Prostate Cancer Diagnosis
A biopsy, or needle aspiration, is a minimally invasive way for doctors to remove small samples of the prostate to identify if the prostate tissue has indeed cancer or not.
At HALO Diagnostics, we use MRI guided biopsy to verify if or what type of cancer is present. MRI-guided biopsy is performed under an MRI that allows the team to guide the biopsy needle in real-time to target exactly the area of the prostate that looked suspicious under the mpMRI, and can ensure a more accurate sampling without damaging healthy prostate tissue.
In comparison, traditional prostate biopsy approaches like TRUS (transrectal ultrasonography–guided biopsy), take a “poke and hope” approach, where biopsy cores are taken with much less clear views on the prostate. TRUS biopsy can miss 30% or more of cancers leading to false negative diagnoses.
Another type of frequently performed prostate biopsy is called an MRI Ultrasound Fusion Guided Biopsy. This approach is more accurate than the traditional TRUS approach and is often performed by a urologist using previously obtained prostate MRI images combined (hence the term fusion) with real-time ultrasound imaging. While sometimes not as accurate as MRI-guided biopsy, MRI ultrasound fusion biopsy is an improvement to the traditional TRUS approach.
Advantages of MRI 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 samples taken (3-4) instead of 12 samples with TRUS
- 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
- 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.
HALO Dx is Pushing the Envelope: Biomarker & Genomic Testing
Much like the prostate specific antigen that is used in PSA testing, there are other biomarkers that may help your physician diagnosis prostate cancer. HALO Dx works with ExosomeDx™ to offer the ExoDx Prostate Test, a urine-based test that is used similarly to a PSA test before biopsy. The test analyzes three cancer-specific biomarkers found in the urine associated with aggressive prostate cancer: ERG, PCA and SPDEF. This simple non-invasive test can help assess your risk of having clinically significant high-grade prostate cancer and help you and your doctor determine whether to proceed with or defer a prostate biopsy.
Along with traditional pathology of the biopsy results, HALO Dx offers genomic tests on the same tissue sample to help identify the appropriate treatment option(s) and help determine the metastatic potential of the tumor through the Decipher® Prostate Cancer Test. We have seen impressive results over the years and have demonstrated that the Decipher test can be used to help predict response to Laser Focal Therapy.
Gleason Score and Grade Groups*
Based on the prostate biopsy, doctors use the Gleason scoring system to classify how aggressive a cancer may be:
Gleason scores are organized into grade groups. Grade groups are meant to be simpler and more accurate by breaking up Gleason score 7 into two subgroups. This helps prevent over treatment for those with low-grade prostate cancer. Grade Group 2 (Gleason pattern 3+4) means that the cancer cells in the largest area of the cancer are less aggressive than the cancer cells in the second largest area, and Grade Group 3 (Gleason pattern 4+3) means that the cancer cells in the largest area of the cancer are more aggressive than the cancer cells in the second largest area.