, Dr. Brian Moran, medical director of the Chicago Prostate Center, used perineal biopsies on 747 men, all of whom had rising PSA scores, a sign of potential cancer, yet consistently negative rectal biopsies.

Moran said he found cancer in 39 percent of the men, suggesting that this method is better at finding hidden cancer. But only 40 percent of these newly detected cancers were serious, that is, carried a "Gleason score" of 7 or higher.

And there is the conundrum. The saturation perineal method may increase the cancer detection rate, "but are we necessarily detecting significant cancers? That is the great issue," said Dr. Kevin Loughlin, a senior urologist at Brigham and Women's .

If most of the cancers found by the new technique are not life threatening, is it worth putting men through the ordeal of more aggressive detection?

Probably not, say some doctors, advising instead that the new method should be saved for men in that gray zone of rising PSA scores and negative findings on rectal biopsies.

JUDY FOREMAN