New imaging technology tests for a "smarter" prostate biopsy

A fusion-guided biopsy helped physicians get a more accurate view of Edward Downey's prostate.

For three decades, men have undergone prostate biopsies in the same way, with no reliable imaging tools to aid in the diagnosis of prostate cancer. There have been no new potential solutions for patients with a suspicion of prostate cancer — until now. The North Shore-LIJ Health System prostate cancer team has incorporated imaging developed by Philips Healthcare that helps to visualize suspicious areas in the prostate.

Edward Downey, of Garden City, is one of 30 men treated at North Shore-LIJ’s Smith Institute of Urology who have signed on to a national clinical trial called “MRI/US Fusion-Guided Prostate Biopsy — An Improved Way to Detect and Quantify Prostate Cancer.” The trial combines magnetic resonance imaging (MRI) with ultrasound-guided biopsy. Mr. Downey, 56, had high levels of PSA (prostate-specific antigen) for his age. During an annual checkup, Ardeshir (Art) Rastinehad, DO, director of interventional urologic oncology at the Smith Institute and the principal investigator for the study, recommended an MRI of the prostate. The findings on the MRI were discussed with Mr. Downey and he enrolled in the clinical trial. This was the first time the diagnostic test was offered for patients outside the National Institutes of Health.

“The standard biopsy samples only less than half a percent of the prostate,” said Dr. Rastinehad. “Men with an elevated PSA have approximately a 27 to 40 percent chance of having a positive biopsy. This leaves almost 70 percent of men after a negative biopsy with no definite answer if they harbor some form of cancer within the prostate. As a result of poor sampling, the cancer goes undetected.” The MRI can provide images of 100 percent of the prostate gland to get the most accurate diagnosis possible. Dr. Rastinehad said it makes sense to “take a look first and then determine the best course of action.”

During the study, North Shore-LIJ physicians found that Mr. Downey had prostate cancer that was confined to the gland. As part of the evaluation, Mr. Downey underwent the standard 12-core biopsy, which was negative. There is no telling when the more traditional techniques and standard biopsies would have arrived at the same finding for his cancer, which was located in a difficult-to detect area outside the normally sampled zones on ultrasound-guided biopsy. Mr. Downey received treatment in June and is doing well. 

The fusion-guided biopsy can sample areas of the prostate not readily sampled by the standard 12-core biopsy. Here’s how the procedure works: During the prostate ultrasound, Dr. Rastinehad uses a field generator (the size of a small box). Similar to a GPS unit, it is placed over the patient’s hip to guide the biopsy. The MRI and ultrasound images are overlaid (fused) in real time. A blue dot appears to mark the target area and precise location on the fusion image. This combination of GPS with imaging allows the physician to track specific biopsy locations and target those suspicious areas seen on the MRI. 

Mr. Downey had a radical prostatectomy (full removal of the prostate), performed by Lee Richstone, MD, chief of urology at North Shore University Hospital and vice chair of urology at the Smith Institute.

“The fusion biopsy that utilizes magnetic resonance imaging provides an accurate roadmap that is tailored to the patient’s anatomy, so the prostate surgery can be done more precisely,” said Dr. Richstone. Using a less invasive robotic approach to surgery, Dr. Richstone explained that the specialized MRIs allow him to get “as close to possible to the prostate gland, sparing vital nerve bundles for continence and sexual function.” Dr. Richstone added, “The fusion biopsy and surgery translated into a remarkably high degree of recovery for Mr. Downey.”

Three weeks after his surgery, Mr. Downey and his wife took a getaway to Montauk. “I was happy with my recovery and very impressed with the treatment I received,” he said.

The prostate gland is about the size of a walnut and is located under the bladder. Prostate cancer affects one in six men in the US. More than 240,000 new cases are diagnosed each year in this country, and approximately 30,000 men die of the disease.

The clinical trial at North Shore-LIJ is currently evaluating the potential benefits a fusion biopsy system could have on the standard urologic practice. The combination of information obtained from prostate MRI and the unique availability of the trial to target these areas may better help physicians select patients for treatment versus active surveillance. At the Smith Institute, a team of healthcare providers works with patients to assess and determine individualized treatment plans. They will also discuss quality of life issues and review and compare treatment options — including surveillance, focal therapy, cryotherapy, radiation or surgery — to select the best course of action for each patient.

“All the stars were aligned for me to receive the fusion biopsy,” said Mr. Downey. “I am truly blessed and fortunate that my cancer was diagnosed and treated so successfully.” 

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