Prostate cancer causes significant morbidity to the elderly male population.
In those with clinical concern for prostate cancer, MRI is often used as a preferred method for initial detection of a specific lesion prior to tissue sampling (e.g. see figure below).
Once such a lesion is detected, image-guided biopsies can be performed either with ultrasound (free-hand or with grid) or with MRI. A corresponding lesion can sometimes be visible on ultrasound although overall detection sensitivity for lesions on ultrasound is low....
Methods and materials
In our institution, we undertake transperineal freehand ultrasound-guided biopsies for those with suspected prostate cancer. Almost all of these patients tend to have an MRI scan prior to the procedure.
A retrospective analysis of 98 such transperineal free-hand prostate biopsies performedover a time period fromJanuary 2020 to November 2020 at Royal Perth Hospital was carried out.
The mean age of patients was 67 with an age range of 45 to 88 years.
All patients had initial diagnostic MR imaging and then underwent subsequent...
A total of 98 cases were biopsied with the preceding MRI reporting:
a lesion greater than PI-RADS 3 in 78 (79.6 %) cases
a lesion greater than PI-RADS 4 in 61 (62.2 %) cases.
a lesion of PI-RADS 5 in 28 (28.6 %) cases.
Of the 98 biopsied cases, a positive histology result for a tumour of Gleason 6 or above was present in 71 % of cases.
In 15 of the 78 cases (19.2 %) having lesions reported as PI-RADS 3 or above on...
Combined use of MR imaging with subsequent ultrasound-guided biopsy (trans-perineal freehand in our case) can provide a good yield in histological confirmation of prostate cancer in a particular MRI suspected location.
Although ultrasound only tends to visually identify a small proportion (~19 %) of MRI detected lesions as a "sonographically visible" lesion, targeted sampling “at or adjacent (within one clock face position) to this region can yield a high (up to 93 % in our case) positive histology (Gleason 6 or above) when the MRI...
Jessica Rührup, Felix Preisser, Lena Theißen et al. MRI-Fusion Targeted vs. Systematic Prostate Biopsy-How Does the Biopsy Technique Affect Gleason Grade Concordance and Upgrading After Radical Prostatectomy?. Frontiers in surgery, 2019 Sep 18;6:55. DOI:10.3389/fsurg.2019.00055
Catherine Elizabeth Lovegrove, Mudit Matanhelia, Jagpal Randeva et al. Prostate imaging features that indicate benign or malignant pathology on biopsy. Transl Androl Urol. 2018 Sep; 7(Suppl 4): S420–S435. doi: 10.21037/tau.2018.07.06
Susanne Tewes, Inga Peters, Ansgar Tiemeyer et al. Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches. Volume 2017...