V6-11: Magnetic Resonance Imaging/Transrectal Ultrasound (MRI/TRUS) Fusion Guided Biopsy of the Prostate to Detect High Grade Cancer

Video

Introductions and Objectives
Multiparametric MRI has been shown to be a valuable adjunct to identifying suspicious lesions for prostate cancer diagnosis. Magnetic Resonance Imaging/Transrectal Ultrasound (MRI/TRUS) fusion platforms allow for the detail and information provided by MRI to be combined with the real-time capabilities of ultrasound in an office-based setting. Additionally, MRI/TRUS fusion platforms have demonstrated improved detection of clinically significant prostate cancer compared to systematic 12-core TRUS biopsies.

Methods
This video demonstrates the MRI/TRUS fusion biopsy procedure of a 62 year old male with history of elevated serum PSAs in the setting of multiple negative TRUS biopsies. The patient was initially biopsied under the standard of care 12-core TRUS with no evidence of prostate cancer with subsequent TRUS biopsies also demonstrating no evidence of cancer. The patient then elected to undergo MRI/US fusion biopsy. A diagnostic pre-biopsy multiparametric MRI with surface and endorectal coils was taken and identified one lesion that was highly suspicious for prostate cancer based on NIH scoring criteria. The entire fusion biopsy procedure using the UroNav platform is depicted and includes: patient preparation, TRUS sweep, MRI/TRUS image co-registration, and targeted and standard biopsy. Screenshots of the UroNav platform during biopsy target acquisition and sampling are shown followed by an optional 12-core TRUS biopsy.

Results
Four targeted biopsy cores were taken from the midline anterior apical central gland (two in the axial direction, two in the sagittal direction) with all cores detecting prostate adenocarcinoma. Three of the four targeted cores demonstrated Gleason 4+4=8 disease involving between 30-90% of the needle core. All 12 systematic cores failed to demonstrated evidence of prostate adenocarcinoma. Targeted biopsy lengthened total biopsy procedure time by a few minutes with no additional post-operative complications.

Conclusions
The UroNav MRI/TRUS fusion platform enables urologists to quickly and efficiently identify and biopsy MR suspicious lesions in an office-based setting.

Funding: None