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Old 07-03-2010, 10:38 AM   #1
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Do needle biopsies spread cancer?

I just did a search on this and the answer from one source said that it does spread cancer about 50% of the time. The first time I heard about it was when I went to a health expo in my area. One doctor had a table set up with a BIG sign that read, "Needle Biopsies Spread Cancer". And he gave me some material to read so I could be more informed.

I'll never forget when I saw that sign. It came as a big shock and I couldn't believe it.

My brother had a needle biopsy for prostate cancer. The doctor said not to worry because it was the slow growing type of cancer. But a year later he had extensive inoperable cancer throughout his midsection. It makes me wonder if it was the biopsy that caused it.

 
Old 07-03-2010, 05:39 PM   #2
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Re: Do needle biopsies spread cancer?

There is no credible evidence that biopsies spread cancer. This may be possible, but it has never been documented. There are plenty of other issues such as infection that are much more apt to happen during a biopsy.
JT

 
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Old 07-04-2010, 05:44 AM   #3
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Re: Do needle biopsies spread cancer?

Hi John,

Johnt1 covered the facts here, but what you wrote just does not ring right for prostate cancer.

Would you mind identifying the doctor with the sign so we can check him? Would you mind giving us the citation details for the material the doctor gave you: the authors, the title, the year of publication, and where it was published? Did the doctor have medical credentials? Would you mind identifying his medical degree? (MD, DO, etc.)

Quote:
Originally Posted by JohnR41 View Post
I just did a search on this and the answer from one source said that it does spread cancer about 50% of the time.
Please provide the citation details for the study you found that said that needle biopsies spread cancer 50% of the time.

Would you mind some questions about your brother, as the circumstances you describe are odd for prostate cancer, though not unheard of? Was it prostate cancer that had spread, or, if not, what kind of cancer? If prostate cancer, what were the key case details at the time it was diagnosed? When surgery was ruled out ("inoperable"), what other therapies were proposed? Which did he choose, and how is he doing?

Take care,

Jim

 
Old 07-05-2010, 03:02 PM   #4
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Re: Do needle biopsies spread cancer?

Jim,

I went back to look at the item I searched and it was about biopsies for breast cancer. But I found other information that applies to prostate biopsies. On "yahoo" I searched the following: Prostate Needle Bioopsy Procedure vs. MRI-S

I don't mind giving information about the doctor at the health expo but I don't have the information with me today. Hopefully, I'll be able to post it tomorrow.

As far a my brother, he died a little over a year ago. Not being on speeking terms with him or his family, I got the information (details) in a round about way. I was told it was slow growing prostate cancer. Then perhaps over a year later he had cancer in the area of his pancreas but not pancreatic cancer. I later learned about the biopsy thing but am no longer able to get information concerning my brother. The person who told me he had prostate cancer no longer remembers anything about him having prostate cancer.

The story I was told to begin with was this: Because he was about 79 years old and the cancer was the slow growing type of cancer, he was to do nothing (no treatment). Then when he began getting pains in his midsection, they opened him up and found extensive (widespread) cancer. If I remember correctly, he decided not to get any treatment because it was too advanced. Chemotherapy would have served no purpose except to make him more miserable in his final days. That's the way I understood it.

Last edited by JohnR41; 07-06-2010 at 09:29 AM. Reason: MRI-S

 
Old 07-06-2010, 09:48 AM   #5
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Re: Do needle biopsies spread cancer?

Jim,

The doctor's name is: Dr. Ronald Wheeler

Type of doctor: Urologist



Let me know if you need anything more and I will be glad to help if I can.

Last edited by JohnR41; 07-07-2010 at 02:14 PM.

 
Old 07-07-2010, 08:38 AM   #6
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Re: Do needle biopsies spread cancer?

Hi John,

I'm familiar with Dr. Wheeler. He has been a long time advisor and contributor to the organization known as PAACT, which stands for Patient Advocates for Advanced Cancer Treatments, but which is really focused on prostate cancer. PAACT publishes a newsletter known as Prostate Cancer Communication, and Dr. Wheeler has authored a number of articles, including some thought provoking pieces on prostatitis. PAACT is a non-conventional organization, which is a good point in my view, but, partly in that role, it is somewhat free wheeling and willing to go out on a limb in advance of evidence, at times.

I cannot find the article you mention by Dr. Wheeler on biopsies spreading prostate cancer. In fact, that seems counter to his clear view that detecting prostate cancer is important. Do you have a title?


