biopsy and metastasis
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From: rosbif on 20 Mar 2006 02:57 .....(still boning up my meagre knowledge!).. This must have been aired before - is the risk of metastasis through needle biopsy fully discounted amongst the cognoscenti?
From: Alan Meyer on 20 Mar 2006 07:32 "rosbif" <ici(a)he.re> wrote in message news:11os121e3iac0c2d104vg1ukjfmgvdp9st(a)4ax.com... > ....(still boning up my meagre knowledge!).. > > This must have been aired before - is the risk of metastasis through > needle biopsy fully discounted amongst the cognoscenti? Here's an old report in Pubmed from 1987. I have no idea how accurate it is, or whether current techniques are better or worse than they were then. The authors are claiming pretty precise knowledge of how often this occurs, 1/3 of 1% of the time. --------------------------------------------------- Seeding and perineal implantation of prostatic cancer in the track of the biopsy needle: three case reports and a review of the literature. Haddad FS, Somsin AA. Several months (an average of 12.86 months) after perineal needling of the cancerous prostate for the purpose of obtaining tissue for biopsy, a tumor nodule becomes clinically evident in the subcutaneous tissue of the perineum, at the site of the needling in 0.34% of the cases. This nodule presents the same histological picture as the biopsy of the prostatic tumor. This is a review of 15 such cases (12 collected from the literature and an additional three unpublished cases, two of which are personal observations). At the time of needling, no metastases could be clinically detected in any of the patients; the serum acid phosphatase was normal in 73% of them. The average age of the patients was 65.66 years. The perineal nodule was tender in 40% of the cases; its average size was 2.5 cm. Excision of the nodule was the most frequently employed form of management. At the time of reporting, 60% of the patients were living and well, for an average of 18.56 months after excision. In order to prevent perineal implantation, especially in patients who are at risk, it is suggested that a fine needle be employed to obtain prostatic tissue for biopsy, and that every possible therapeutic effort be made.
From: Leonard Evens on 20 Mar 2006 09:48 rosbif wrote: > ....(still boning up my meagre knowledge!).. > > This must have been aired before - is the risk of metastasis through > needle biopsy fully discounted amongst the cognoscenti? According to Walsh in Guide to Surviving Prostate Cancer, prostate cancer cells escape the prostate all the time. The issue is whether or not such cells have the capability to survive distant from their point of origin. That is called metastatic capability, and it is what we all fear since in that case early treatment won't cure the disease. Some recent research confirms that cancer cells are found in the blood of men with prostate cancer, and at least for early cancers the incidence drops significantly after treatment. Also note Alan's answer. It seems to me that having the biopsy probably doesn't significantly change the risk of recurrence after treatment, and that the risk of metastasis is much much greater if the cancer is undiagnosed and untreated than from any cells which may escape during biopsy. Of course, whether that risk is high enough to merit treatment depends on a variety of factors such as the life expectancy of the patient and the degree of aggressiveness of the cancer. There are those who argue that for many men treatment or even screening is not generally helpful, but I think the issue of whether or not the biopsy is a significant factor in metastasis, is a red herring.
From: ron on 20 Mar 2006 10:46 Here's a similarly low number from the Hopkins' team...Ron J Urol. 1991 May;145(5):1003-7 Needle biopsy associated tumor tracking of adenocarcinoma of the prostate. Bastacky SS, Walsh PC, Epstein JI. Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland. We reviewed 350 previously biopsied completely submitted clinical stage B radical prostatectomy specimens resected between January 1, 1987 and December 31, 1988 in an attempt to identify the incidence of needle biopsy associated tumor tracking into periprostatic soft tissue. We identified 7 cases (2.0%) of needle biopsy associated tumor tracking, 3 in which the only tumor penetration in the gland was limited to the needle track. The maximal soft tissue extension from the biopsy site ranged from 0.1 to 1.2 cm. and approached the nearest soft tissue margin to within 0.5 mm. in 4 cases. In contrast to prior reports showing clinically evident tracking only with transperineal biopsies from high grade tumors, 6 of our 7 cases were of intermediate grade (in the glandular and tracking components) and 6 had transrectal biopsies. Needle biopsy associated tumor tracking occurred with core (14 gauge) and biopsy gun needles (18 gauge). An additional 13 cases (3.7%) showed some features of needle biopsy associated tumor tracking but they were equivocal. These findings have significant implications in light of recent proposals advocating serial mapping of prostate cancer using the biopsy gun with potential conservative observation of smaller tumors.
From: rosbif on 21 Mar 2006 07:42
thanks Alan, Leonard, ron for illuminating that. My fear about this was aroused initially in reading Scardino's book where he counsels patients not to even bother with a biopsy unless they intend to undertake treatment soon after. As a gleason6 (2 years ago, now GL7) I opted for WW. Just wondered what those loosened cancer cells might have been up to in the meantime. |