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Prostate Biopsies

Transperineal brachytemplate ultrasound guided saturation prostate biopsies

The widespread use of the blood test PSA for the early detection of prostate cancer has brought along good and bad news. The good ones: earlier detection of prostate cancer where treatment may totally cure the patient, as opposed to the pre-PSA era when most men were diagnosed with advanced metastatic disease where cure is no more possible. With time and experience we have learnt that PSA is not specific to the existence of prostate cancer but perhaps indicative only, and that an elevated blood PSA value will probably mandate a biopsy. Biopsies however are randomly taken from the gland and thus may still not detect the disease when in fact it is there in a third of the men. Only in follow up biopsies will the disease be detected.

All biopsies are currently done with trans-rectal ultrasound guidance, however the biopsy needle can be introduced either transrectally or transperineally. Each method has its sensitivity and specificity rates as well as side-effects. Currently almost entirely first set of biopsies is performed with the trans-rectal approach, but given the persistence of elevated blood PSA when a second or third set of biopsies is indicated, the trans-perineal approach taking many (so called "saturation") biopsies is becoming a well established standard.

The trans-perineal approach enables one to reach areas in the prostate not reachable with the trans-rectal approach, thus better sampling the entire gland after the first set failed to detect disease in the rectal-peripheral area of the gland. Moran et al in 2006 and 2009 have shown that while second set biopsies done trans-rectally detect cancer in 20% of men, employing the trans-perineal approach resulted in 38% being diagnosed.

Since the trans-perineal approach is based on Brachytherapy equipment and methodologies, it was only natural for Prof. Matzkin to get involved and well experienced in this biopsy method. After more than 1300 brachytherapy treatments for prostate cancer, Prof. Matzkin obviously owns the knowhow and equipment to perform these biopsies.

Biopsies are performed in an ambulatory set up of less than 24 hours in hospital admission at the new Assuta Medical Center in Ramat Hachayaal. To maximize outcomes Prof. Matzkin has engaged a dedicated highly qualified private uro-pathologist to read the biopsy results.

If you are in a situation of a negative first set of biopsies and contemplating a second or more set of biopsies, you should carefully decide which biopsy technique to employ next. A consultation seems in place and highly recommended.

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