Take care,

Jim
[/QUOTE]

 
Old 07-08-2010, 07:02 AM   #7
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Re: Do needle biopsies spread cancer?

Hi suelynn48,

Welcome to the board!

I have some information for you that may change your mind or perhaps give you another way of looking at the issue, at least about prostate biopsies. I'll insert it in your post in green.


Quote:
Originally Posted by suelynn48 View Post
JohnR51,

Thanks for posting the TRUE problems regarding needle biopsies. A nurse gave me this explanation - if you took an orange and put a needle into it and then pulled it out what would come out of the poke hole and what would be on the needle as it is being pulled back out of the flesh of the orange. Yes, MICROSCOPIC CELLS that are now let loose in ones body to spread the cancer.

Yes, this is a possibility. It is also a possibility with brachytherapy for prostate cancer in which radioactive "seeds" are inserted into the prostate through extremely narrow tubes, which are withdrawn after the seeds are inserted.

Now here's the question for you to think about: if biopsies (and seeding too) really do spread prostate cancer, what results would be expected in men who have had biopsies, and what results would be unexpected? Please think about that for a moment before reading further.


NEEDLE BIOPSIES ANYWHERE ON OUR BODIES IS VERY DANGEROUS!!!!!!!!!!!!!!!

Okay, if needle biopsies are very dangerous, we would expect to be seeing evidence of spread of cancer in those having biopsies, right? Also, we would not expect to be seeing high rates of apparent cure for such men who were treated only with "local" therapy that did not reach beyond the prostate (surgery, cryosurgery, sometimes radiation), or only slightly beyond it by a few mm (seeds)? Are you with me so far?

Now let's look at the research that bears on these points. Fortunately, a lot of credible research results are available. First, it's a safe assumption that virtually all men diagnosed with prostate cancer in the US have had a biopsy. Basically, a diagnosis of PC is not official unless there has been a biopsy showing prostate cancer. Also, a lot of men are newly diagnosed with prostate cancer each year in the US, with accepted numbers varying between around 180,000 and around 210,000, depending on the year.

Let's look at "cure" rates. I'm putting "cure" in quotation marks because no one but God knows if we have actually been cured. On earth, we instead use the absence of evidence of disease for an appropriate follow-up time as an indicator of cure. For some faster growing cancers, no evidence of disease at five years is the indicator of likely cure. Prostate cancer is slower growing, but we have rates for five years and beyond, and we prostate cancer patients also have the wonderful protein known as PSA (Prostate Specific Antigen), which is excellent at indicating the state of prostate cancer - especially whether it is recurring, for the vast majority of prostate cancer patients. In essence, if the PSA is appropriately low and not rising in a tell-tale way, and if any other types of evidence checked is negative, we have a solid indicator that the patient is free of recurrence and perhaps cured.

Now at five years, if cancer cells spread by the biopsy are causing trouble, they should have had plenty of time to grow and throw their weight around, right?

So here's what survival rate is for US prostate cancer patients at five years according to the 128th (Library) Edition of the Statistical Abstract of the United States 2009, Table 173, p. 118: for white men, 99.4%; for black men, 95.9%! Those numbers are for the period 1996-2004, and no doubt they will be even higher for the period 2005-2013, or whatever the cut off is. The numbers have been steadily rising since the initial period from 1987-1989. Using another source of data, survival of high risk prostate cancer at 10 years is 95%! Do you see any evidence of spread of cancer by needle biopsy in those numbers?

Okay, so maybe, you could argue, the men are alive but are suffering from cancer spread by the biopsies. Let's look at the "no evidence of disease" figures. A recent review of sound studies conducted by the Prostate Cancer Results Study Group found many studies with long term results of no evidence of disease rates at 90% and above for local therapy. In fact, for the low risk case group, they display ten studies with follow up from about nine to about eleven years with rates of 90% and above for no evidence of disease, with the majority involving just seeds as the therapy (increasing the theoretical chances for spreading the cancer via needles).

Let's summarize: we are not seeing widespread evidence of cancer that we would expect if needle biopsies were spreading cancer; in fact, we are seeing minimal evidence that might possibly indicate biopsy needle based spread. We are seeing high rates of recurrence free success for long periods that we should not be seeing if biopsy needles were very dangerous, or even mildly dangerous.

As for the orange analogy, it is possible that some prostate cancer cells are released at the time of biopsy. However, the thinking is that even where this is so, those cells have an extremely hard time surviving, and growing so as to cause a problem. The evidence, as you can see, strongly suggests that.


