COMPREHENSIVE UROLOGY

Prostate Biopsy

After skin cancer, prostate cancer is the most common form of cancer among men. However, this disease can be curable when diagnosed in the early stages, making it critical that men be screened for the disease once they hit a certain age. With today’s technology and innovations, prostate cancer is a very treatable disease, but the first step starts with the patient choosing to undergo a screening.

With a collective experience of over 125 years, the urologists at Comprehensive Urology are equipped with the industry’s cutting-edge diagnostic and surgical tools. Whether obtaining a diagnosis for the first time or looking for a second opinion, our specialists can get faster and more accurate results than ever before. With new imaging techniques and highly refined, minimally invasive procedures, prostate cancer screenings and biopsies have come a long way in the last few decades, allowing us to offer men higher detection and survival rates and a better quality of life.

Screening Tests

PSA (Prostate-Specific Antigen)
PSA testing is used to measure the level of PSA, a protein produced by normal and malignant prostate gland cells, in a man’s blood. Doctors frequently define a PSA level of 4 nanograms of PSA per milliliter of blood as normal. If a man’s PSA level exceeds 4 ng/mL, a doctor may recommend additional prostate cancer testing. However, in some studies, men who have a PSA level below 4 ng/mL have developed prostate cancer as well.
Digital Rectal Exam (DRE)

A DRE allows a doctor to evaluate a man’s lower rectum, pelvis, and lower belly. It is used to identify prostate cancer and other health problems, including blood in the stool or an abnormal mass in the rectum or anus.

Multiparametric MRI of Prostate

A multiparametric MRI of the prostate allows a doctor to visualize and examine the prostate’s anatomy. That way, a doctor can identify any prostate anomalies.

Genetic Tests (PCA3, ProPSA, 4K Score)

Studies have linked several genes and chromosomal regions to prostate cancer. If a patient’s parent, sibling, or other family members have experienced prostate cancer, genetic tests may be used to detect prostate cancer in its early stages. Several genetic testing options are available, and these include the prostate cancer antigen 3 gene (PCA3) and ProPSA tests.

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MRI Fusion Biopsy

Perfusion dynamic MRI of the prostate is a new way of evaluating patients with prostate cancer. This is based on the following three principles:
1. Prostate cancers can look different than normal prostate tissue and can therefore be readily identifiable on an MRI of the prostate.

2. Since the blood vessels of prostate cancers can be more “leaky,” cancerous cells excrete contrast material differently than normal prostate cells. During a perfusion dynamic MRI of the prostate, a special contrast agent is used that is picked up and excreted differently by prostate cancer cells as compared to normal prostate tissue. This difference in contrast absorption and excretion can help identify the location of the cancer with great precision.
3. Since the cells in most prostate cancers are more tightly packed than the cells in the normal prostate tissue, water does not travel through the cancerous tissue as easily as it does through the normal prostatic tissue. A perfusion dynamic MRI study is able to identify the difference in the flow of water in the more tightly packed cancer as compared to the less compact normal prostate tissue. By being able to identify this difference in water flow, we can, with great precision, identify the location and extent of the cancerous cells.

The precision of perfusion dynamic MRI allows us to:

  • Precisely identify patients at risk of prostate cancer, and therefore help identify who does and doesn’t need to have a prostate biopsy (this cuts down on unnecessary biopsies being performed).
  • Provide a better roadmap for our robotic surgeons and radiation therapists when they operate or provide radiation therapy.
  • Optimize patient’s outcomes by aiming to preserve their normal bodily functions while providing them with the best cancer cure options possible.
  • Perform prostate biopsies with more precision (MRI fusion biopsies).
  • Precisely identify the grade and size of the tumor.
  • Determine the best treatment option for patients with prostate cancer. (Active surveillance vs. focal therapy vs. whole-gland therapy such as robotic surgery and radiation therapy. In addition, our doctors will determine the best course of action regarding alternative therapeutic options and systemic therapy).

Active Surveillance
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In order to maintain a patient’s quality of life (and avoid over-treating patients), some patients with early-stage disease have been placed on active surveillance. Under active surveillance, patients are not treated immediately. Instead, they are monitored closely, and with repeat biopsies, the volume and aggressiveness of their prostate cancer is monitored. Prostate cancer treatment is then offered when a patient’s volume increases or if the aggressiveness of the prostate cancer worsens (or if the patient no longer wants to remain on active surveillance). At that time, either surgery or radiation therapy is provided to the entire prostate gland with the potential side effects as listed above (impotence, loss of urinary control, change in ejaculation, etc.).

