Does stereotactic transperineal prostate biopsy (STPB) increase the numbers of insignificant cancers? Are we finding cancers that don’t need to be treated? This is a legitimate concern because it creates anxiety for the patient. And in essence, maybe some of these cancers do not need to be treated. For example, a 75-80 year old man with a small amount of disease and low-grade Gleason 6, but has heart disease and/or diabetes, may be somebody who is better off being left untreated. No question.
The more serious question is whether or not transrectal biopsy is inadequate in certain patients to detect lethal malignancies. And that, is in fact, the case for a select group of patients we have found, who have had prior rectal biopsies, all of which were negative, yet their PSA’s continued to elevate. These patients then underwent the stereotactic transperineal prostate biopsy. At Chicago Prostate Cancer Center, we have found cancer in 40% of these patients. Of that group, the data suggests that 60% are high-grade Gleason 8, 9 & 10 and bulky 7’s. These are without question, cancers that would progress and be potentially lethal tumors. So to the criticism that all this new biopsy technique does is increase the numbers of insignificant malignant diagnoses, we have found the opposite; STPB is picking up aggressive, potentially lethal, high-grade malignancies in young men. The median age for the STPB group is ten years younger than the average biopsy population. Our data supports, that while we may diagnose some insignificant cancers, we are diagnosing more significant cancers.