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Will Biopsy be discontinued as unnecessary for PCa Diagnosis?for PCa

User
Posted 14 Jun 2025 at 06:34

Interview of leading UK researcher with USA Doctor on omitting Biopsy for PCa following German study,  (after comparing differences between UK and USA systems).  Also more on Focal Therapy. https://www.youtube.com/watch?v=0toibiLXRjs 

Barry
User
Posted 15 Jun 2025 at 18:54

It's a worthwhile watch. 

It skated over the implications of 'it doesn't exist until you can see it'.

Interesting comments:  A visible lesion is 100m cells 0.2cc.  The next 10yrs are about imaging rather than histology.

User
Posted 15 Jun 2025 at 20:28

An interesting video. Whether the UK is now truly transrectal biopsy free I would question. I had a transrectal biopsy in 2021. I also had a supressed immune system at the time so in hindsight is does make me wonder whether it was worth the risk. I was PIRADS 5 so cancer was pretty much a certainty and the biopsy didn't change the way I was treated. What I couldn't get my head round was the implication that a Gleason 6 wasn't going to show up on imaging. Is that true?

User
Posted 15 Jun 2025 at 21:58

I'm a bit confused about ruling out biopsies. No matter how wonderful the imagining may be, surely only biopsies and histology can give a Gleason score. We've had several blokes on here whose MRIs were pirads 5 yet the suspicious areas were benign. 

Numerous people have posted their MRI scan result and we've always advised them only  a biopsy can confirm or negate cancer and how aggressive it's likely to be. There is also research now taking place to actually examine the genetic make up of the cancer cells to see if they are more or less likely to spread. Surely that can't be advanced without biopsies.

Apparently the very small sample of 25 men from the German trial, who had surgery without biopsies, had refused biopsies. It appears it was luck more than judgement that they all had cancer. A similar sample of 11 men in China revealed that unfortunately one of them had a benign tumour.

https://sperlingprostatecenter.com/a-prostatectomy-without-having-a-biopsy/#:~:text=Refusing%20a%20biopsy,suspicion%E2%80%9D%20for%20localized%20prostate%20cancer.&text=These%20findings%20qualified%20the%20patients,prostate%2C%20cancer%20and%20all%E2%80%9D?

I had a transrectal biopsy late 2020. 2 years later when they discovered significant disease progression. I was advised to have a follow up transperineal biopsy done under general anaesthetic. I was told it would be far more accurate than the first. 

Edited by member 15 Jun 2025 at 22:34  | Reason: Additional text

User
Posted 15 Jun 2025 at 23:17

I think it will take quite a time before omitting biopsies for PCa becomes widely accepted but things are changing with regard to PCa. The likelihood of being able to detect PCa from blood test is one possible tool although it won't show location. Clearly, if there are alternatives to having a biopsy this will be great. It is interesting that 'tracking' causing seeding by needle biopsies could not be ruled out. The interviewed Professor here, has said elsewhere that DRE was a very poor test as much of the Prostate could not be reached and opinions on findings differed. He said DRE was being less used so perhaps another controversial change.

Edited by member 15 Jun 2025 at 23:18  | Reason: Not specified

Barry
User
Posted 16 Jun 2025 at 20:56

No basics like a DRE,  what will doctors do?

If expensive treatments become the norm you could go to Boots for an on demand psa test and then MRI and PSMA scans will automatically be part of the process for a raised psa without seeing a doctor. AI will assess the scans and prescribe treatments which the patient can amend from an offered tailored menu.

As the doctor says 'the next decade is about imaging, not histology'.

User
Posted 17 Jun 2025 at 09:40

Originally Posted by: Online Community Member
As the doctor says 'the next decade is about imaging, not histology'.

He obviously knows far more than me. However, even he says he still uses biopies. Unless scans can suddenly distinguish between benign and malignant cancer and how aggressive that cancer is, I can see biopsies remaining the gold standard of cancer diagnosis for many years to come?

However, I can see imagining becoming so good that it could significantly improve the accuracy of biopsies.

Edited by member 17 Jun 2025 at 10:01  | Reason: Additional text

User
Posted 17 Jun 2025 at 13:34

Originally Posted by: Online Community Member

It's a worthwhile watch. 

It skated over the implications of 'it doesn't exist until you can see it'.

 

 


Interesting comments:  A visible lesion is 100m cells 0.2cc.  The next 10yrs are about imaging rather than histology.

Isn’t .2cc lesion quite large? Isn’t this visible on MRI? It is interesting.

 
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