PROSTATE CANCER

Additional Resources

Prostate Cancer Detection Biopsies

 

A prostate biopsy plays a major role in effective prostate cancer diagnosis and treatment. During a biopsy, a doctor will remove a small sample of tissue from the prostate and test it for cancer. A biopsy may be performed if an individual displays prostate cancer symptoms, and it may be completed in conjunction with other prostate cancer screenings as well.

Prostate Biopsy

A prostate biopsy generally requires only a few minutes to complete. At this time, a doctor inserts a needle into the wall of the rectum and extracts cells from the prostate for testing. A doctor collects multiple samples from different parts of the prostate as part of his or her evaluation.

Next, the prostate tissue samples will be sent to a laboratory and reviewed under a microscope. In most cases, a patient will receive the lab test results within a few days. If prostate cancer is identified, a patient will receive a Gleason score that indicates how quickly the cancer will grow and spread. The higher the Gleason score, the more likely it becomes that prostate cancer will quickly grow and spread.

MRI Fusion Prostate Biopsies

Prostate cancer is a disease that has many treatment methods, but patients must be very careful when selecting a treatment option that is suitable for them. Many factors go into deciding the proper form of therapy, including a patient’s age, the extent of his cancer, its level of aggression, and more.

Before determining a treatment method, patients need to ensure that their cancer is properly identified and diagnosed. MRI fusion targeted biopsies are a new procedure that can easily identify men who should be treated for prostate cancer.

How MRI Targeted Biopsies Work

An MRI targeted biopsy removes all the guesswork present in traditional biopsies. During an MRI targeted biopsy, prostate cancer specialists use MRI (magnetic resonance imaging) and ultrasound images together to be more comprehensive and accurate than traditional biopsy measures.

When performing an MRI targeted biopsy, specialists use magnetic resonance imaging to create a 3D image of a patient’s prostate. This image is then superimposed onto the live ultrasound image, allowing the specialists to better identify targets and differentiate them from normal, healthy cells. A needle is inserted directly into the marked (and likely cancerous) region of the prostate (no guesswork is required) and tissue samples are taken from the gland.

MRI targeted biopsies have made prostate cancer identification much more accurate and comprehensive. Prior to the advent of target biopsies, an estimated 38% of cancer cases were misidentified by traditional biopsy procedures. Since prostate cancer is best treated early, proper identification is incredibly important when treating the disease.

Ultrasound VS MRI Fusion for Prostate Cancer Detection

Traditionally, a urologist performs a prostate biopsy through the use of an ultrasound probe into the patient’s rectum. As the prostate is found in front of the rectum, this allows the prostate to be seen and evaluated during the procedure. With the guidance of the ultrasound images, tissue samples can be taken from different locations in the prostate (i.e. prostate biopsy).

While this technique provides some degree of guidance for the urologist to obtain biopsy samples, it is far from perfect. In fact, the most important advances in prostate biopsies have been through consistently improving imaging technology. Multi-parametric MRI imaging advancements that are tuned specifically towards detecting abnormalities in the prostate gland now allow our team at Comprehensive Urology to identify many prostate cancers with unprecedented accuracy.

During an actual prostate biopsy, live ultrasound imaging (not MRI) is used to guide the urologist. The difficulty to date has been how to simultaneously provide the information from an MRI test to the urologist who is performing the biopsy using a rectal ultrasound device as the guide.

Advances in medical imaging technology now allow us to use the MRI images (obtained prior to the biopsy day) and overlay them on the ultrasound images in real time (i.e. MRI ultrasound fusion biopsy or simply “MR Fusion” Biopsy). That means that we are able to use the MRI as a real-time map when doing an ultrasound evaluation of the prostate. We are therefore no longer performing relatively blind biopsies, but in fact are able to have very targeted precise prostate sampling.

This technological advance has been revolutionary. At the time of the biopsy, we can now see the suspected lesions and accurately biopsy them. This leads to more precise diagnoses and fewer repeat biopsies for patients.

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