Tuesday, February 10, 2015

MRI/Ultrasound Fusion Prostate Biopsy

By: Dr. Bryant Poole with Urology Centers of Alabama

New technology is now available that allows urologists to detect prostate cancer with more accuracy. The procedure is called MRI/Ultrasound fusion prostate biopsy. Urologists at Urology Centers of Alabama started using this technology in December, 2014 making them one of the few centers in the southeast offering this service. The technology takes advantage of magnetic resonance imaging’s (MRI) ability to identify lesions within the prostate that look suspicious for prostate cancer. The first step is to do the multiparametric MRI at the hospital. The radiologist will read the MRI, and if he identifies an area within the prostate, he will then outline it, thus creating a target that the urologist will be able to see on ultrasound. The targeted lesions are graded 1 through 5 (5 being “highly suspicious” and 1 being “not suspicious”). The urologist will usually biopsy any lesion that is graded as 3 or higher. The next step is to perform the biopsy in the office. Transrectal ultrasound is used to visualize the prostate during the biopsy, but the urologist will take the MRI image with the outlined target and “fuse” it with the ultrasound image that is used in the office. Instead of having an ultrasound image that only shows you the prostate, now the urologist can see an outlined target within the prostate and can now aim the biopsy needle directly at the suspected lesion. Before this technology became available, urologists could only do random biopsies of the prostate. We believe this procedure will allow urologists to more accurately detect prostate cancers.

In the past, the concern was that urologists were diagnosing too many non-aggressive cancers and missing some of the aggressive prostate cancers. A recent study showed that MRI/US fusion biopsy detected 30% more aggressive cancers that would have been missed by the old random biopsy method. The overall cancer detection rate for the MRI/US fusion biopsy is about 54%, whereas the cancer detection rate for the random biopsy method is about 32%.

Currently, MRI/US fusion biopsy is recommended for patients who have had a previous prostate biopsy that showed no cancer, but their urologist feels they need another biopsy because the PSA (prostate specific antigen) continues to rise or if they develop a nodule that can be palpated on their prostate. The procedure is also indicated for patients who have been previously diagnosed with a cancer that is presumed to be non-aggressive and are currently doing active surveillance. Sometimes these patients may have an aggressive prostate cancer that may co-exist with the non-aggressive cancer, and the MRI may be the only way to detect it. This procedure will not only allow the urologist to diagnose prostate cancer more accurately, it may also cut down on the number of unnecessary biopsies. If the MRI fails to show a suspicious lesion, the patient may be able to forego the biopsy. In the long run, we believe this procedure will save on costs because we can reliably stratify patients that will need more aggressive treatment versus those who do not.

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