With a new procedure known as targeted MRI directed prostate biopsy, urologists can more precisely detect prostate cancer in men. The technology to perform this procedure is available at a limited number of hospitals across the country, including Coastal Carolina Hospital in Hardeeville.
This is good news for men who might be at risk for prostate cancer. According to the American Cancer Society, one man in seven will get prostate cancer during his lifetime. A more precise diagnosis can lead to a more appropriate treatment plan.
Targeted biopsy employs sophisticated magnetic resonance imaging (MRI) technology to visualize the prostate gland, usually in the case of an elevated prostate specific antigen (PSA) level, and then fuses the MRI images with real-time ultrasound using a device called the Artemis.
This enables the urologist to visualize the lesion in real time when performing the biopsy, something that wasn’t possible in the past.
For decades, urologists have been unable to visualize the specifics of the prostate gland during a prostate biopsy.
The state-of-the-art technique, since the mid-1980s, involves using ultrasound through the rectum to systematically sample the prostate gland.
This technique is systematic, but “blind.”
Approximately one million prostate biopsies are performed in the United States each year, the vast majority prompted by elevated PSAs. Three fourths of them are negative for cancer.
That leaves a pool of roughly 750,000 men each year who show abnormal PSA levels and a negative biopsy.
This is an anxiety-producing situation because some of these men will have a prostate cancer that is missed by a conventional ultrasound directed biopsy.
Recently, new MRI technologies have enhanced the ability of radiologists to identify and evaluate areas of the prostate that are suspicious for cancer.
By feeding these MRI images into the Artemis device, they can be fused with the ultrasound to virtually map the suspicious areas on to the ultrasound image.
The biopsy can be targeted directly towards a specific area of concern. Likewise, we believe that MRI-ultrasound fused biopsies taken from random areas of the prostate might be superior in quality to traditional ultrasound directed biopsies.
Further, the fusion biopsy procedure is performed under IV sedation, greatly enhancing patient comfort compared to the office-based “local anesthesia “techniques.
Who should have a targeted prostate biopsy?
- Patients with persistent, unexplained elevated prostate specific antigen (PSA)
- Prior negative biopsy but continued rise of PSA
- Increased prostate cancer gene expression (PCA 3 urine test with an elevated score)
- Patients with apparent low-risk prostate cancer, with an interest in active surveillance (watchful waiting).
Dr. Michael Langley is a board certified urologist on the medical staff at Coastal Carolina Hospital. He practices at New River Urology.