Prostate MRI can identify discrete tumors within the prostate. These images can be processed with computer software and specialized equipment to be combined with ultrasound images obtained during a prostate biopsy procedure at a later date.
The prostate biopsy is conducted without sedation using an ultrasound probe in the rectum to guide needle core samples after injection of local numbing medication. About 12 needle core samples are taken from the various regions of the prostate as part of a standard biopsy. During MRI-fusion biopsy, additional samples are taken from the area of interest identified on prior prostate MRI. We are proud to be among the first Urology groups in the area to be able to offer this exciting technology.
When to ask a Urologist about MRI-Fusion Prostate Needle Biopsy
You should speak with a Urologist about MRI-Fusion Prostate Needle Biopsy if you have a persistent elevated PSA level with prior negative biopsy or if you are considering active surveillance for known prostate cancer.
Cost
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Effectiveness
Transrectal ultrasound-guided prostate needle biopsy is the gold standard method to diagnose prostate cancer, but it relies on a relatively random distribution of biopsy samples and has a 30% likelihood of missing prostate cancer when present. MRI-fusion biopsy can increase the diagnosis of intermediate- and high-risk prostate cancer by about 18% though still misses about 4% of clinically significant cancers. Consequently continued follow-up is important even with negative findings.
Possible Side Effects
The risks of prostate needle biopsy include about a 50% chance of minor blood in the urine, stool and semen for up to 6 weeks and a 2% chance of temporary difficulty urinating, serious bleeding or serious infection requiring hospitalization. About 5% of men experience a urinary tract infection. Urinary burning or frequency may last for several days. There has never been conclusive evidence that prostate biopsy affects erectile function in any way.
Alternative Approaches
Alternatives to MRI-fusion biopsy include traditional prostate needle biopsy with cognitive fusion where the surgeon directs the biopsy based on his interpretation of the MRI imaging without computer software targeting.
What to do to Prepare for Procedure
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive. To limit infectious risk, you will be prescribed antibiotics for the day of the procedure. If you do not have regular bowel movements, you will be instructed to perform an enema at home on the day of procedure to clear stool from the area.
Unless the procedure is planned with sedation, you may eat and drink on the day of surgery. You should take your other home medications as usual. Patients will receive an additional antibiotic injection just prior to the procedure.
What to Expect after Procedure
The procedure is typically performed without sedation in the outpatient setting after a local injection of numbing medication. The entire procedure takes about 30 minutes. At the conclusion of the procedure, rectal pressure will be temporarily held with the ultrasound probe or finger to stop any lingering bleeding areas. The pathology results are typically returned in 1-2 weeks. Most patients have minor bleeding notable in the urine, stool and semen. Unless performed with sedation, you can drive yourself home. You may have some blood spotting from the rectum on the drive home and may want to consider placing a pad on your car seat.