Originally published 10/2/2014
The blog below was posted nearly nine years ago. It’s as important today as it was then, but quotes from much more recent journal articles demonstrate how the value of in-bore MRI guided biopsy (MRGB) is globally recognized.
First, a team of Polish clinicians are relative newcomers to this method, and they are enthusiastic converts. They write, “Performing prostate biopsy under the guidance of real-time MRI allows precise collection of material for histological examination (even from a very small lesion). As a result, both primary cancer and local recurrence after previous radiotherapy of prostate cancer can be confirmed.”[i]
Next, a group of Australian authors offer specifics, including the role of high PI-RADS score in identifying clinically significant disease (CSD): “MRGB in PI-RADS™ 3-5 targets yields high rates of cancer diagnosis. High detection rates are also seen in men with prior negative biopsy and AS [Active Surveillance] cohorts. PI-RADS™ score, age and PSAD [PSA density] can reliably predict CSD detection.”[ii]
Finally, an Italian team’s comparison between TRUS-guided biopsy and MRGB confirmed MRGB’s greater diagnostic rate of CSD “…with a very low number of cores needed and a negligible incidence of complications, especially in patients with a previous negative biopsy. MRI-GB is optimal for the diagnosis of anterior and central lesions.”[iii]
This small sample of recently published papers solidly underscores what we posted nearly a decade ago.
Numerous studies have shown that multiparametric MRI (mpMRI) of the prostate before biopsy improves the detection rate and diagnosis accuracy of targeted biopsies. A summary of the importance of targeted vs. systematic TRUS biopsies bears repeating. If you or someone you love is being recommended for a prostate biopsy, here are key points about traditional 12-core TRUS biopsies to keep in mind:
- TRUS biopsies are basically blind and random, so they often completely miss prostate cancer. When this happens, a “negative” result cannot be trusted.
- TRUS biopsies often under-sample a tumor by hitting at the edge instead of striking the core where the most aggressive cancer cells are more likely to be.
- TRUS biopsies may pick up insignificant prostate cancer (very small Gleason 3+3 tumors) that may be amenable to active surveillance, yet countless patients have undergone radical surgery, perhaps needlessly, and suffer from incontinence and/or sexual dysfunction as a result.
- TRUS biopsies of 12 or more needles have an increased risk of infection from bowel bacteria in the prostate or surrounding tissue due to the numerous times the wall of the rectum is punctured.
Now compare the above points with the important advantages of obtaining a pre-biopsy multiparametric MRI and using the results to guide a targeted biopsy if imaging shows a suspicious area:
- mpMRI shows four functional differences between healthy prostate tissue and diseased prostate tissue, including prostate cancer.
- mpMRI is especially sensitive to significant prostate cancer, which is the kind that should be biopsied and treated. More men may be able to hold off on a biopsy and monitor by imaging if the MRI does not show significant prostate cancer.
- mpMRI reveals the location of any prostate cancer, greatly reducing the number of sampling needles. This also greatly reduces the risk of infection.
- mpMRI guides a sampling needle into the center of a suspicious area, where the most dangerous cell lines are likely to be found. Thus, the biopsy results are more trustworthy, and treatment can be planned accordingly.
At our Center, we offer state of the art multiparametric MRI using a 3 Tesla (3T) magnet, which improves the quality of images over those obtained on a 1.5T magnet. We do not use an endorectal coil, thanks to the strength of our magnet. In addition, our protocol includes the full range of imaging parameters which, when taken together, provide an extraordinarily accurate picture of each patient’s prostate gland and any abnormality it may contain. For more information, visit our page on MRI Guided Biopsy at https://sperlingprostatecenter.com/mri-guided-biopsy-new-york-city/.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Rembak-Szynkiewicz J, Wojcieszek P, Hebda A, Mazgaj P et al. In-bore MR prostate biopsy – initial experience. Endokrynol Pol. 2022;73(4):712-724.
[ii] Pokorny M, Kua B, Esler R, Yaxley J et al. MRI-guided in-bore biopsy for prostate cancer: what does the evidence say? A case series of 554 patients and a review of the current literature. World J Urol. 2019 Jul;37(7):1263-1279.
[iii] D’Agostino D, Romagnoli D, Giampaoli M, Bianchi FM et al. “In-Bore” MRI-Guided Prostate Biopsy for Prostate Cancer Diagnosis: Results from 140 Consecutive Patients. Curr Urol. 2020 Mar;14(1):22-31.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
