Originally published 7/14/2016
It stands to reason that UCLA’s 2016 study (below) ruffled feathers. At that time, MRI/ultrasound fusion-guided biopsy was quickly becoming the new darling for urologists. However, subsequent comparison studies continued to challenge the claim that fusion offers the same accuracy as real-time in-bore MRI targeting.
This update draws attention to an editorial from the American Journal of Roentgenology. After emphasizing clinical reasons for greater in-bore MRI biopsy accuracy vs, fusion (on a needle-to-needle basis), the author notes that to compensate for inferior fusion targeting, urologists must supplement it with additional random sampling of the rest of the gland—thus adding more needles to gain better accuracy.
He states, “With growing evidence that in-bore biopsy enables more accurate sampling of suspicious lesions than does the more commonly used fusion technique, it is imperative for radiologists to be aware of and to consider offering in-bore biopsy to patients as an alternative.”[i]
In short, in-bore MRI-guided targeting offers greater “cost-utility and cost-effectiveness”—not to mention being more accurate with fewer needles, and thus kinder and safer while producing better diagnosis.
The University of California/Los Angeles (UCLA) completed a study that not only affirms our work at the Sperling Prostate Center but also offers terrific news for all prostate cancer patients. A team from their medical school’s Department of Radiology completed a retrospective study of in-bore MRI-guided prostate biopsy cases. They found that in-bore biopsy is head and shoulders above conventional TRUS and even MRI/ultrasound fusion biopsy.
When they compared their own detection rates with published data on other techniques, here’s what they found:
| TRUS random biopsy | MRU/ultrasound fusion biopsy | UCLA in-bore MRI biopsy | |
| Detection of PCa | 10-30% | 25-50% | 59% |
| Avg. number of cores | 12 | 12 or more | 5-6 |
NOTE: In the UCLA experience, 80% of the patients with positive biopsies had significant PCa.
According to one of their team members, Dr. Nelly Tan, “It’s an outstanding time for clinicians, scientists and patients. For the first time in decades, we have better ways to diagnose prostate cancer and more accurately risk stratify patients to various less-invasive therapies, which may confer better quality of life for patients and their families.”[ii]
The UCLA study confirms our own experience at the Sperling Prostate Center. Our detection protocol using 3T multiparametric MRI can rule the need for a biopsy in or out. If a suspicious area shows up on the scan, we can use a minimal number of needles to sample from the location most likely to harbor significant disease. For patients whose lab report is positive for cancer, we can determine if further genomic analysis is indicated. Ultimately, patients have the most accurate information possible to support appropriate treatment decisions. For qualified patients, this includes MRI-guided focal laser ablation (FLA) which destroys the tumor with almost zero risk of side effects.
We are grateful to the researchers at UCLA and other locations, including Radboud University in The Netherlands, for contributing to the body of knowledge on all the advantages of multiparametric MRI when it comes to dealing with prostate cancer.
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.
References
[i] Costa DN. Editorial Comment: Which Targeted Prostate Biopsy Technique Is Better-In-Bore or MRI Transrectal Ultrasound Fusion? AJR Am J Roentgenol. 2021 Nov;217(5):1130-1131
[ii] “MRI-Guided Prostate Biopsies Have Potentially Higher Yield With Fewer Samples.” MedicalResearch.com, April 26, 2016. http://medicalresearch.com/author-interviews/mri-guided prostate-biopsies-have-potentially-higher-yield-with-fewer-samples/23791/
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.
