Fusion biopsy of the prostate gland is a novelty in the diagnosis of prostate cancer. Fusion biopsy combines the traditional form of core-needle biopsy performed as standard under the ultrasound image with magnetic resonance imaging, which clearly better visualizes clinically significant neoplastic changes. How does a prostate fusion biopsy work? What are the benefits for the patient and how does it proceed?
Fusion biopsy of the prostate glandallows for early diagnosis of cancer and initiation of treatment as it reduces the risk of missing the lesion. It also allows you to reduce the number of clippings taken. In addition, thanks to it, we avoid unnecessary, additional non-targeted biopsies, which are burdensome for the patient and burden him with certain complications. It is important to know that a large number of tests of this type may temporarily cause hematuria, hematospermia (the presence of blood in semen) or rectal bleeding.
Prostate biopsy - indications
Suspicion of prostate cancer occurs in the case of high PSA (prostate-specific antigen) values, a disturbing rectal examination result, or detection of suspicious neoplastic changes in transrectal ultrasound or magnetic resonance imaging of the prostate. A core needle biopsy is required to confirm the diagnosis.
- A prostate biopsy is the basis for initiating treatment for prostate cancer. The only way to confirm the presence of prostate cancer is to take samples from this gland, which is always done with a core needle biopsy. Other types of biopsy, e.g. liquid biopsy, are diagnostic tests assessing the percentage of the risk of malignant disease, but they certainly do not confirm it in one hundred percent and on the basis of them we cannot perform such operations as radical prostatectomy in prostate cancer - explains Dr. Przemysław Dudek, urologist of the Krakow SCM clinic.
Standard core-needle prostate biopsy
Contrary to the disturbing name, the diameter of the needles used in the core biopsy is approx. 1 mm. With its help, small fragments of prostate tissue (rollers) are collected, which are then fixed and sent to the pathology department, where they are assessed bya histopathologist.
The material can be downloaded in two ways:
- transrectally under ultrasound guidance under local anesthesia or short intravenous anesthesia
- or transperineally under general anesthesia.
Unfortunately, it is not always possible to obtain material confirming or excluding the disease as a result of a standard biopsy. For example, in the case of an early stage of cancer, when the tumor focus is small, an ultrasound-guided biopsy may be false-negative as approximately seventy percent of prostate tumors are not visible in this type of image. So we aim a little blindly, despite the fact that approx. 10 rolls of tissue are collected for histopathological examination.
Some patients must have this test repeatedly when their biopsy result under ultrasound guidance is negative, and at the same time all other tests, such as an increased PSA measurement, still indicate that the risk of developing the disease is high. This means that the tumor may have been missed by the biopsy needle.
Prostate biopsy and MRI
The European Society of Urology recommends performing an MRI of the prostate gland before the biopsy, even the first one. This test detects suspicious tissues very well. It is estimated that with its help we are able to visualize up to eighty-five percent of malignant prostate tumors, although it must also be emphasized that resonance alone is not a method of cancer diagnosis, but only an assessment of the prostate gland.
This examination should be performed after the PSA results are obtained and after the transrectal examination, and before the biopsy. This order matters! - A biopsy disrupts the structure of the tissue in the prostate gland, which later makes it difficult for radiologists who perform multi-parameter resonance imaging. They cannot judge the changes well.
Therefore, the resonance should be performed first, of course, on a suitable device and by a good specialist who can correctly map changes and describe them. Then such a test is a very useful indication for a urologist and on its basis the doctor may refer the patient for a biopsy - explains Dr. Przemysław Dudek, MD.
Prostate fusion biopsy
A novelty in the diagnosis of prostate cancer is the fusion biopsy of the prostate gland, which combines the traditional form of core-needle biopsy performed under the ultrasound image with magnetic resonance imaging, which clearly better visualizes clinically significant neoplastic changes.
- When performing a fusion biopsy, we put the previously obtained MRI image over the image in the biopsyUltrasound. We do this with the help of a special computer program. Such action allows us to better detect and mark areas suspected of cancer, and thus more accurately take samples using a core needle biopsy for histopathological examination - describes the specialist of the Krakow SCM clinic, where this type of prostate cancer diagnosis has recently been performed.
So, a fusion biopsy has many advantages. First of all, it allows for early diagnosis of cancer and initiation of treatment, as it reduces the risk of missing the lesion. It also allows you to reduce the number of clippings taken. In addition, thanks to it, we avoid unnecessary, additional non-targeted biopsies, which are burdensome for the patient and burden him with certain complications. It is important to know that a large number of tests of this type may temporarily cause hematuria, hematospermia (the presence of blood in semen) or rectal bleeding.
Therefore, if the first test does not bring the expected results, the European Society of Urology recommends performing another biopsy under the so-called fusion. Although this research is more and more popular and very useful, unfortunately it is still available only in a few centers in Poland.
- Prostate - prostate gland: structure, functions, diseases of the prostate
- Prostate biopsy: a study that diagnoses prostate cancer
- Prostate examination. Men should get these prostate screening tests
- Enlarged prostate: causes, symptoms, treatment
Przemysław Dudek, MD, PhD - urology specialist from SCM clinic in Krakow (www.scmkrakow.pl) In 1996 he graduated from the Medical Academy in Warsaw. After passing the European urological exam, he was awarded the FEBU (Fellow European Board of Urology) title. He actively participates in the scientific congresses of the Polish Urological Society, as well as the European Society of Urology and numerous regional societies and medical associations. He is interested in oncological urology and the treatment of urolithiasis, with particular emphasis on minimally invasive methods: endourological treatment of urolithiasis both in the upper and lower urinary tract and laparoscopic removal of ureteral kidney tumors, bladder and prostate gland. The doctor's interests also include endoscopic and laparoscopic treatment of prostatic hyperplasia, treatment of bladder diverticula and urinary tract defects in adults. Since 2012, he has been working at the Clinic of Urology and Urology Oncology at the University Hospital in Krakow (headed byProfessor Piotr Chłosta). Currently, he is the Deputy Head of the Clinic.