V12-11: MR/transperineal Ultrasound Fusion-guided Prostate Biopsy in the Patient without Anus
Transrectal ultrasound (TRUS) guided prostate biopsy has long been the gold standard for obtaining tissue in the diagnosis of prostate cancer. Even as newer techniques have developed including transperineal and MR/ultrasound fusion-guided biopsies, it remains technically challenging in certain patient populations. Specifically, in men who have undergone total colectomy or abdominoperineal resections (APR) that do not have a rectum or anus and those with severe anal stenosis unable to accommodate an endorectal probe for imaging or needle guidance. All current options for biopsy in these men are technically challenging and inadequate. In this video, we describe a novel technique to perform MRI/transperineal US fusion-guided prostate biopsy.
The procedure consists of MR acquisition, MR segmentation of the prostate and region of interest, ultrasound imaging of the prostate with sweep and segmentation, coregistration of the images, and finally the targeted biopsy followed by the standard of care systematic 12-core biopsy. An electromagnetic fusion biopsy system is utilized with an end-fire endorectal probe placed against the perineum for prostate imaging and needle guidance.
We describe the case of a patient who after APR underwent successful MR/transperineal ultrasound fusion-guided prostate biopsy of his PIRADS 5 MR lesion using the above described technique. Pathology showed prostate cancer in all three cores through the region of interest and was negative in the standard 12-core biopsy.
In conclusion, MR/transperineal ultrasound fusion-guided prostate biopsy is a novel, feasible, and safe procedure extending the benefits of prostate MRI and targeted biopsy to men who cannot undergo transrectal ultrasound.