SIU 2018: Technique for MR/US Fusion Prostate Biopsy

Seoul, South-Korea ( Ardeshir Rastinehad, MD finished off the Master Class by providing a brief overview to the technique for fusion biopsy – he provided some data, but passed along some important take-home points in the process. I highlight these primarily, as his talk was short on details but rather focused on broader concepts!

Fusion biopsy, as a concept, is relatively new and is rapidly growing. The number of studies on the topic has skyrocketed – going from a handful in 2007-2008, to well over 140 in 2017. The number continues to increase. The quality of data has also gotten much stronger with more RCTs included!

His first take-home point is the high degree of variability between institutions and its impact on publication data. Always critically examine the studies for differences in marking, grading, treatment decision making as the results can vary significantly.

To highlight this, he looked at 3 talks that assessed tumor volume using mpMRI – the three talks varied significantly in terms of how much mpMRI underestimated tumor volume. It ranged from 7% to 80%, depending on how the tumor was marked out!

So, one main take home was the quality of the study matters. Ultimately, do not cite papers from other institutions for the way you do things at your institution – look at your own institutional data! This will help guide management.

  • IE what is the cancer detection rate for PIRADS 3 at your center – if high, biopsy PIRADS 3 lesions. If low, stop biopsying!
Garbage in == Garbage out! Quality of images matter. So, we need to begin figuring out a way to grade image quality and take that into consideration in the fusion technology decision making.

The theoretical benefit of fusion biopsies is combining 2 different imaging modalities (ultrasound and mpMRI), each with its own benefits, in a real-time 3D assessment of the prostate. It also allows the ability to guide, track and record biopsies in 3D space.

  • Another take-home point: always record your biopsies! You can go back and view the procedure once pathology is back. You can check for errors in technique and learn how to improve! This is important for quality control and education!
He also briefly touched on the transperineal approach – he has started to do more TP approach for fusion biopsy. His sepsis rate is 0% (though his sepsis rate for TRUS is ~1%). However, he feels TP is the better procedure for patients – but limited in use in the US likely due to time and cost limitations.

Lastly, the benefit of fusion biopsy technology is that it naturally lends itself to focal therapy. It is a quick step forward to focal therapy! He has already started to do cryotherapy in this setting!

Presented by: Ardeshir Rastinehad, MD, Associate Professor of Urology and Radiology, The Mount Sinai Hospital, United States

Written by: Thenappan Chandrasekar, MD, Clinical Instructor, Thomas Jefferson University at the 38th Congress of the Society of International Urology - October 4- 7, 2018 - Seoul, South Korea

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