I think it is in Australia that they do not do these very risky needle biopsies - because they know how dangerous it really is to the patient.

Can you give us any documentation of that? Australia actually has an active prostate cancer research community. They publish in respected journals, and biopsy proven prostate cancer is what they base their research on. I suspect you have heard an "urban legend" that is not true.

I believe it is done here because it is cheaper, faster and easier than traditional surgery to remove the tumor.

Biopsies do not remove tumors, except for miniscule samples. They are just a diagnostic tool.

Patients do not realize that WE can actually still say NO to any test or procedure that we want to. I've done so many times and the only thing it changes is the Dr. has to come up with different options for me. But it is my life and I (we) have to live through the outcomes of whatever is done to us - not the Doctor.

Your point about our lives being our lives is one I'll agree with, but I hope we do not discourage anyone from having a biopsy. Truly, a biopsy, done right, as the are the vast majority of the time, is not a big deal!

Take care and please ask any follow-up questions if you have them.

Jim

 
Old 07-08-2010, 08:10 AM   #8
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Re: Do needle biopsies spread cancer?

To Jim & suelynn48,

I think both of you have made some good points so I'm going to reserve judgement for the time being. However, I tend to lean somewhat to the side of worrying about the safety of biopsies.

Jim, you asked for the title of the paper:

"Needle Biopsy Associated Tumor Tracking of Adenocarcinoma of the Prostate"

"Rectal Wall Recurrence of Prostatatic Adenocarcinoma"


In the first article he states: "Needle tracking takes place with every prostate biopsy."
And: "....every time cancer is found, cancer cells are spread."

Good luck getting your hands on the material.

Last edited by JohnR41; 07-08-2010 at 08:11 AM.

 
Old 07-08-2010, 08:37 AM   #9
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Re: Do needle biopsies spread cancer?

Hi again suelynn,

I hope you will bear with me a bit longer and consider some follow-up points. I'll again put them in green.


Quote:
Originally Posted by suelynn48 View Post
Jim,

You do have some very good points, but it does not takes away from the facts that needle biopsies DO pose a % risk of actually spreading or seeding the cancer.

Your words indicate that you accept that the risk, if any, must be extremely small. That's good to see, but it's also clear that you are clinging to your original view. Isn't that so? The next thoughts you present do take the discussion to the next level: whether there are any alternatives to a needle biopsy for prostate cancer, and, if so, what are their risks?

And I personally would not put myself at risk no matter how small the percentage is for the possible spread of cancer in my body when there is a much SAFER alternative to finding out if a growth is cancerous or not.

The unfortunate fact is that there is no alternative to a biopsy at present for certain diagnosis of prostate cancer. You state that there is but do not identify it. I'm somewhat familiar with quack medicine for prostate cancer, but I'm not aware that even the quacks have an alternative to the needle biopsy. If you think you know of one, please identify it, and I'm sure you'll get responses from the board about it. Also, since we've already kind of agreed, I think, that needle biopsies are extremely safe, how is there room for any alternative to be "much SAFER"?

It's like writing out your own death certificate.

Do you notice how you have slipped back into the thinking in your original post that prostate needle biopsies pose a deadly threat? "Writing out your own death certificate" implies a very high risk of spreading not only prostate cancer but spreading it in a lethal way; yet we have just established that the risk, if any, must be extremely low, and lethality has not even been part of the discussion! It's looking like your mind is reluctantly accepting the facts, but your heart is still sold on what so far appears to be a quite bogus concept of the risk of needle biopsies. Could that be do you think?

I do believe that patients should always educate themselves on any procedure that they will go through and thoroughly understand ALL the RISKS involved.

That's a good point, but many people fall into the trap that some have called "analysis paralysis." Partly I think the media is to blame for that. So often they give us a grossly distorted view of risk. For example, they will breathlessly convey that a beneficial drug increases some health risk by 30% over an older, much less beneficial drug. What they do not tell us is that the absolute risk for the older drug is just .001% - a tiny fraction of a single percent - and the risk for the newer drug is .0013% (.001% X 30%) - a slightly higher but also tiny fraction of a single percent. If you think back, I'll bet you have seen instances of that yourself. We need to be aware of that and think it through for ourselves! Of course, the thoughtful approach - the one that would report an extremely tiny increased risk - would not scare us, boost our adrenalin, or sell papers and boost ratings. Getting back to risks of prostate cancer needle biopsies, it's also vital to consider the risks of not doing the biopsy. Now there you have some risks that are serious indeed, even potentially life threatening! Have you considered that side of the issue in the absence of a safer alternative?

