• Michael Misialek, MD

Targeted Prostate Biopsy More Effective Than Standard Random Biopsy

The approach to sampling the prostate, for those with an elevated PSA or abnormal digital rectal exam may be changing. A new technique, MRI fusion biopsy is showing promise as a more accurate and precise method than standard biopsy.

MRI fusion biopsies fuse pre-biopsy MRI images of the prostate with ultrasound-guided biopsy images in real time. The entire prostate is seen which is especially good for finding cancers in the anterior as well as apex areas, which are not adequately sampled by a standard 12-core random biopsy. The technique has proven more precise and accurate than standard biopsy.

The University of Maryland Medical School reported a recent study showing the effectiveness of MRI fusion biopsy. They report:

“The study of 1,003 men was conducted at the NIH in Bethesda, Md., from 2007-2014, with Peter A. Pinto, MD, the head of the prostate cancer section of the urologic oncology branch, serving as the senior investigator. The participants were referred for biopsy because of elevated PSA or an abnormal digital rectal exam. They received targeted and concurrent standard biopsies.

Researchers noted that 461 prostate cancer cases were diagnosed with targeted biopsy vs. 469 cases with standard biopsy. Targeted and standard biopsies produced the same results in 69 percent of the cases. But the scientists found that 30 percent more high-risk cancers – those that doctors want to detect – were diagnosed through targeted biopsy than standard biopsy (173 vs. 122 cases) and 17 percent fewer low-risk cancers – those that are often over-diagnosed and over-treated (213 vs. 258). Adding standard biopsy to targeted biopsy led to a 22 percent increase in cancer diagnoses, the vast majority of them for low-risk cancers.

Researchers also found that targeted biopsy was better able to predict whether the disease was low- or intermediate risk than standard biopsy or the two approaches combined. They were able to make that determination by comparing biopsied tissue with tissue taken from a patient’s prostate after it was later surgically removed.”

It appears MRI fusion is a more effective method for detecting and diagnosing high risk and aggressive prostate cancers and results in less false negatives. Targeted fusion biopsies reduce the possibility of finding indolent or clinically insignificant cancers, which helps in lowering overtreatment and overdiagnosis.

#pathology #biopsy #prostatecancer #targetedbiopsy #mri #fusionbiopsy

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