What is a Biopsy, and How Effective Is It?

A needle biopsy is the only way to diagnose prostate cancer when it is suspected. But there are problems with the method most commonly used, called transrectal ultrasound (TRUS) guided biopsy. These problems often lead to inaccurate diagnosis.

For the last two decades, TRUS biopsy has been used to diagnose prostate malignancy. It is actually a “blind” and random procedure. Specific prostate tumors, especially very small ones, cannot be identified because ultrasound cannot visually detect specific cancer sites. Therefore, it is blind to tumors. In addition, TRUS biopsies tend to target the peripheral aspects of the gland and are likely to miss 30-40% of prostate cancer located in the anterior, midline transition zone, or apex. This is called sampling error. To attempt to overcome it, TRUS biopsies typically average 12-14 needles; “saturation” biopsies use as many as 24 needles. The more needles used, the greater the risk of discomfort, infection, and urinary or sexual side effects while tumors continued to be missed. No other type of tumor cancer is biopsied this way!

The Sperling Solution

The Sperling Prostate Center provides a better solution for prostate biopsies—advanced 3T technology with powerful imaging results. Magnetic resonance imaging (MRI) guided biopsy uses advanced, real-time imaging to reveal the tumor location, size, and shape so a doctor can guide a minimum number of needles through the rectal wall into the core of the tumor. It is typically done under a local anesthetic. The doctor can “see” and therefore target needles into the tumor.

Our BlueLaser™ 3T mpMRI is the latest technology for diagnosing and treating prostate tumors. We do not use an endorectal coil, so our 3T mpMRI is a non-invasive, high definition, 360° visual analysis of the entire prostate gland. Our scanner is twice as powerful as conventional 1.5T magnets and over 10 times as powerful as open MRI scanners, producing exceptional scan details.

Patients want clear, reliable information that can only come from an accurate diagnosis. If prostate cancer is diagnosed, the choice of Active Surveillance or treatment will depend on many factors, especially the nature of the prostate cancer identified during a patient’s biopsy.

By having the highest quality imaging of your prostate gland, Dr. Sperling is able to examine your prostate gland with the most advanced technology available. Our BlueLaser™ 3T mpMRI scan may even eliminate the need for a biopsy when no suspicious areas are detected.

Advantages over TRUS biopsy

Image Quality

Our BlueLaser™ 3T mpMRI high-resolution 3D images distinguish normal from diseased tissue, precisely pinpointing suspicious tumors. The result? A better way to characterize and target tumor malignancy, especially important in today’s diagnosis of smaller, lower risk tumors.

Patient Comfort

Because our MRI-Guided Biopsy, done under a local anesthetic, is highly targeted to the area seen during the scan, patients find it more comfortable than traditional TRUS biopsies. Also, the risks of infection and side effects are greatly reduced.

Diagnostic Accuracy

An MRI-Guided Biopsy is highly targeted to select tissue revealed by the MRI imaging. That means physicians and patients have the confidence that any tissue samples come from locations identified as having the most likely chance of containing cancer. The result is a targeted approach vs. the “blind” approach of a TRUS biopsy.

Advanced Laboratory Analysis

The biopsy tissue samples are analyzed in top laboratory facilities by expert pathologists. Depending on individual risk factors, further analysis can be done to evaluate molecular markers and test gene sequences for dangerous mutations. When indicated, we utilize genomic testing for the most thorough results. The findings, correlated with our MRI images, give definitive confirmation of prostate cancer. A tumor identified as low-to-moderate risk may qualify for a focal treatment.

“Fusion-guided biopsy”? Not the same!

Doctors who use a fusion-guided biopsy method may say it’s an MRI-guided biopsy, but this is misleading. The fusion process uses previously captured MRI images that are “fused” (co-registered on a point-for-point basis by software) with real-time ultrasound. Unlike real-time MRI guidance, fusion compromises accuracy due to differences in patient positioning, or slight patient movement during live ultrasound that deviates from the old MRI scan. Thus, fusion is not the same as real-time MRI guidance when the patient is in the bore (tunnel) of the MRI scanner. While fusion has proven more accurate than TRUS alone, it has been proven less accurate than real-time MRI. Compare TRUS, fusion, and real-time in-bore MRI biopsies here.

Questions Patients Ask Us

The Sperling Prostate Center Advantage

Our philosophy is to match the treatment with the disease. Our BlueLaser™ 3T mpMRI-Guided Biopsy is the most responsible and accurate way to know your disease before making a treatment decision. We help patients avoid the risk of under-treating aggressive disease, or over-treating insignificant disease that can safely be monitored. We pride ourselves on having attained international recognition for excellence in real-time MRI-guided prostate cancer diagnosis.

If BlueLaser™ 3T mpMRI detects cancer, a biopsy is essential because prostate cancer may not show early symptoms, though certain warning signs indicate increased prostate cancer risk:

• An elevated or rising PSA blood test result
• An abnormal digital rectal exam (DRE)
• A family history of prostate cancer or breast cancer
• Being of African-American descent
• Exposure to certain cancer-causing toxins, e.g. Vietnam vets exposed to Agent Orange
• In later stages, prostate cancer may show symptoms such as urinary difficulties, blood in urine, pelvic or back pain, and bone pain. See a doctor if any of these symptoms occur.