There are quite a few people in the prostate cancer medical and advocate/survivor communities who feel men should have full explanations of the pros and cons of screening for prostate cancer, including a description of possible biopsy discomfort and complications. Many others of us feel that is the wrong approach, tending to focus a man's attention on truly minor risk, inconvenience and discomfort instead of the great benefit in catching cancer early when it is much more likely to be cured, when there are more options, and when active surveillance with supportive lifestyle tactics often make treatment unnecessary. You may have guessed that I am firmly in the latter camp. I'm firmly convinced that prostate cancer screening should be routine for virtually all men at appropriate ages and relatively sound health, with the key condition that "active surveillance" should be the favored option for men diagnosed with very low risk and low risk cases.


So a year or so later when the cancer has spread to vital organs you can't go back in time and undo the needle biopsy.

If you think about this sentence too, you may see that your heart still wants to believe the worst about needle biopsies for prostate cancer, despite the compelling data and analysis, which you at least partly accept, indicating that the risks of needle biopsy must be miniscule. There is absolutely no credible data that I'm aware of, as an eleventh year survivor of a challenging cancer that has led me to become informed, that needle biopsies broadcaset viable prostate cancer to vital organs, especially within the short space of a year or two.

I'm concerned that new patients reading this exchange may be discouraged if they have cases where the cancer has already spread through the usual paths, the blood and lymph systems. There is still a hope for cure, even if the cancer is metastatic, provided the metastases are not wide spread. There is also a strong basis for expecting the cancer can be controlled long-term, often for the rest of the patient's life, even if it cannot be cured.

Please don't just accept my statements on this, as I'm doubtful they will really convince you. You need to go to the source, which, fortunately, we can use on this board because it is Government sponsored. The source is PubMed (for Public Medicine), an agency of the National Library of Medicine sponsored by the National Institutes of Health. The websiste is www.pubmed.gov, and it has virtually all of the significant medical research in the world in its electronic database. This is the same information that doctors use; much of it is written in language we non-doctors can understand. Try searching it to see if you can come up with any documentation of rapid spread of prostate cancer to vital organs as a result of needle biopsies. I'll be stunned if you find any.


And God knows the Dr. sure isn't at that point going to tell you that needle biopsies CAN SPREAD CANCER.

Thank God that doctors do not do that! First, there is no credible evidence. Second, there is abundant evidence that biopsy results are of great value in identifying and managing prostate cancer, something that men lose if they are scared off by ill-founded concerns and fears. Third, many patients, perhaps like you, are already afraid of wise medical procedures and ready to seize on excuses to avoid them, a habit that may prove lethal.

Most all medical test have release forms that one must sign before they will proceed with the test - because of the RISK to the patient, and this releases them from liability. Come on - common sense - which isn't so common anymore.

Yes, common sense is important. But uninformed "common sense" is not sound sense, it is often just faulty conventional wisdom. Please think over our discussion! It's clear that these questions really matter to you, and I salute you for facing them and trying to sort them out!

Take care,

Jim

Last edited by IADT3since2000; 07-08-2010 at 08:43 AM. Reason: Shifted invisible Italics to underline in one spot just after posting.

 
Old 07-08-2010, 08:59 AM   #10
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Re: Do needle biopsies spread cancer?

Despite the performance of hundreds and hundreds of thousands of biopsies, the theoretical possibility of spreading cancer has not been convincingly reported in the literature.

The 2004 report about breast cancer biopsies which is quoted by Dr Wheeler and others caused pockets of hysteria (and still does), as evidenced by lots of exclamation points (!!!) and irrational thought processes (sorry, but comments like “It's like writing out your own death certificate” present as hysterical). One finds that the websites which continue to make this claim also happen to be touting “alternative” treatments for cancer, or touting (as in Dr. Wheeler’s case) use of his expensive alternative equipment (MRI-S) for assessment purposes. (Nowhere, by the way, do Dr Wheeler’s papers claim that prostate cancer is spread by transrectal prostate biopsies; there is merely the loose association to the 2004 report.)

It should be noted that the report’s author (Dr Nora Hansen) wrote this the following year to help clarify and quell the hysteria:
"This study does not link biopsy with spread [of breast cancer]. We have not changed our practice and do not plan to. We still prefer to perform a needle biopsy to confirm the diagnosis of cancer and then will proceed at another time to definitive surgical management."
By the way, in the 6-years since publication, Dr Hansen’s published works have continued to focus on areas of importance in the field of breast cancer; but no further findings on spread have been published.

