Prostrate Cancer Screening - A Better Way

Current Method

Current methods of prostate cancer screening, such as prostate-specific antigen (PSA) tests and digital rectal exams (DRE), are somewhat unreliable and can lead to many uncertainties for both patient and urologist. Prostate biopsy, the most reliable method of detection, is a challenge because of the difficulties in visualizing not only the entirety of the prostate, but also the location of the biopsy needle. Trans-rectal ultrasound-guided prostate biopsy (TRUS), the current biopsy standard, commonly suffers from poor image resolution, and the biopsy needle often passes through tumor-free areas of the prostate - potentially missing the tumor entirely.

In addition, it can be difficult to distinguish between lesions that necessitate only a “watchful waiting” period and more aggressive lesions that require therapy. A more confident characterization of the type of lesion could help avoid the risk of side effects such as incontinence, impotence and bowel problems that can result from therapy.

This is the current method of biospy and its drawbacks from random sampling:

To obtain prostate tissue for cancer testing, a series of needles is poke  (between 12 and 24) into different areas of the gland, guided by ultrasound. This method was used since the 1980s. The ultrasound images help to place the needles properly, but the pictures aren’t distinct enough to be able to tell if it is cancerous from normal prostate tissue, so there is no certainty of the target to home in on suspicious areas for biopsy. The truth is the current method is a scattershot “blind” approach in the hope that, if a tumor is present, one of the needles will encounter it. These random biopsies can miss some harmful tumors, while turning up others that are inconsequential and may end up being treated unnecessarily.

 

The new Technology - Image Guided Prostrate Biopsy

An MRI scan is better than ultrasound at revealing details in soft tissue in the case of the prostate gland. Prostate cancer cannot be diagnose from an MRI image, but can certainly it can be used to identify suspicious areas that warrant closer examination with a needle biopsy.  The new fusion guided targeted biopsy technology combined the detailed MRI scans with live real-time ultrasound images of the prostate will enable a better diagnosis and outcome.
 
Targeted MR/ultrasound biopsy is poised to become a new standard in prostate care. This technique fuses pre-biopsy MR images of the prostate with ultrasound-guided biopsy images in real time, for excellent delineaon of the prostate and suspicious lesions, as well as clear visualization of the biopsy needle.

The fusion of the MR and ultrasound images uses electromagnetic tracking, similar to your car’s GPS system. A small, localized electromagnetic field is generated and used in conjunction with a navigation sensor mounted to the trans-rectal ultrasound probe to determine the location and spatial orientation of the biopsy device. A sophisticated algorithm maintains the fusion of MR and ultrasound images even when the patient moves.

The Use of Uronav

 

A revolutionary new test can better pinpoint trouble spots and lead to a quicker prostate cancer diagnosis. Invivo’s UroNav uses a combination of MRI and Ultrasound. Unlike traditional biopsies that take twelve samples, UroNav allows doctors to identify and remove only what looks irregular. “Standard prostate biopsies are random and are systematically obtain random samplings from the prostate. There’s no guarantee that a biopsy will hit the cancer. For men who are moderate to high risk, UroNav can cut down on random biopsies that may find nothing. It can also help to diagnose the cancer faster. The new technology, called UroNav, is like taking the blindfold off. The new UroNav technology that is being used utilizes the UroNav Fusion Biopsy System, and fuses (overlay) pre-biopsy MR images of the prostate with ultrasound-guided biopsy images in real time, for clear delineation of the prostate and suspicious lesions, as well as clear visualization of the biopsy needle.

Prostate cancer specialists at the University of Michigan Comprehensive Cancer Center (link is external) are refining prostate cancer diagnosis to better identify those cancers that are more likely to grow quickly and spread to other parts of the body.
The University of Michigan is the first in the region to offer men a new technology that combines MRI and real-time ultrasound to help guide a biopsy needle, ensuring that tissue from all suspicious areas is captured.

The fusion guided biopsy approach isn’t perfect. A recent study found that the fusion method missed almost as many prostate tumors as did standard biopsy. But as my Cleveland Clinic colleague, urologist J. Stephen Jones, MD, noted, the cancers that the fusion method missed were far more likely to be clinically insignificant ones.

Put another way, fusion guided biopsy is better than the existing approach at finding prostate tumors we need to treat, while overlooking those we don’t need to worry about.

Each year in the United States, about 700,000 men with worrisome PSA levels undergo repeat prostate biopsies. The fusion guided biopsy approach should help reduce that number, by giving better information the first time around. This tool should also be a boon to men who’ve been diagnosed with small, slow-growing prostate tumors and who are on active surveillance – also called watchful waiting – by possibly reducing the number of biopsies they must undergo.

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Refernce: http://www.uofmhealth.org & https://health.clevelandclinic.org