'Fused' technologies give 3D view of prostate during biopsy
By David M. White, Public Affairs Office, Eisenhower Army Medical CenterJanuary 2, 2019
David M. White
Public Affairs Office
Eisenhower Army Medical CenterFORT GORDON, Ga. -- A high-tech procedure that makes prostate biopsy more accurate and thorough is being rolled out at Eisenhower Army Medical Center.The procedure merges ultrasound with MRI images to give urologists a real-time, three-dimensional view of the prostate. Because the MRI images are analyzed by a radiologist prior to the biopsy, the urologist has a targeted approach to collecting tissue samples."Eisenhower is one of a few hospitals doing this procedure in the state of Georgia," said Lt. Col. Jennifer Pugliese, MD, chief of Urology at Eisenhower Army Medical Center.Other than skin cancer, prostate cancer is the most common cancer in American men, according to the American Cancer Society. For 2018, the Society estimates "about 164,690 new cases of prostate cancer will be diagnosed and there will be about 29,430 deaths from prostate cancer.""About 1 man in 9 will be diagnosed with prostate cancer during his lifetime," according to ACS statistics. "Prostate cancer develops mainly in older men and in African-American men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66."
The standard screening for prostate cancer, according to Pugliese, is a blood test that specifically measures PSA, or prostate serum antigen, and a digital rectal examination. Abnormal PSA levels may indicate the need for a prostate biopsy where, using ultrasound alone for guidance, tissue samples are taken with a biopsy needle that is passed through the ultrasound probe and rectal wall into the prostate."Using a standard grid pattern, I'll take at least 12 samples," she said. This method returns a false negative result of 20 to 30 percent."The difference with the ultrasound/MRI fusion," Pugliese said, "is that I can better 'visualize' which areas of the prostate need to be sampled. This is a multidisciplinary approach with an experienced radiologist" who identifies and digitally marks the suspect tissue on the MRI before the actual biopsy.The urologist moves the ultrasound probe around the prostate while the fusion software shifts the overlaid MRI image, already marked by the radiologist, giving the medical team a real-time, 3-D ultrasound/MRI view. They use the fused image to guide the biopsy needles precisely to the tissue indicated as suspicious, rather than poking around a pre-determined grid, hoping they find something."This is an exciting new approach that yields a lower false negative rate than standard template biopsy and has a higher likelihood of identifying clinically significant prostate cancer," Pugliese said. "It is simply a more accurate prostate biopsy."According to the ACS, "prostate cancer is the second leading cause of cancer death in American men, behind lung cancer. About 1 man in 41 will die of prostate cancer."Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today."The earlier prostate cancer is diagnosed, the better the long-term prognosis is for the patient and the more likely a curative treatment will be successful. Curative treatments can include radiation and surgery. Hormone therapy, immunotherapy and chemotherapy are typically reserved for advanced or metastatic prostate cancer. Active surveillance can even be offered to patients with low risk or very low risk disease, avoiding active treatment all together.Early and reliable diagnosis is key to sorting out the appropriate treatment and, thanks to the ultrasound/MRI fusion procedure, it's easier to get an accurate diagnosis sooner.