One should also note that shortly after the 2004 report mentioned above, another report was published which summarized that “preoperative breast biopsy does not cause artificial tumour cell spread to the SLN, with possible negative impact on the prognosis of breast cancer.” This article can be found on PubMed.com, a non-commercial government medical library site run by the National Institute of Health.
http://www.ncbi.nlm.nih.gov/pubmed/15477859?dopt=Abstract

Sorry, but the notion of a biopsy being "like writing out your own death certificate" is clearly internet mythology which needs debunking with a dose of common sense.

 
Old 07-08-2010, 09:39 AM   #11
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Re: Do needle biopsies spread cancer?

Hi John,

Thanks for looking up the titles. I plugged the first title into PubMed (which you can do to) and it popped up immediately. It's an old study from 1991 with three authors from Johns Hopkins, one of the top-notch centers for prostate cancer surgery and research in the US. Many of us will recognize the latter two as prominent leaders in prostate cancer research, particularly for surgery: Dr. Patrick Walsh, MD, surgeon, and Dr. Johathan Epstein, MD, pathologist. Dr. Walsh revolutionized the prostatectomy operation, in fact, he revolutionized it at least twice, first figuring out how to drastically reduce blood loss and substantially reduce the odds of mortality from the operation itself, and second figuring out how to spare the nerves that enable erections. He is the most famous prostate cancer surgeon, and he trained countless surgeons in his methods.

I'll put my comments in green.

Here's the citation:


J Urol. 1991 May;145(5):1003-7.
Needle biopsy associated tumor tracking of adenocarcinoma of the prostate.
Bastacky SS, Walsh PC, Epstein JI.

Here are some key excerpts, from this short abstract, and you probably will want to check it yourself. I'll put the quotations from the abstract in orange.

"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.

"periprostatic soft tissue" means the tissue just outside the prostate. As the article was published in May of 1991, we can surmise that it was probably written in about 1990 as there is a time lag between submission of a paper and publication. In any event, that was fairly shortly after Dr. Walsh's innovations in surgery, and the team was likely checking out as many aspects of success and risk as they thought potentially significant, including possible spread of prostate cancer through the needle biopsies.

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.

Okay, so let's look at the odds here. Yes, a 2% chance that the biopsy needle MIGHT spread VIABLE prostate cancer, versus a 98% chance that it would not! In other words, we're looking at a chance less than 2% of viable cancer being spread! On the other hand, the biopsy succeeded in identifying prostate cancer for 100% of the patients. For patients who were not diagnosed with cancer based on biopsies, in virtually all cases they had no prostate cancer that could even potentially be spread by the needles. Don't you like the odds?

...

There's some interesting detail in the part I omitted (...), but it detracts from the main points. I'll answer if you read the complete abstract and have questions. I'll make this one point: some of those stray cells, even if they were viable - unlikely, perhaps a majority, would be well within the range of radiation therapy, especially external beam therapy.

An additional 13 cases (3.7%) showed some features of needle biopsy associated tumor tracking but they were equivocal.

That finding could up the ante slightly.

...


It's important to remember here that this study did not determine whether any of the spreading resulted in viable cancer that was going to cause a problem. Other research studies have taught us that the vast majority of stray prostate cancer cells simply die or are at least dormant. I don't want to scare you, but a majority of even low-risk prostate cancer patients already have prostate cancer cells in their circulating blood or bones. The good news here is that these cells rarely cause problems. I can provide detail if you wish.

Quote:
Originally Posted by JohnR41 View Post
To Jim & suelynn48,

I think both of you have made some good points so I'm going to reserve judgement for the time being.

Would you mind noting the points that suelynn advanced that still bother you, if any, after my previous reply and this reply?

However, I tend to lean somewhat to the side of worrying about the safety of biopsies.

Suelynn, John is the kind of patient who could be turned away from a vitally important path to deal with possible prostate cancer. He is not alone by any means. In fact, some of these reasons bounced around in my own mind and caused me to delay a PSA test until it was almost too late, with likely lethal consequences if I had delayed much longer. That's probably why I'm so concerned here. That is why it is so important to get the facts and perspective right!

Jim, you asked for the title of the paper:

"Needle Biopsy Associated Tumor Tracking of Adenocarcinoma of the Prostate"

"Rectal Wall Recurrence of Prostatatic Adenocarcinoma"

I found the citation for the second paper in PubMed, but that's all as it did not have an abstract. Here's the citation:

J Urol. 2002 Nov;168(5):2120.

