Biopsy and Prostate Imaging

Sperling Prostate Center’s clinical research reader on MRI-Guided Prostate Therapies

van de Ven WJ, Barentsz JO. “Prostate cancer: MRI/US-guided biopsy—A viable alternative to TRUS-guidance.”  |  Nat Rev Urol. 2013 Oct;10(10):559-60.
The authors look at the advantages of MRI/ultrasonography fusion biopsy over traditional transrectal ultrasound (TRUS)-guided biopsy, including the ability to detect more high-grade prostate tumors and avoid overtreatment of indolent tumors.

Hambrock T, Hoeks C, et al. “Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort.”  |  European Urology. 2012 Jan;61(1):177-84.
This study finds that diffusion-weighted imaging (DWI)-directed MRI-guided prostate biopsies significantly improve pretreatment risk stratification by obtaining biopsies that are representative of true Gleason grade. In comparison, transrectal ultrasound (TRUS)-guided biopsies showed substantial underestimation of Gleason grades.

“New data on risks of prostate biopsy and prostate cancer diagnosis, follow up.”  |  The New Prostate Cancer Infolink. September 23, 2011.
Researchers found that 6.9 percent of men having a prostate biopsy are hospitalized within 30 days of the biopsy compared to 2.7 percent of a control group of men who did not have a prostate biopsy. The study also showed that men hospitalized with biopsy-related infections had a 12-fold higher risk of death compared to men who did not have a biopsy.

Heijmink SW, Fütterer JJ, et al. “State-of-the-art uroradiologic imaging in the diagnosis of prostate cancer.”  |  Acta Oncol. 2011 Jun;50 Suppl 1:25-38.
A look at the available imaging technologies for prostate cancer diagnosis. The authors note that “MRI achieves high accuracy rates, particularly when functional information from dynamic contrast-enhanced MR and MRSI are added. A multiparametric approach was shown to optimize the diagnostic accuracy.”

Somford DM, Fütterer JJ, Hambrock T, Barentsz JO. “Diffusion and perfusion MR imaging of the prostate.”  |  Magnetic Resonance Imaging Clin North America. 2008 Nov;16(4):685-95, ix.
This article focuses on the role of diffusion-weighted MR imaging (DWI) and dynamic contrast-enhanced (DCE) MR imaging (or perfusion-weighted MR imaging) of the prostate. Background aspects and the clinical usefulness of DWI and DCE MR imaging for assessment of prostate cancer are reviewed. The authors find that the combination of T2-weighted imaging, DWI, and DCE MR imaging (multimodality MR imaging) may be able to accurately detect, localize, stage, and grade prostate carcinoma.

Pondman KM, Fütterer JJ, et al. “MR-guided biopsy of the prostate: an overview of techniques and a systematic review.”  |  European Urology. 2008 Sep;54(3):517-27.
The authors conclude that diagnostic MR imaging provides more accurate selection of regions in which prostate cancer tumors are suspected. Using these diagnostic images during an MRI-directed biopsy procedure improves the quality of the biopsy; therefore this is a promising tool that may be used in patients with previous negative TRUS-guided biopsies.

Vos PC, Hambrock T, et al. “Computerized analysis of prostate lesions in the peripheral zone using dynamic contrast enhanced MRI.”  |  Medical Physics. 2008 Mar;35(3):888-99.
Researchers describe the use and accuracy of computer-aided dynamic contrast enhanced MRI to detect tumors in the peripheral zone of the prostate.

Ito H, Kamoi K, et al. “Visualization of prostate cancer using dynamic contrast-enhanced MRI: comparison with transrectal power Doppler ultrasound.”  |  British Journal of Radiology. 2003 Sep;76(909):617-24.
Compares the use of transrectal power Doppler ultrasound (PDUS) and dynamic contrast-enhanced MRI (DCE-MRI) to demonstrate hypervascularity in prostate cancers. DCE-MRI was significantly more sensitive than PDUS for visualizing of prostate cancers without loss of specificity in the peripheral zone.

Genetics

Liu W, Laitinen S, et al. “Copy number analysis indicates monoclonal origin of lethal metastatic prostate cancer.”  |  Nature Medicine. 2009 May;15(5):559-65.
A look at the genomic archeology of metastatic prostate cancers.

Radiation

Proton Beam No Better than IMRT for Prostate Cancer.  |  by Crystal Phend. MedPage Today. February 2, 2012.
Researchers from the University of North Carolina at Chapel Hill found that proton beam radiation treatment for prostate cancer has a higher risk of bowel complications, and resulted in a higher rate of cancer recurrence then the traditional intensity modulated radiation therapy (IMRT) treatment.

A Device to Kill Cancer, Lift Revenue.  |  by John Carreyou and Maurice Tamman. The Wall Street Journal. December 7, 2010.
An investigation into Medicare claims finds a sharp rise in the use of intensity-modulated radiation therapy for prostate cancer tied to patterns of “self-referral” by clinical groups that own the equipment.

Rectal Cancer Might Occur After Radiation for Prostate Cancer.  |  by Allan S. Brett, MD. Journal Watch General Medicine. May 3, 2005.
Commentary on a study that suggests that external-beam radiation for prostate cancer confers moderately increased risk for rectal cancer.

Targeted Focal Therapy

Oto A, Sethi I, et al. “MR imaging-guided focal laser ablation for prostate cancer: phase I trial.”  |  Radiology. 2013 Jun;267(3):932-40.
A phase I clinical trial finds that transperineal MR imaging-guided focal laser ablation appears to be a feasible and safe focal therapy option for clinically low-risk prostate cancer.

Colin P, Mordon S, et al. “Focal laser ablation of prostate cancer: definition, needs, and future.”  |  Advances in Urology. 2012;2012:589160.
A review of focal laser ablation to treat low-risk prostate cancers. The authors found that “precision, real-time monitoring, MRI compatibility, and low cost of the integrated system are principal advantages of this minimal invasive therapy.”

Sullivan KF, Crawford ED. “Targeted focal therapy for prostate cancer: a review of the literature.”  |  Therapeutic Advances in Urology. 2009 Aug;1(3):149-59.
A review of the role of targeted focal therapy in treating men for prostate cancer without the side effects of more aggressive therapies. Discusses how mapping biopsy techniques can better determine what patients are candidates for targeted focal therapy.