MR Fusion Prostate Biopsy
While prostate diseases, which are the most common disease group in men in the world, are seen as prostate infections in younger ages; it appears as benign prostatic hyperplasia (BPH) or prostate cancer (PCa) more after the age of 50.
With the rapid aging of the population, we are beginning to see BPH and especially prostate cancer more often. Prostate cancer is now the most common cancer in men and is the second most common cause of death after lung cancer. Therefore, it becomes a quite important social and medical problem in the aging society. Voiding problems affecting quality of life start in almost half of men after the age of 50.
Digital Prostate Examination and PSA measurement in blood provide important clinical information in prostate cancer diagnosis. Prostate biopsy is needed to make definitive diagnosis in suspicious cases. Currently, prostate biopsy is performed through anus as standard. Twelve blind biopsies are performed from the prostate tissue using an ultrasound device placed through the anus (transrectal route). If cancer is not detected in suspicious cases, the biopsies are repeated at least 3 times. Therefore, the complications of this procedure are increasing. In addition to the inadequacy in cancer diagnosis, serious risk of infection, bleeding and pain complaints occur in the patients because anal canal is used. When the patients, who are performed prostate biopsy via the standard method, are asked “Do you want to have biopsy again?”; more than half of the patients do not want to have biopsy because of this.
The best imaging and treatment methods for prostate cancer are now provided with fusion systems. In targeted fusion prostate biopsies, the patient's prostate structure is revealed by detailed MRI. The suspicious areas within the prostate are clearly visible (Figure 1). Then, these images are transferred to 3-Dimensional (3D) Ultrasonography device with a special software. Following the marking of the suspicious areas, real-time targeted biopsies are obtained with specially designed biopsy apparatuses. The marking of the suspicious areas minimizes the error margin. Thus, biopsies from unnecessary areas are prevented. The biopsies to be obtained from the targeted areas will provide the definitive diagnosis of the tumor, if any (Figure 2).
Every type of cancer in prostate cancer does not contain the same danger in vital terms. Some slow-growing low-risk cancer types are followed-up for lifelong by performing only monitoring protocols without the need of any treatment. However, effective and rapid treatments are needed for fast-growing high-risk prostate cancer types. One of the most important stages that provides the differentiation of these two large groups is targeted fusion biopsy systems. With MR fusion biopsy systems, higher risk prostate cancers are diagnosed by 30% and unnecessary biopsies are avoided by 17%.
One of the most important advantages of the fusion biopsy system used in our hospital is that the anal canal is not used (Figure 3). Biopsies are obtained by direct prostate imaging over the skin. Therefore, infection, pain and bleeding complications observed in standard biopsies do not occur. Approximately 4% of patients require treatment that needs hospitalization due to infection in biopsy methods that anal canal is used.
- The most accurate diagnostic method until now.
- Exclusion of unnecessary areas from biopsy with targeted biopsies.
- Obtaining the true image of the prostate with MRI and 3D US.
- Side effect ratio is too low because anal canal is not used compared to the standard method.
- Repeated biopsy rates are very low.
1: Prostate in 3D image guidance.
2: Targeted fusion biopsies prevent unnecessary biopsies.
Figure 3: Comparison of standard transrectal and fusion biopsy methods.