Rectal wall recurrence of prostatic adenocarcinoma.
Koppie TM, Grady BP, Shinohara K.

Department of Urology, Mt. Zion Comprehensive Cancer Center, University of California, San Francisco, USA.

Dr. Shinohara, the senior author, is a highly respected expert in imaging prostate cancer, probably among other talents.

However, without the abstract or a trip to a medical library, I can't comment further.



In the first article he states: "Needle tracking takes place with every prostate biopsy."

It's no wonder you have been concerned! Someone is misquoting the JHU work to you, and that is worth some reflection. In fact, I suggest you contact your source and kick a little butt. As you can see, we are only talking about 2% and that may not be viable, perhaps plus a doubtful additional few percent.

And: "....every time cancer is found, cancer cells are spread."

Again, I can see why that is a scary prospect; fortunately, it is untrue, apparently a deliberate lie if it came from a medical professional that has ready access to the truth and who even provides the title of the study. That sentence appears to imply there is viable spread for the extremely few instances in which there is needle tracking. My very strong impression is that that is simply not so. Again, I recommend you kick some butt! Such statements by medical professionals are grossly irresponsible and unacceptable. We need to hold them accountable! If the source is Dr. Wheeler, I am really disappointed. I would like to be able to pin this down but have not found the issue so far in Dr. Wheeler's publications.

Good luck getting your hands on the material.
Try PubMed. You'll like it!

If you still have concerns, please follow up. My experience is that once you advance your understanding to one point, you see fresh issues and have new questions.

Take care,

Jim

 
Old 07-09-2010, 05:36 AM   #12
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Re: Do needle biopsies spread cancer?

Yes, needle biopsies do spread cancer! Just be careful about what and where you get your information. I have four family members that have had cancer. The two that had needle biopsies died in less than two years from having that done. My aunt before she died talked a lot about her regrets of the needle biopsy. She believed (as did her oncologist at M.D. Anderson) that this was the reason her cancer was in her liver, kidney, lung and brain. It started out as a non aggressive type of breast cancer and was told she needed to have a needle biopsy to verify what it was. She did and then had surgery. The Dr. told her they believed 'they got it ALL." 8 to 9 months later she had a re-check and the reports came back that it had spread. She went to M.D. Anderson. Her oncologist there told her that there is a small percentage of seeding that occurs with needle biopsies and he did not recommend it on any growth that was suspected to be cancer. For each of these people who had the needle biopsies the Dr.'s told them that the cancer had spread to their vital organs. The other two family members had surgical removal of the tumors. And one of those didn't even go through chemo because the Dr. was able to remove the tumor completely. He even told her that 'you should NEVER disturb a potential cancerous tumor, thus causing the seeding or spread of the cells'. Always go on the side of caution and leave the tumor undisturbed and remove the whole thing with surrounding tissues.'
Obviously each persons experiece is different, but seeing this first hand it has made a believer out of me.

 
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PyMAKb2 (03-08-2012)
Old 07-09-2010, 10:10 AM   #13
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Re: Do needle biopsies spread cancer?

Hi sld1961,

Welcome to the HealthBoards, and particularly to our prostate cancer board!

I'm afraid I need to welcome you with some probing thoughts to the view you expressed in your post, but I hope we will all be better for it. If you will take the time to read what kcon and I have posted, if you think through the points we've made on this thread, I believe you will have a lot more confidence in our health system. On the other hand, if you can support your points, kcon, I and others will need to make some huge changes in what we believe, though I think that is extremely unlikely because our points are based on extensive, solid, credible evidence and sound analytical thinking. I'll put my points in green in an excerpt from your post this morning at 8:36 AM, which will be in black.


"Yes, needle biopsies do spread cancer! Just be careful about what and where you get your information."

Technically, your point is correct about the spread, but highly misleading. We survivors are looking for guides to decisions we need to make, and that view, without proper perspective and understanding, would naturally make more patients hesitant about having biopsies. That would be tragic as the biopsy is a vital tool of modern medicine. As I hope you will see, we have good reason to be confident in getting biopsies for prostate cancer.

As for where to get information, I and many of us who lack medical education and who are participating on this board have had to work through that issue as we have faced our own medically challenging or otherwise puzzling choices about what to do. Early on most of us will contact or think of someone we know, often a non-medically trained friend, coworker, neighbor, church member or family member, who has had our type of cancer or any cancer. So often these contacts will be strongly in favor of their particular type of experience/therapy if the outcome has been good so far, or they will be strongly opposed if the outcome has not met their expectations. Often they will not take a more balanced view that they are just one of many patients getting that type of therapy, let alone with just one doctor.

