Learn more about a prostate biopsy for the detection of prostate cancer.
A prostate biopsy is indicated for the detection of prostate cancer. Screening is done with the PSA test and rectal exam. If EITHER of these tests are concerning your Urologist may recommend a prostate biopsy. The traditional method of performing a prostate biopsy is done with an ultrasound (through the rectum) to guide biopsies. Unfortunately, an ultrasound is not accurate at determining what is normal vs cancerous prostate tissue. Therefore, biopsies are obtained by taking 12 systematic, but still random, samples of the prostate. As this is random it has been estimated to miss up to 30% of clinically significant cancers.
MRI (Magnetic Resonance Imaging) uses a high powered magnet to image certain areas of the body. It has a better ability to image certain cancers, including prostate cancer. But, real time MRI guided biopsies are not practical due to the time it takes to obtain an MRI and process the images. To get around this, we can use previously obtained MRI images and “fuse” these with real time ultrasound images allowing targeted biopsy.
How is the procedure performed and what to expect? A MRI-fusion biopsy starts with a MRI of the prostate. Following the MRI, a radiologist will review the images and very specifically mark concerning lesions (orange ball; see above image). We perform the biopsies in our surgery center under sedation for your comfort. Prior to the procedure you will be given antibiotics to decrease the risk of infection. After you are asleep, a rectal ultrasound is used to map (blue/green mesh; see above image) the prostate by taking 3-D images. A computer system then fuses these images with the MRI images that were previously obtained. Now using the ultrasound, concerning lesions can be specifically targeted and biopsied (red lines; see image above). Following the procedure, it is common to see some blood in the urine, stool, and semen. Results will be back around 1 week after the biopsy and you can discuss them with your Urologist.