FRIDAY, Aug. 16 (HealthDay News) -- An innovative fusion of MRI
and ultrasound might be a better way to detect and assess prostate
cancer, while helping men avoid unnecessary biopsies, researchers
The technology blends real-time imaging from both MRI and
ultrasound devices, allowing doctors to more accurately direct the
biopsy needle that draws cell samples from suspected tumors.
"This approach does detect cancers that can go missed by standard biopsy," said Dr. Art Rastinehad, director of Interventional urologic oncology at North Shore-LIJ's Arthur Smith Institute for Urology, in New Hyde Park, NY.
In particular, the MRI/ultrasound fusion technique can guide
physicians to tumors at normally neglected regions of the prostate
"There are two screens in front of you, and the MRI is capable of pointing out areas that might contain cancer," explained Dr. Scott Eggener, associate professor of surgery and director of translational and outcomes research in the University of Chicago Medical Center's urology section. "Using the two screens, you can more intelligently direct your biopsy needles toward those areas."
The technology is part of an overall approach to first use MRI
scans to best determine which men need to undergo prostate biopsy,
and then use the MRI/ultrasound fusion to perform the most
efficient biopsy possible.
Right now, doctors typically rely on blood tests to look for
elevated levels of prostate-specific antigen, or PSA. A man with an
elevated PSA is often urged to undergo a biopsy, most often
conducted using a needle guided by ultrasound that draws cell
samples from the prostate.
However, these biopsies only sample a small portion of the
prostate, leaving the rest of the gland unchecked. Such random
sampling can easily miss tumors, experts say.
Under the new approach, a man with elevated PSA levels would
first undergo an MRI that would provide a visual scan of the entire
prostate, Rastinehad explained. If potentially cancerous areas are
found on the prostate, then the man would undergo a biopsy.
Studies have found that using an initial MRI scan to figure out
who needs a biopsy can reduce the overall number of biopsies by
about a third, according to a review of the data published this
summer in the journal
"We are working toward a goal that if you have a PSA that is elevated, you would instead get an MRI," Rastinehad said. For some patients, that may mean that "you may never need a biopsy," he said.
MRI also would be used during the biopsy itself. In that
scenario, an electro-magnetic field generator is placed over the
patient's hip, creating real-time MRI images that are combined with
ultrasound readings to guide the needle biopsy. Images from the
earlier MRI screening can then be overlaid with the real-time
images to provide visible "targets" for the doctor to biopsy.
Studies have found that MRI-targeted biopsies are better at both
detecting prostate tumors and determining which tumors are more
advanced, Rastinehad said.
The technology helped detect advanced prostate cancer in Robert
Herr, a Long Island, N.Y., resident who had high PSA levels but
underwent a biopsy a couple of years ago that detected no
"Then the PSA elevated again and my urologist said, 'Why don't you go for this new MRI biopsy and see how it works out for you?'" said Herr, 66.
The fusion biopsy conducted in May ended up detecting high-grade
prostate cancer near the top part of the prostate gland, an area
normally not sampled in standard biopsy. Herr will begin radiation
treatment in August.
"If I had gone for the regular biopsy again, it might not have shown up again and then I'm living with the cancer not knowing anything, and I don't think that's a good idea," Herr said. "To me, I don't think anybody wants to have cancer of any type, but if I have it I want to know about it and do whatever I need to do to treat it. To put your head in the sand, I don't think that's any kind of solution at all."
At this point the technology is both rare and expensive. Only
five medical centers in the United States use MRI/ultrasound fusion
prostate biopsy, and the devices cost about $180,000, Rastinehad
The U.S. Food and Drug Administration approved the device, which
was developed in collaboration with the U.S. National Institutes of
Health, in April. It is being manufactured by Invivo, a division of
Philips Healthcare. Rastinehad said he does not have a financial
stake in the company.
While the technology is expensive, Rastinehad believes hospitals
will end up saving money because they will be able to cut back on
the amount of pathological examinations needed to assess suspected
For his part, Eggener said the new MRI approach can help doctors
meet the overall goal of finding serious cancers in a timely
"There are some early data to suggest it may be a better way of targeting cancers, finding more cancers and finding more meaningful cancers," Eggener said. "MRI is the best picture we can get of the prostate. It's not perfect, but it is better than what we've had."
For more information on prostate cancer detection, visit the
American Cancer Society.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.