‘GPS for Cancer’
What is a MR US fusion guided prostate biopsy ?
It combines the highly detailed information from the MRI with the ultrasound to allow the doctor to biopsy specific areas within the prostate.
Targeted Prostate Biopsy
INTRODUCTION FUSION GUIDED PROSTATE BIOPSIES:
Historically, prostate cancer was diagnosed by finger guided trans-rectal prostate biopsies. However, with the advent of PSA screening and improvements in ultrasonography, trans-rectal ultrasound guided prostate biopsy have become the standard of care to screen and diagnose localized prostate cancer for the past 30 years. The traditional prostate biopsy is known colloquially as a ‘Blind’ biopsy. It only uses ultrasound to guided the biopsy to different sections of the prostate (non targeted).
THE NEXT STEP:
A prostate biopsy consisting of 12 cores only evaluates less than 1% of the prostate for cancer and the chances of finding cancer is approximately 33% (27-40.3%) (Fleshner NE. et al: J Urol 1997). Did you know that prostate cancer is the only solid organ malignancy that is still diagnosed by an indirect method. which includes randomly sampling the prostate attempting to diagnose cancer?
An MRI looks at 100% of the prostate. This leaves about 70% of men with no definitive answer whether or not they have cancer after a negative prostate biopsy. The NIH has reported that approximately 40% of men have a cancer detected on a subsequent biopsy when MR/US fusion biopsies have been performed, compared to the repeated standard 12 core biopsy in which only 10% is detected in a large European prospective study. MRI offers the opportunity to evaluate the entire gland with positive and negative predictive values > 90%, detecting and ruling out clinically significant cancers (intermediate and high grade disease with volumes greater than 0.5 cc).
Are there any differences using MR US fusion guided prostate biopsy versus the standard biopsy?
1) The fusion biopsy has a targeted approach which allows direct targeting and tracking of biopsy needles. This allows direct access the areas not sampled using the traditional 12 core random biopsy.
2) The fusion biopsy technology use state of the art multi-parametric magnetic resonance imaging (MRI) to look at 100% of the prostate. The MP-MP has reported sensitivities/specificities to be greater than 90%. This allows visualization of the central/transitional zone of the prostate which is in the top half of the prostate that the standard biopsy does not sample.
Dr. Rastinehad discusses a new biopsy technology that may improve prostate cancer screening. Dr. Rastinehad leads one of two teams researching and developing this new technology.