Targeted prostate biopsies using a technique that combines magnetic resonance imaging (MRI) with real-time 3D ultrasound may improve prostate cancer detection, according to a report in the online in Urologic Oncology.
The approach may be most beneficial for patients on active surveillance and those who have had prior negative biopsies but have persistently elevated PSA levels.
“The advent of MRI-ultrasound fusion has led to a promising advance in prostate imaging and biopsy targeting. Despite the technology revolution of the past several decades, we are still performing prostate biopsies just the same as in the mid-1980s,” said investigator Leonard S. Marks, MD, Professor of Urology at the University of California at Los Angeles (UCLA). “We are hopeful that new imaging methods like MRI ultrasound fusion may soon change that.”
He and his colleagues conducted a study with 218 men aged 35-87 years who underwent prostate biopsies. Of the 218 men, 47 were either on active surveillance or had prior negative biopsies but persistently elevated PSA levels.
All 47 men received prostate biopsies using MRI images fused with real-time ultrasound. These patients first received MRI scans that assessed suspicious contrasts in tissue, abnormal cellular density, and unusual blood flow within the prostate. After reviewing the MRI scans, researchers graded each component and provided an overall score to gauge cancer risk.
The data and scores from the MRI scans were entered into software created at UCLA. A 3D image was generated of the 47 patients’ prostates. The information was transferred to a compact disc that was ready for use in the clinic during real-time ultrasound prostate biopsy.
The researchers found that targeted biopsy was about five times more likely to find cancer than non-targeted, systematic biopsy. Re-biopsy of a suspicious site was found to be accurate within a few millimeters. The investigators concluded that while these early results are promising, more studies are warranted.