J.D. has had a rising PSA for over 10 years with multiple standard systematic ultrasound biopsies, also over the past 10 years, some at my office (4), one at Stanford University, and one at the University of California at San Francisco, all negative for prostate cancer. This year his PSA reached 14 (normal is less the 4). In January, 2015, he had a multiparametric MRI, which revealed a highly suspicious area in his prostate, which was missed on all the previous biopsies. He then had a MRI-ultrasound fusion guided targeted biopsy of the suspicious spot, and high grade, aggressive prostate cancer (Gleason 8) was finally diagnosed. Fortunately, the cancer still seems to be confined to the prostate and he has been offered treatment with curative intent: either radiation therapy with Calypso or surgery to remove the prostate.
Prostate cancer is the commonest cancer in men, and the second leading cause of cancer deaths in men. Prostate cancer is curable if caught early enough, before it spreads out of the prostate. Therefore, finding prostate cancer early is imperative. Unfortunately, there are usually no symptoms of prostate cancer at its earliest and most curable stages. Doctors have relied on 2 tests, the PSA blood test, and a digital rectal exam, to determine if a prostate biopsy is indicated. Neither test is 100% accurate, even when used in combination. If either test is abnormal, traditionally men have undergone “systematic ultrasound-guided” prostate biopsies. Unfortunately, the systematic biopsy technique, where 12 random biopsies are taken, often misses the cancer.
A new technique, multiparametric MRI has been shown to be very accurate in identifying prostate cancer, often in places which were not traditionally encompassed in the “systematic biopsy” technique. A prostate biopsy is still necessary to establish a definite diagnosis. However, performing the biopsy in the MRI machine itself is not possible. The multiparametric-MRI ultrasound fusion is a new technique, where the MRI images are transferred to an ultrasound machine. Then, a real time prostate ultrasound is fused with the MRI image, which allows accurate targeted biopsies of the suspicious areas to be obtained. Multiparametric-MRI in conjunction with MRI-ultrasound fusion guided targeted biopsy offers the promise of more accurate and timely diagnosis of prostate cancer. It is especially helpful in the following situations:
- Men with previously negative prostate biopsies, continued rising PSA, presence of a prostate nodule on digital rectal exam, or a very high PSA.
- Men on “Active Surveillance” for “low risk” prostate cancer, where treatment is deferred until “high risk” features are identified.
Truly, MRI-ultrasound fusion guided targeted prostate biopsy is a “game changer” for the early and accurate diagnosis of prostate cancer.
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