A prostate biopsy is a standard diagnostic tool for identifying prostate cancer. However, the procedure can be painful and stressful and does not always reach an accurate diagnosis.
While they can be medically useful, a prostate biopsy can lead to needless worry and immediate treatment for prostate cancer when it is not necessary. Many people do not need active treatment for early signs of prostate cancer.
Several reliable alternatives to a biopsy can help a person assess their risk for prostate cancer, decide on further screening, and test for prostate cancer without causing excess worry.
In this article, we explain three of these alternatives and their benefits.
People should discuss with their doctors whether a prostate biopsy is suitable or an alternative may be better. A biopsy may be the best option when:
- Levels of prostate specific antigen (PSA) are high or significantly higher than the size of the prostate suggests.
- Imaging of the prostate suggests an aggressive form of cancer may be present.
- An individual has an increased risk of prostate cancer.
Three of the possible alternatives to a prostate biopsy include the following:
Prostate cancer enzyme tests
Some tests check for enzymes that prostate cancer produces to see if cancer is present and gauge whether it may be aggressive or fast growing. These tests use either blood or urine samples to determine a person’s overall risk for prostate cancer.
Doctors usually recommend these tests for males who have high PSA scores or whose doctors find abnormalities during a digital prostate exam.
A newer blood test is the 4Kscore test, which measures a person’s risk of prostate cancer.
This test does not completely replace the need for a biopsy, but it can help identify who should have one. As a result, it may help doctors reduce the number of people who have biopsies.
The 4Kscore test is also effective for testing African American and Afro Caribbean men for prostate cancer.
Enzyme tests cannot identify every case of prostate cancer, but neither do biopsies. Instead, blood and urine screenings can identify the most aggressive presentations of the disease.
Some forms of prostate cancer are slow growing rather than aggressive. Slow growing prostate cancer is unlikely to be fatal.
In most cases, a doctor will recommend a prostate biopsy due to a high PSA score. However, other health issues can contribute to an elevated PSA score. A PSA score also tends to increase with age.
Waiting and testing PSA levels again can be helpful. If a PSA score remains high but has not changed since the last test, a person may not have prostate cancer.
An MRI scan uses a magnetic field and radiofrequency pulses to produce a clear image of the prostate.
Similarly to biopsies, MRIs can sometimes produce an incorrect result. However, they are less invasive and still give an accurate guide to prostate cancer risk.
Doctors use a variety of MRI techniques to look for prostate cancer, including:
- Diffusion weighted imaging: This examines how the prostate absorbs water.
- Contrast imaging: The doctor observes blood flow in and around the prostate with the help of a dye.
- Spectroscopic imaging: This aims to distinguish prostate cancer from other causes of prostate enlargement, such as infection.
Each technique has strengths, weaknesses, and a variable ability to detect a type of prostate cancer. The most effective MRI methods combine several of these imaging techniques.
For most men, testing for prostate cancer includes a blood test for PSA. Higher-than-normal PSA scores may suggest a problem with the prostate.
If a PSA test or a digital rectal exam of the prostate shows a possible irregularity, a doctor may recommend further testing, such as a biopsy.
During the biopsy, a doctor uses an ultrasound machine to look at the prostate. They insert a small device into the rectum to perform the ultrasound.
Using a small, hollow needle, the doctor removes a tissue sample from the prostate. They send this to a laboratory where a pathologist views the sample under a microscope to check for abnormal cell growth.
The biopsy may involve collection of several samples of prostate tissue during the procedure.
A prostate biopsy can also help a doctor decide the stage of any cancer that is present. Knowing whether cancer is advanced or aggressive can help a doctor determine the best treatment.
It will also help them decide whether treatment is necessary. For many men with low stage or slow growing prostate cancer, watchful waiting may be the best course of action.
A prostate biopsy is a standard procedure. Benefits of choosing this option include:
- getting accurate information about how aggressive the cancer is
- confirming a diagnosis of suspected prostate cancer
- enabling prompt treatment of prostate cancer
If diagnosis and treatment remove prostate cancer before it spreads to distant organs, the 5 year survival rate is almost 100%.
This means that a person with prostate cancer is nearly 100% as likely to survive for 5 years beyond diagnosis as a person who does not have prostate cancer.
The disadvantages of a prostate biopsy include:
- Discomfort: Most people receive pain medication to reduce discomfort during the procedure. However, it is common to experience bleeding and pain in the days following a prostate biopsy.
- Inaccurate or incomplete results: Prostate biopsies miss about 20% of cancers. They can also produce false-positive results. This means some people may need to have multiple biopsies.
- Risk of hospitalization: This might occur due to infection and other prostate issues.
Men who have a high risk of developing prostate cancer may benefit from a prostate biopsy if a PSA test shows elevated results.
The risk of developing prostate cancer increases with age. Other risk factors include:
- a family history of prostate cancer
- race and ethnicity, as people of African and Caribbean descent have higher rates of prostate cancer
- geography, as prostate cancer occurs more often in North American, northeastern Europe, Australia, and on Caribbean islands
- having genetic mutations, including the BRCA1 and BRCA2 genes
- having Lynch syndrome
- eating a diet high in fatty dairy products or red meat
- being obese
- a history of sexually transmitted infections (STIs) or prostate inflammation
- exposure to certain toxic chemicals
Some research suggests that a vasectomy may slightly elevate the risk of prostate cancer.
People can ask their doctor questions to help them decide whether a prostate biopsy is appropriate. These include:
- Do I have a higher-than-usual risk for prostate cancer?
- What treatment options are available for prostate cancer?
- Will another test be safer or more accurate?
- Is it likely that I will need a repeat biopsy?
- How high is my PSA reading?
- Did my digital rectal exam produce normal results?
- What are the cancer screening guidelines for my age and risk factors?
Prostate cancer can be a frightening diagnosis, but the disease is also highly treatable and often progresses slowly.
People often do not need every test for prostate cancer, and not all prostate cancers require treatment. People should consult with their doctors to determine the best preventive checks for them.
Can I avoid a biopsy for other types of cancer?