Men, Beware of Biopsies for Prostate Cancer Dx

Physicians often downplay the risks.

Ferdinand “Ferd” Becker Jr., MD, a retired facial plastic surgeon who lives in New Orleans, has one of the scariest biopsy/prostate cancer stories I’ve ever heard.

Initially, Becker was diagnosed low-risk, low-volume Gleason 6. But his MRI records were switched. And he was temporarily diagnosed with extensive prostate cancer. False alarm.

He also was hospitalized for potentially deadly sepsis from an infection caused by a transrectal biopsy. A nightmare.

Becker’s experience is a call for urologists to re-evaluate what they are doing to tens of thousands of men — and for men to question their urologists about biopsies.

Becker has spent much of his adult life on the watch for prostate cancer.

His father Ferdinand Becker Sr. died from metastatic prostate cancer at age 85. The elder Becker’s brother Walter died from prostate cancer in his 60s after extensive radiation treatment that burned his bladder and rectum. He was in severe pain. “It was a horrible death,” Becker Jr. recalled.

Another of the elder Becker’s brothers, Victor, died from heart disease in his 80s, but he also had metastatic prostate cancer.

Now 78, Becker Jr. practiced facial plastic surgery in Vero Beach, Florida, for more than 45 years. He stopped performing surgery in 2009 after he was diagnosed with Parkinson’s disease.

Meanwhile, his prostate specific antigen scores had been on the rise. His PSA went over 5 ng/mL in 2011, up from 4.25 in 2010. His urologist — and friend — in Vero Beach ordered a random transrectal needle biopsy, the commonly used tool to sample a small portion of the gland to try to ferret out prostate cancer.

The urologist had good news: Out of 12 cores, 11 were negative. A single core taken in the left base had a Gleason 6, with only 10% of the core being affected. That’s the sort of cancer that likely will never become a threat.

But 6 days later, on Easter Sunday, Becker spiked a fever of 103.5. “That’s pretty high for someone my age,” he said. He had chills and fever and was delirious.

He met the urologist at the hospital, where he was diagnosed with sepsis.

As a patient on AS for prostate cancer, I can attest to the fact that urologists generally downplay the risk of infection from transrectal biopsy. The rate for all types of infection following a biopsy varies from doctor to doctor, but is roughly 5%.

Becker suggests that infection rates from prostate biopsies are grossly underreported. “Most of these studies on sepsis/infection come from major universities where they report everything. All these doctors in community practice doing random biopsies get infections, but they don’t report them. I know my urologist had some trouble with infections.”

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