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January 8, 2013

What do the results of a prostate biopsy mean?

I hope you enjoyed your long Christmas vacation. This week we will continue with our discussion with prostate cancer. So, you have had your biopsy or sample test and you are awaiting your results. You have not had any significant complications apart from some mild discomfort for which you took some Paracetamol.{{more}} What should you now be worried about? In other words what are the possibilities of the results of the sample test? This is what you can be told about your results:

BENIGN: this basically means that your results are normal and there is no evidence of cancer. That’s what benign means. It means “no cancer seen”. So you might ask, so why is my PSA high? The possibilities are: there is really no cancer, the presence of infection in your prostate, something wrong with the blood test or sampling the wrong area of your prostate. That’s why I exclude and treat any evidence of prostate infection before the biopsy. I also repeat the PSA if I have any suspicion that the test was inaccurate or did not explain what was happening to the prostate. Sometimes the biopsy is “benign” because we did not “catch” the growth. Sometimes, finding a growth is like finding a needle in a haystack. The test sometimes has to be repeated under different conditions to find the cancer.

MALIGNANT: This means that there is cancer present. The test will also tell you what type of cancer and how aggressive is the cancer. It will also indicate if there is any microscopic evidence of spread and how much of the prostate has cancer and how extensive is the cancer; in other words, where in the prostate is the cancer and how much cancer is there. This information is needed to treat the cancer properly. That explains why some men are treated differently for their prostate cancer, because treatments depend on age, level of PSA, aggressiveness of the cancer, extent of the cancer and the patient’s wishes and resources. This is very important, because I continue to get people asking me “Doc, why did I have this treatment for my prostate cancer when, someone else had another treatment?” The above facts explain why.

PROSTATITIS: this basically means that there was evidence of infection seen. The infection could have been one that started recently (acute), or more commonly, one that was there for a long time (chronic). The treatment includes treating the infection with a long course of an appropriate antibiotic, reducing the swelling on the prostate with an anti-inflammatory and reducing the risk of infection recurrence by placing the man on a medication to help him empty his bladder properly. If the prostate truly has infection, then the PSA should reduce back to normal or near normal levels. This leads us to the last scenario.

INCONCLUSIVE: This basically means that, after looking at the samples under the microscope, the pathologist cannot say for sure there is or is no evidence of cancer. It could be that the specimen was not prepared properly for the microscope (i.e. an error from the lab. This is rare). More commonly is the presence of “suspicious cells”. This means that under the microscope the cells look like cancer, but it is not conclusive. Second opinions are usually requested and sometimes the samples are sent overseas, usually to the USA, for further testing, after which it is usually possible to classify it as cancerous or benign. Next week, I will discuss the treatment of prostate cancer and its effects on men’s sex lives.

For comments or question contact:

Dr Rohan Deshong

Tel:(784) 456-2785