“If results of a prostate-specific antigen test or digital rectal exam are positive, the next port of call is normally a prostate biopsy to confirm whether cancer is present. In a new study published in JAMA, researchers claim a targeted biopsy method is much more accurate in detecting high-risk prostate cancers than the standard biopsy technique.
“The standard method of prostate biopsy, also referred to as a core needle biopsy, involves a doctor removing samples of tissue from the prostate using a thin, hollow needle. The samples are then sent to a pathologist who views them under a microscope and assesses them for cell abnormalities that indicate cancer.
“But the research team, led by Dr. Mohammad Minhaj Siddiqui of the University of Maryland School of Medicine – who was a fellow at the National Institutes of Health at the time of study – says the technique used in their study involves a combination of ultrasound and magnetic resonance imaging (MRI), which they say can effectively differentiate high-risk prostate cancers from those that are low risk.
” ‘There is a concern that we overdiagnose and overtreat low-risk cancers that are unlikely to be terminal, and this technology enables us to make a more reliable diagnosis than the current standard practice,’ says Dr. Siddiqui.”
“The latest advancement in prostate cancer detection is magnetic resonance imaging and ultrasound fusion-guided biopsy, which offers benefits for both patient and physician.
“The only place in the Southeast offering the MRI-US image fusion technique is at the University of Alabama at Birmingham Program for Personalized Prostate Cancer Care.
“It is estimated that 2014 will see more than 240,000 new cases of prostate cancer, and more than 29,000 deaths from the disease, according to the National Cancer Institute.
“Jeffrey Nix, M.D., along with colleague Soroush Rais-Bahrami, M.D., both assistant professors in the UAB Department of Urology, studied the MRI-US image fusion as fellows at the NCI. Nix and Rais-Bahrami are two of a select few urologists in the United States trained to utilize this technology; together they have five years’ experience using this approach.
“Nix and Rais-Bahrami say this new technology offers a ttargeted biopsy,’ which refers to direct tissue sampling of suspicious areas seen on MRI as opposed to the traditional method of random, systematic sampling that is essentially performed ‘blindly’ in different ‘ZIP code’ regions of the prostate.”
“Ultrasound-guided biopsies miss prostate cancers that are detected by the slightly more expensive and slightly more invasive 3D mapping biopsies. For example, in a 2006 study of 180 men diagnosed with early stage prostate cancer via ultrasound-guided biopsy, nearly a quarter were upgraded to a more clinically significant stage of disease after 3D mapping biopsy found pockets of cancer the first technique had missed. Now, a University of Colorado Cancer Center study reports the locations of these most-missed pockets of prostate cancer.
” ‘There are three major reason we perform these 3D mapping biopsies in the clinic: first, a man may have rising PSA despite a series of negative biopsies and so want a more detailed opinion; second, a man may prefer additional reassurance that watching and waiting rather than treatment is the best course of action; and third, a man may pursue focal therapy in which only the cancerous sections of the prostate are removed and so need accurate information on the position of his cancer,’ says Al Barqawi, MD, investigator at the CU Cancer Center, associate professor at the CU School of Medicine, and the paper’s senior author. Barqawi is a pioneer of the 3D mapping biopsy technique, in which needle biopsies are taken 5mm apart across the x, y and z axes of a three-dimensional grid through the prostate, and has performed over 600 of the procedures.”