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MRI-TRUS FUSION biopsy

Also known as MRI targeted biopsy is a method of Prostate biopsy where, MRI images are superimposed onto the real-time ultrasound using a software, to target the suspected lesion noted on MRI. This approach has shown potential in improving the detection of clinically significant prostate cancer when compared with systemic prostate biopsy especially in the small volume, non-palpable anterior tumor.

Where is it indicated:

–  Previously negative TRUS biopsy and raised PSA (recommended)

–  Raised PSA with normal DRE (optional)

–  Whenever Surveillance is being considered (optional)

–  When Focal therapy is being planned (optional)

Workflow:

Step1: A patient first undergoes the multiparametric MRI scan in the Radiology suite. An experienced radiologist reviews it and marks suspicious areas using dedicated software. The different color outline can be given to the suspicious-looking site depending on the level of suspicion (based upon PIRAD score of an individual lesion). MRI data with the markings are then loaded on a CD/DVD and sent to the biopsy room (usually in the treating Urologist’s office).

Step 2:CD with the marked data is loaded onto the computer inbuilt into the MR-FUSION machine (with an articulated semi-automated robotic arm attached to it, that tracks the motion of the ultrasound probe relative to the MRI). The patient is made into the left lateral position (same as for TRUS biopsy) and the periprostatic block is given. Subsequently, the handheld transrectal Ultrasound probe is latched on to the robotic arm. Once this is done, the patient is instructed not to move so that the coordinates registered by the robotic arm remain undisturbed.

Using special fusion technology, the recorded MRI image is fused with a live transrectal ultrasound by the Urologist who performs an MRI/TRUS fusion biopsy. Target biopsies are taken from the select locations revealed by MRI imaging. Once the targeted biopsy is taken, then a standard template biopsy (12 core) is also taken.

The software also records and store the actual location of the biopsy along with the patient’s clinical information. This information is also beneficial for future reference, confirmation, and follow-up. In turn, this means better and more personalized long-term patient management.

Results: The cancer detection rate of clinically significant (CS) cancer on MRI-targeted biopsy in the re-biopsy setting ranges from 11-54%, although from 16-40% when restricting inclusion to studies that define CS cancer as having a Gleason score ≥ 7. Additionally, the data indicate the potential to increase CS cancer detection on repeat biopsy when comparing MRI-targeted biopsies to standard systematic sampling alone.

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