When Should I Get a Biopsy of My Prostate?

The decision to get a biopsy of your prostate is a big one. There can be anxiety while awaiting results. Once results are obtained, a cancer diagnosis can carry a heavy weight. These drawbacks are especially concerning when we consider a large number of prostate cancers are slow growing and will not cause death. Notwithstanding, there are some prostate cancers that are aggressive and deadly. Therefore, a prostate biopsy becomes an important means to identify and separate slow growing cancers from aggressive ones. Let’s find out more about when you should consider getting a biopsy of your prostate.

First and foremost, the decision to obtain a biopsy your prostate should be made in discussion with your urologist, who is a specialist that deals with diseases of the prostate. The decision to have a prostate biopsy is not necessarily an easy one to make, even for a doctor. If your primary care doctor feels lumps or irregularity on your prostate gland, you may be referred to a urologist to obtain pictures and a biopsy of your prostate. (1) Remember, some medical societies do not give strong recommendations on performing a digital rectal exam on the average risk man. Therefore, it you are concerned about prostate cancer or have symptoms of difficulty urinating, blood in your urine or semen or a strong family history of prostate cancer, you may want to consider asking your doctor to perform a digital rectal exam.

Also, the Prostate Specific Antigen, or PSA, level can be an important clue as to whether you need a biopsy. Again, the decision for a biopsy rests with you and your urologist. Your urologist will look at your prostate level and determine whether the value is concerning or not. The PSA level is not a “one size fits all” number. On one hand, anyone with a PSA level over 7.0 should be referral to a urologist as this can be concerning for the development of prostate cancer. On the other hand, for someone in their 70s a PSA of 7.0 could be normal as PSA level increase with age. (2) There are small details, like matching your PSA level to your age, that your urologist will pay attention to when deciding on the need for a prostate biopsy.

Importantly, if your PSA level increases by more than 0.75 year over year, this can be a concerning trend and require a urology referral and assessment for the need of a biopsy. (1) In truth, you doctor may not always catch this subtle rise in you PSA level. Therefore, it important to know your own PSA level. In fact, keep notes of your PSA levels over the year. Work in partnership with your doctor to help uncover concerning trends in your PSA levels. Furthermore, your doctor may get a MRI of your prostate to help determine if you need a biopsy at all or the best areas of your prostate gland for a biopsy. To find out more, read our blog or listen to our podcast on “I Have a Positive PSA, Should I Get an MRI Before the Biopsy?”

Finally, family history is extremely important in determining the need for a biopsy. If a woman in your family has breast cancer before the age of 50 or ovarian cancer, you may be at increased risk for prostate cancer. This is because BRCA (Breast Cancer) mutation as this gene can also cause prostate cancer. If anyone in your family has a history of cancer of the colon or pancreas, your risk of prostate cancer may also be higher. If you had genetic testing and are known to be a carrier of the BRCA gene, or any other cancer gene, there is an increased likelihood you will need a biopsy. Being an African American man places one at a higher risk for prostate cancer as well as older in age. All these factors can help your urologist come to a decision for a biopsy.

In summary, the decision for a prostate biopsy is a difficult one, but this procedure is an important means to help separate slowing growing harmless cancers from aggressive and deadly ones. There are not set parameters for deciding when to get a biopsy. How your prostate feels on digital rectal exam, the PSA level, family history, ethnicity and age can all play a role in your decision to get a prostate biopsy. Such a complicated discussion is best made in conjunction with you urologist, who can help tease out the fine details of the risks and benefits of a biopsy. Take notes, ask questions and empower yourself to know more about this disease as you partake in these discussions with your doctor.

REFERENCES
1. Taplin ME & Smith JA. Clinical Presentation and Diagnosis of Prostate Cancer. In: UpToDate, Vogelzang N & Lee R (Eds), UpToDate, Waltham, MA. (Accessed on December 26, 2021.)
2. Hoffman RM. Screening for Prostate Cancer. In: UpToDate, Elmore JG & O’Leary MP (Eds), UpToDate, Waltham, MA. (Accessed on December 26, 2021.)