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Who should get a prostate biopsy? | Peter Attia & Ted Schaeffer — Whalespan

Content›Video›Who should get a prostate bi…

Who should get a prostate biopsy? | Peter Attia & Ted Schaeffer

Peter Attia16m · 2023-11-18

Support Rate

83%

24 of 29 claims supported

Support rate

24 of 29 claims supported

24 supported5 partial / not

Claims from this content

20

✓Well SupportedImmediate biopsy is indicated for prostate cancer if MRI shows RADS 4 or 5, or RADS 3 with high PSA density.✓Well SupportedA prostate biopsy is indicated for individuals with abnormal blood testing who subsequently have a suspicious MRI.✓Well SupportedThe Gleason score is a sum of pattern 3 and pattern 4, with the percentage of pattern 4 being the most critical factor in determining prognosis.✓Well SupportedA prostate biopsy is recommended if PSA density is below a certain threshold but other factors like high PSA and low percent free are present.◐Partially SupportedGleason 6 prostate cancer is generally monitored rather than treated due to its least aggressive nature and favorable prognosis.

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Attia walks back the clinic protocol: too aggressive for healthy adults

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AV

A. Volkovreader

4h

Bookmarking — the dossier-vs-overview split is the right call. Most of the time I want overview; sometimes I want receipts.

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N. Park

2d

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◐Partially SupportedTwo samples of a target lesion in a prostate biopsy are inadequate because the biopsy needle can bend or deflect, especially when inserted 20 cm.

◐Partially SupportedA standard prostate biopsy should include 12 systematic samples plus 3 samples of any targeted lesions.

◐Partially SupportedIn men with Gleason 6 prostate cancer who underwent radical prostatectomy, there was no lymph node metastasis.

◐Partially SupportedA neural network predictor built using MRI and biopsy data can estimate a patient's absolute risk for prostate cancer requiring treatment.

◐Partially SupportedProstate MRI is recommended for 99.5% of individuals.

◐Partially SupportedThe Gleason score describes the pattern of cancer gland development observed by a pathologist.

◐Partially SupportedPSA density can be calculated using an ultrasound.

◐Partially SupportedThe thickness of the peripheral zone of the prostate decreases as the prostate enlarges, making it harder to biopsy.

◐Partially SupportedProstate cancers typically originate in the peripheral zone.

✕Not SupportedMen with bilateral hip replacements should not undergo prostate MRI as it is effectively useless for them.

◐Partially SupportedPSA density is a significant factor in determining cancer probability when sampling suspicious lesions.

◐Partially SupportedA prostate MRI can be effectively read by a radiologist even with a single hip replacement.

◐Partially SupportedThe Gleason score for prostate cancer is determined by the sum of the two most common or highest grade abnormal glandular patterns observed by a pathologist.

◐Partially SupportedProstate biopsies require a high degree of skill, with significant variation between practitioners.

◐Partially SupportedGleason 6 prostate cancer is the least aggressive type and is generally recommended for monitoring rather than immediate treatment.