By: Dan Sperling, MD
Patients frequently ask me about the differences between a standard transrectal ultrasound (TRUS) prostate biopsy vs the MRI-guided biopsy we offer at the Sperling Prostate Center. I point out the superior imaging of 3T multiparametric MRI technology over the much lower resolution of ultrasound. I also discuss the low number of needles we use to target the suspicious area(s) that we see on the MRI, compared to the 10-12 or more needles used during a TRUS biopsy. These are not just my opinions. An ever-growing body of research highlights the advantages of prostate MRI for detection, diagnosis and treatment.
For example, two papers on MRI-guided prostate biopsy were presented last year at the European Congress of Radiology (ECR).[i] The first, presented by Stephan Polanec, MD ( Medical University of Vienna) discussed results of 44 biopsies taken from 41 patients, all of whom had suspicious areas on MRI. Cancer was diagnosed in 11 of the patients; the other 30 patients out to have benign biopsies, and when followed for up to 36 months, no prostate cancer developed in the benign areas. Thus, if the targeted biopsy did not find cancer, it was a true negative—something that no doubt relieved those patients of worry.
The second study, reported by Tobias Franiel, MD (Charité Medical University, Berlin) compared acceptance, adverse effects, and complications between MR-guided biopsy and TRUS biopsy. Although there were several design limitations, Dr. Franiel remarked, “Sixty-five percent of patients indicated they preferred the MR-guided biopsy because there were fewer side effects and they expected better results than with the transrectal approach.” Patients also rated pain significantly lower with MRI-guided biopsy, and 82% would prefer that approach for any future biopsies. The complication rates were low for both MRI and TRUS biopsies (6%).
I believe as more patients ask for the greater precision, fewer needles and more accurate diagnosis based on actual tissue samples, the trend will begin to shift away from TRUS and much more to MRI-guided biopsies.
[i] Reported January 21, 2014 at www.medscape.com/viewarticle/780624_print