Yet that balanced view is really what patients need - not anecdotes based on likely misunderstood information or information from an unreliable source. Fortunately, we have a number of sources of information that rise above the individual anecdote or urban legend level of dependability . For instance, education and support groups (such as Us Too! and Man-to-Man for prostate cancer), provide a chance to compare experience from a number of patients and also make publications readily available. Books, newsletters and other information resources by medical professionals can also be very useful. Finally, and with the most credibility, medical research papers published in peer-reviewed, respectable medical journals are now available to us in abstract form. I explained earlier on this thread to suelynn48 how to access this information using PubMed, www.pubmed.gov, a site we can use on this board because it is Government sponsored.


"I have four family members that have had cancer."

I'm sorry to read that. Your family certainly has had to bear a heavy load, and I hope this board may lighten it a bit.

"The two that had needle biopsies died in less than two years from having that done."

Here's the obvious key question, and you really owe us an answer, I think: What makes it believable that she died because of cancer spread by the biopsy rather than dying because she already had a serious case of cancer?

"My aunt before she died talked a lot about her regrets of the needle biopsy. She believed (as did her oncologist at M.D. Anderson) that this was the reason her cancer was in her liver, kidney, lung and brain."

Did your aunt have any medical training or any medical credentials that would enable her to take an informed view of the role of the biopsy in her case?

M.D. Anderson is one of the most highly respected institutions treating cancer in the United States, and many of its doctors have published extensively about their practices and research, frequently with studies based on biopsy results. I find it hard to believe that an oncologist from M.D. Anderson would make such a statement, and I'm thinking your aunt has a selective memory of the conversation that fit her own views. Please provide the name of her oncologist at M.D. Anderson. That may enable us to check the oncologist's views on PubMed or follow-up in other ways.


"It started out as a non aggressive type of breast cancer and was told she needed to have a needle biopsy to verify what it was. She did and then had surgery. The Dr. told her they believed 'they got it ALL." 8 to 9 months later she had a re-check and the reports came back that it had spread."

That's a little backward. The way a cancer is determined to be non-agressive is with a biopsy, as far as I know; you cannot tell ahead of time. However, I need to state that I've learned a lot about prostate cancer and not much about breast cancer. Still, I'm pretty sure I'm right based on contacts with breast cancer patients.

Here's a very important point: Even when doctors believe they "got it all," sometimes that is not true: the cancer had already spread beyond the range of their therapy attempt at the time they did it, but almost surely not because of the biopsy. There are some excellent ways of assessing apparently low-risk prostate cancer beyond the biopsy, but they just are not considered cost effective for such cases as they rarely turn up anything. For instance, for low risk cases, bone scans and CT scans now fall into that category, let alone ProstaScint scans, and Combidex scans (temporarily unavailable). If such scans were done, some of the stealthy cases would be smoked out. Instead, an excellent option for truly low risk cases is putting the cancer on what is called "active surveillance," a type of strict probation that will throw the cancer in the slammer if it proves aggressive.


"She went to M.D. Anderson. Her oncologist there told her that there is a small percentage of seeding that occurs with needle biopsies and he did not recommend it on any growth that was suspected to be cancer."

Again, while the small percentage part is accepted (probably should be extremely small percentage, at least for prostate cancer, with the added point that spread cells would usually not be viable), that second part about not recommending biopsies for any growth suspected to be cancer is just not believable! Please provide the name of the oncologist.

"For each of these people who had the needle biopsies the Dr.'s told them that the cancer had spread to their vital organs."

The problem is that you are drawing a cause and effect relationship between the biopsy and the spread of their cancers, when what you really have is an association. Most likely each of these people also ate dinner daily, but would you say that eating dinner caused their cancers to spread? See what I'm getting at here?

"The other two family members had surgical removal of the tumors. And one of those didn't even go through chemo because the Dr. was able to remove the tumor completely. He even told her that 'you should NEVER disturb a potential cancerous tumor, thus causing the seeding or spread of the cells'. Always go on the side of caution and leave the tumor undisturbed and remove the whole thing with surrounding tissues.'"

This is just not believable because it is so contrary to modern medical practice. We need the names of the doctors. Consider this too: how does the doctor know in the first place that a suspected breast or prostate growth is actually cancer and of a type that NEEDS to be removed if a biopsy has not been done. Are you saying that these relatives had surgery for breast cancer without ever having had a biopsy? I've never heard of such practice!

