How accurate are prostate biopsies?

User

Posted 10 Nov 2026 at 04:44

The bad news is, less than 60%,

Data from the British Association of Urological Surgeons (BAUS) Radical Prostatectomy Registry on prostate cancer biopsy and post-radical prostatectomy (RP) pathology show the following concordance, upgrading, and downgrading rates.

A total of 17,598 patients met full inclusion criteria. Absolute concordance between initial biopsy and pathological grade was 58.9% (n = 10,364), whilst upgrade and downgrade rates were 25.5% (n = 4489) and 15.6% (n = 2745) respectively. Upgrade rate was highest in those with D’Amico low risk compared with intermediate and high-risk disease (55.7% versus 19.1 and 24.3%

The good news is, it's getting better.

This study also demonstrated a reduction in upgrading in more recent years, with the rate falling from 30.6% in 2011 to 23.2% in 2016.

User

Posted 10 Nov 2026 at 07:21

Hi Adrian

That's interesting. My hope would be that the improvement will have continued since 2016 which is not all that recent.

My understanding is that a lot more biopsies these days are guided by MRI findings rather than just being random samples as they were in the past. This should mean that they are much less likely to miss the more aggressive areas of cancer within the prostate. It would certainly be interesting to see more recent figures.

Kevin

User

Posted 10 Nov 2026 at 10:52

Hi Kevin. It's always good to hear from you, mate

Biopsies are the corner store for diagnosing and formulating treatment plans for prostate cancer. Yet they are woefully inaccurate.

It surprises me, as they are so pivotal to cancer management, how little research has been done about how efficient they are.

I did find more recent research from China.

It's results were even worse than our BAUS figures.

With concordance at only 45%

This study retrospectively analyzed 218 PCa patients diagnosed by transperineal prostate biopsy and subsequent treated with radical prostatectomy from January 2021 to February 2024

Among the 218 patients included in this study, 80 (36.7%) exhibited pathological upgrading postoperatively, 39 (17.9%) showed pathological downgrading, and 99 (45.4%) maintained consistent pathological results.

https://pubmed.ncbi.nlm.nih.gov/41492874/

During the PSA national screening debate, there was much publicised debate on the inaccuracies of testing. Yet the inaccuracies of biopsies, though far more important, are rarely discussed.

I'm usually quite upbeat about prostate cancer management. However, sometimes no matter how positive I try to be, I cant help thinking that about 40% of biopsies are inaccurate and to plan treatment on inaccurate information, is a bit like building a house on very dodgy foundations.

I think, if I could turn the clock back, I'd have paid much more attention to my initial biopsy, and questioned how reliable it was, rather than taking it as fact. I'd have perhaps at least got a second opinion.

Edited by member 10 Nov 2026 at 11:45 | Reason: Typo

User

Posted 10 Nov 2026 at 11:10

60% accuracy in terms of staging and grade perhaps but the accuracy of whether or not you’ve got prostate cancer is surely a great deal higher and that is more important.

yes obviously some people might make treatment choices based upon the grade and that is an issue but we don’t have anything better. So what choice do we have? Perhaps this is part of the reason why they’ve gone towards template biopsies rather than unguided trus biopsies? For what it’s worth I had an MRI before my trus biopsy and it got the correct diagnosis. There was no upgrade or downgrade in my case once the pathology from the prostatectomy came back.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User

Posted 10 Nov 2026 at 11:59

The cancer diagnosis is the main thing but I think that getting the stage and particularly the grade right is also very important. So I find those recent figures revealed by Adrian to be disappointing.

Ideally we want more men to get tested before their cancer becomes a problem. But very many men (and maybe even the majority if you count all those who currently never find out about their cancer) will be Grade Group 1 (or Gleason 3+3). These men are in principle great candidates for Active Surveillance, but many will not feel good about going on AS if they are anxious that their diagnosis is wrong. The result could be a lot of overtreatment which we should ideally be seeking to avoid.

User

Posted 10 Nov 2026 at 12:44

Originally Posted by: Online Community Member

There was no upgrade or downgrade in my case once the pathology from the prostatectomy came back.

Hi Alex,

You make some very valid points. I'm glad that you were in the 60% whose treatment plan were based on an accurate biopsy.

I accept we've got what we've got. Until there are more technical developments in taking biopsies and more conformity in interpreting the results, there will always be discrepancies. It's probably never going to be an 'exact science'.

Like Kevin, I think it is as important, if not more important, to have accurate biopsies for treatment plans as it is for actually 'finding' cancer. After all, inaccurate biopsies, could put into question whether cancer has actually been found or not.

User

Posted 10 Nov 2026 at 16:49

Originally Posted by: Online Community Member

I accept we've got what we've got. Until there are more technical developments in taking biopsies and more conformity in interpreting the results, there will always be discrepancies. It's probably never going to be an 'exact science'.

In any kind of sampling there is always a chance you get an unrepresentative sample unless you sample the whole thing.

What we really need is some kind of scan which is an order of magnitude or two better than what we have now. Non-invasive too and no chance of "missing". Probably will happen at some point, but probably a long way off.

Originally Posted by: Online Community Member

Like Kevin, I think it is as important, if not more important, to have accurate biopsies for treatment plans as it is for actually 'finding' cancer. After all, inaccurate biopsies, could put into question whether cancer has actually been found or not.

Yes but remember there is also the imagery ultrasound from TRUS, MRI with or without contrast and the finger test which all help to determine whether or not cancer is present. Each presents its own piece of the puzzle. It's not ideal I agree, but it's the current state of the art.

I think people on active surveillance usually get biopsied again if their numbers go up, so there's more chance of grading correctly at the next one. It's a bit random. C'est la vie.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

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