IMAGING-GUIDED BIOPSY

Real-time monitoring provides precision in prostate biopsy

This is a highly specific biopsy technique guided by multiparametric MRI (mpMRI). Real-time detection of the tumor suspicious region prior to the biopsy and then a needle is used to sample only the suspicious area within the gland, sparing healthy tissue.
Unlike the conventional 12-core transrectal ultrasound-guided biopsy (TRUS) approach, where biopsy cores are taken randomly without seeing the tumor within the prostate gland.

 

ADVANTAGES OF IMAGING-GUIDED BIOPSY

How is imaging-guided biopsy better than ultrasound-guided biopsy?

 

  • Specific targeting of tumor suspicious region instead of random sampling (TRUS biopsy can miss aggressive cancer lesions about 30-35% of the time)
  • Minimally invasive with fewer cores (3-4) instead of 12 core TRUS Bx
  • Reduced pain and damage to the rectal wall
  • Reduced chances of infection
  • Increased sensitivity of detecting aggressive lesions with decreased potential for detecting indolent disease.  This reduces overtreatment and prevents the psychological burden with misclassification of cancer stage

  • Precision in diagnosis 
  • Better spatial localization with specialized software to reach tumor suspicious regions otherwise difficult to reach with TRUS
  • TRUS biopsy can underscore lesions due to its inherent random nature.  An aggressive cancer could be “skimmed” or completely missed. A low grade tumor might be sampled while an aggressive one is completely missed.

EVIDENCE-BASED MEDICINE

Study shows MRI-guided biopsy is more accurate than TRUS biopsy in detecting clinically significant prostate cancer

Conclusions from clinical study to compare the accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer suggest:

  • Nearly 27% fewer patients with elevated PSA levels had to get a prostate biopsy 
  • 5% fewer clinically insignificant cancers were detected 
  • 18% more cases of clinically significant cancer were identified

 

(Ref: Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham AP, Oldroyd R, Parker C, Emberton M. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017 Feb 25;389(10071):815-822. doi: 10.1016/S0140-6736(16)32401-1. Epub 2017 Jan 20. PubMed PMID: 28110982.