MRI Fusion Prostate Biopsy

New River Urology is pleased to offer the first MRI-Ultrasound fusion prostate biopsy procedure in the Lowcountry.

For almost 30 years, urologists have utilized ultrasound to guide the prostate biopsy procedure. This is essentially a blind technique whereby ultrasound is merely used to ensure that the biopsy needles have hit the prostate. This has led to false negative biopsies in many instances, as well as over detection of slow growing, non-lethal cancers which may not even require any treatment.

Recent advances in MRI technology now allow us to identify potentially lethal cancers that before could not be visualized on ultrasound. We can now offer patients a screening prostate MRI and if a suspicious lesion is found, specifically target that lesion with our biopsy procedure using a fusion ultrasound device. Using this MRI targeted biopsy, the detection rate of insignificant cancers is lower than with systematic blind ultrasound guided biopsy. Further, when MRI findings have been correlated with pathologic findings, tumor localization appears to be significantly better with MRI than with the digital rectal examination or with ultrasound guided blind biopsy, and in the detection of prostate cancer that is clinically significant, MRI appears superior to all other imaging modalities evaluated to date.

Targeted biopsy brings new level of accuracy to prostate cancer diagnosis. 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, then fuses the MR images with real-time ultrasound using a device called the Artemis, enabling the urologist to visualize the lesion in real time when performing the biopsy. This was not 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 since the mid-1980s involves using ultrasound through the rectum to systematically sample the prostate gland. This technique is systematic, but “blind”.

Approximately 1 million prostate biopsies are performed in the United States each year, the vast majority prompted by elevated PSA. 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 expert 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, so that the biopsy can be targeted directly towards a specific area of concern. Likewise, we believe that MRI-Ultrasound fused prostate biopsies taken from “random” areas of the prostate may be superior in quality to traditional ultrasound directed biopsies. Further, the fusion prostate 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 PSA.
  • Prior negative prostate 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).
  • A fusion prostate biopsy may not be covered by Medicare.