Please also consider this: all doctors have to swear they will abide by the Hippocratic oath. I've heard that the foremost principle of that oath is: "First, do no harm." If biopsies were causing the level of harm you are concerned about, then every doctor ordering or performing a biopsy would be violating that oath. Right? That's not happening.


"Obviously each persons experiece is different, but seeing this first hand it has made a believer out of me."

For the sake of your own future medical decision making, you really need to think through these issues in an objective way. In addition to providing those names, it would help if you answered the questions I posed to suelynn.

I'll close with this statement, which is supported by concrete medical evidence cited in previous posts: according to medical research, biopsies for prostate cancer (at least, probably applies generally to many or all other types of cancer) appear to spread cancer only an extremely small percentage of the time, close to the organ being biopsied, and evidence strongly suggests that those growths are rarely viable, meaning capable of causing any trouble. The evidence is that the benefits of having biopsies far, far outweigh the benefits of not having a biopsy, provided there are good grounds for having the biopsy in the first place.

I truly am hoping you will respond after considering the points that kcon and I have raised.

Take care,

Jim

Last edited by IADT3since2000; 07-09-2010 at 05:57 PM. Reason: Typos.

 
Old 07-09-2010, 11:25 AM   #14
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Re: Do needle biopsies spread cancer?

Sir,

I don't want to get into this argument/debate which you seem very serious about. I was simply sharing my personal experience which is based on extensive, solid, credible evidence and sound analytical thinking.

 
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PyMAKb2 (03-08-2012)
Old 07-10-2010, 06:55 AM   #15
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Re: Do needle biopsies spread cancer?

Quote:
Originally Posted by sld1961 View Post
Sir,

I don't want to get into this argument/debate which you seem very serious about. I was simply sharing my personal experience which is based on extensive, solid, credible evidence and sound analytical thinking.

Hello sld1961,

You appear to be referencing the anecdote of your aunt’s own self-diagnosis, coupled with a doctor’s “maybe” comment, and your own pondering of that experience as “extensive, solid, credible evidence and sound analytical thinking”? No disrespect to you or your aunt or the depth of medical expertise in your family, but the bar is higher—as it needs to be—for believable scientific evidence.

I truly regret hearing about the advancement of your aunt’s cancer, but the fact that she had a biopsy and she had metastatic cancer does not derive causality (whereby the second event is the result of the first). The readily available, published scientific documentation tells us that it is much, much more likely that your aunt’s surgery (despite having a top-notch surgeon, no doubt) was not completely successful on fully removing all of the cancer that was targeted, and that metastasis had begun possibly before (or after) surgery rather than the proposition that the biopsy caused metastasis.

Moreover, and back to the important point for prostate cancer patients at this site, many thousands and thousands of people—all of whom had initial biopsies to confirm what they had—have been cured of cancer.

Because there is a theoretical curiosity about “loose” cancer cells (your aunt’s doctor’s “maybe” comment), there has been research in this area. Dr Patrick Walsh is one of the leading prostate cancer researchers and surgeons, and wrote what many consider to be the “Bible” (or one of the few) for prostate cancer treatments, titled the “Guide to Surviving Prostate Cancer.” Walsh describes [pg. 178] that the key is the stage of the cancer. When cancer is confined to the prostate, even if cells escape into the blood they won’t survive because they haven’t yet gotten the “hang” of living outside the area where they developed. Prostate cancer cells are simply unable to live outside their normal environment until they develop “metastatic capability.” In the progression of prostate cancer, the cells inside begin to differentiate, they eventually grow near and eventually beyond the capsule (adjusting to life outside the capsule), and if left alone will eventually become advanced either locally or distantly.

So, repeating from above with an understanding of “metastatic capability”, it is much more likely that your aunt’s surgery was not completely successful on removing all of the cancer…and that metastasis had begun possibly before (or after) surgery rather than the proposition that the biopsy causes metastasis.


While all experiences are welcomed here, I am indeed concerned that if your comments were left unaddressed, someone might be left with the impression (based on internet rumor) that somehow having a transrectal prostate biopsy could be more risky than not having a biopsy when the other relevant signs exist that prostate cancer might be present, and what an absolutely foolish mistake that would be…and possibly deadly serious.


best wishes in your journey with prostate cancer...

Last edited by kcon; 07-10-2010 at 09:03 AM. Reason: added page reference

 
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