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Dilemmas in the Treatment of Prostate Cancer

Are we moving closer to solving them with the advent of MRI-ultrasound Fusion biopsy of the prostate?

Prostate cancer is unlike the equally common cancers we a familiar with like lung and colorectal cancer. Prostate cancer behaviour has a wide spectrum ranging from a very aggressive cancer that can kill the patient to slow growing disease that does not affect the health of a patient. Since the discovery of PSA in the 1970s screening for prostate cancer has gradually become standard practice in many places. Very often PSA, a simple blood test, is done as part of a health screening package without a second thought. Patients with elevated PSA are then referred to an urologist for a biopsy. Since there were no scans available to accurately predict the presence of prostate cancer, the usual way a prostate biopsy is done is to employ systematic but random biopsies of the prostate with the hope of sampling a cancer that is present. The disadvantage of this technique is that detects both biologically aggressive as well as non-aggressive prostate cancer. This leads to possible overtreatment of those with non-aggressive prostate cancer. There is also the possibility of missing the cancer altogether.

Recently a new radiology technique called multiparametric-MRI or mp-MRI has been shown to be relatively accurate in predicting the presence of prostate cancer especially biologically significant prostate cancer. This opens up new possibilities in the way prostate biopsies are carried in patients with suspected prostate cancer. A new technique employing mp-MRI in guiding prostate biopsy called MRI-ultrasound fusion biopsy is now available. In essence the technology allows the images acquired during mp-MRI to be superimposed into real time ultrasound of a patient’s prostate. The urologist doing the biopsy can then sample the more relevant areas of the prostate. This potentially will allow us to detected significant cancers and the chances of missing a cancer is also reduced. The biopsy technique essentially remains similar to the usual prostate biopsy and shares in its advantage of being a simple day procedure done under sedation with little discomfort to the patient. This technique will be suitable for patients having their first prostate biopsies, those with previous negative biopsies but with rising PSA and those with prostate cancer on active surveillance.

The advantages of a more accurate prostate biopsy applies both to individual patient as well as to the community as a whole. Patients can potentially avoid the morbidities associated with surgery or radiotherapy if they do not have significant prostate cancer and those with aggressive prostate cancer may be treated earlier. Having the MRI done prior to biopsy is also advantageous in terms of staging of the cancer as no biopsy artefacts are present when the MRI is done. It can potentially also reduce the number of unnecessary treatment for prostate cancer in a given community and save on the overall healthcare expenditure. The main disadvantage would be the cost of MRI-ultrasound fusion biopsy as compared to the traditional prostate biopsy. It is likely to cost about 2 to 3 times more at this time. This will come down as the technology becomes widely available and more urologists switch to this technique.

MRI-Ultrasound Fusion Biopsy to Prostate Cancer Treatment

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Are we moving closer to solving them with the advent of MRI-ultrasound Fusion biopsy of the prostate?

Prostate cancer is unlike the equally common cancers we a familiar with like lung and colorectal cancer. Prostate cancer behaviour has a wide spectrum ranging from a very aggressive cancer that can kill the patient to slow growing disease that does not affect the health of a patient. Since the discovery of PSA in the 1970s screening for prostate cancer has gradually become standard practice in many places. Very often PSA, a simple blood test, is done as part of a health screening package without a second thought. Patients with elevated PSA are then referred to an urologist for a biopsy. Since there were no scans available to accurately predict the presence of prostate cancer, the usual way a prostate biopsy is done is to employ systematic but random biopsies of the prostate with the hope of sampling a cancer that is present. The disadvantage of this technique is that detects both biologically aggressive as well as non-aggressive prostate cancer. This leads to possible overtreatment of those with non-aggressive prostate cancer. There is also the possibility of missing the cancer altogether.

Recently a new radiology technique called multiparametric-MRI or mp-MRI has been shown to be relatively accurate in predicting the presence of prostate cancer especially biologically significant prostate cancer. This opens up new possibilities in the way prostate biopsies are carried in patients with suspected prostate cancer. A new technique employing mp-MRI in guiding prostate biopsy called MRI-ultrasound fusion biopsy is now available. In essence the technology allows the images acquired during mp-MRI to be superimposed into real time ultrasound of a patient’s prostate. The urologist doing the biopsy can then sample the more relevant areas of the prostate. This potentially will allow us to detected significant cancers and the chances of missing a cancer is also reduced. The biopsy technique essentially remains similar to the usual prostate biopsy and shares in its advantage of being a simple day procedure done under sedation with little discomfort to the patient. This technique will be suitable for patients having their first prostate biopsies, those with previous negative biopsies but with rising PSA and those with prostate cancer on active surveillance.

The advantages of a more accurate prostate biopsy applies both to individual patient as well as to the community as a whole. Patients can potentially avoid the morbidities associated with surgery or radiotherapy if they do not have significant prostate cancer and those with aggressive prostate cancer may be treated earlier. Having the MRI done prior to biopsy is also advantageous in terms of staging of the cancer as no biopsy artefacts are present when the MRI is done. It can potentially also reduce the number of unnecessary treatment for prostate cancer in a given community and save on the overall healthcare expenditure. The main disadvantage would be the cost of MRI-ultrasound fusion biopsy as compared to the traditional prostate biopsy. It is likely to cost about 2 to 3 times more at this time. This will come down as the technology becomes widely available and more urologists switch to this technique.

MRI-Ultrasound Fusion Biopsy to Prostate Cancer Treatment

Send in your enquiry to get in touch with Dr Sam Peh today!

View Dr SamPeh’s Profile Now!

Contact Us Now
Fill In Your Details Below

Our friendly consultants will be in touch with you

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