12 Sep Prostate Cancer: MRI-Ultrasound Fusion Technology Improves Biopsy Assessment During Active Surveillance
MedicalResearch.com Interview with:
Rajiv Jayadevan, MD
Department of UrologyLeonard S. Marks, MD
MedicalResearch.com: What is the background for this study?
Response: Men with low risk prostate cancer often enter “active surveillance” programs. These programs allow patients to defer definitive treatment (and avoid their associated side effects) until more aggressive disease is detected, if at all. Patients typically undergo a “confirmatory biopsy” 6 to 12 months after diagnosis to verify that their disease is low risk, and then undergo repeat biopsies every 1 to 2 years. These biopsies have traditionally been performed under the guidance of transrectal ultrasonography.
Transrectal ultrasonography is unable to accurately visualize tumors within the prostate, necessitating that biopsy cores be obtained systematically from all parts of the prostate. MRI-ultrasonography fusion biopsy is a newer technology that has been shown to characterize biopsy findings more accurately than transrectal ultrasonography, leading to improved disease detection. This technology also allows us to visualize tumors within the prostate, and directly target these tumors during a biopsy session.
MedicalResearch.com: What are the main findings?
Response: Analysis of our active surveillance database in which all biopsies during the past 10 years were performed by MRI-ultrasonography fusion demonstrated that the pathology found during confirmatory biopsy was strongly associated with patients’ risk of developing more aggressive disease. For example, patients with Gleason 3+4 disease on confirmatory biopsy were more than 3 times more likely to develop disease requiring definitive treatment compared to those with Gleason 3+3 on confirmatory biopsy. We also found that performing both systematic and targeted biopsies during the same biopsy session maximized the detection of aggressive cancer.
MedicalResearch.com: What should readers take away from your report?
Response: The pathology found when confirmatory biopsy is performed using MRI-ultrasonography fusion can help us to provide a patient with a better risk assessment of eventually developing aggressive disease. Obtaining both targeted and systematic biopsy cores is a more sensitive method of detecting tumors that are not suitable for continued active surveillance.
These results suggest that confirmatory biopsy by MRI-ultrasonography fusion technology is associated with improved individual risk assessment and may serve as an appropriate entry point for active surveillance.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future studies are needed to directly compare cancer detection rates for patients undergoing active surveillance with conventional transrectal ultrasonography biopsies to those whose biopsies are performed using MRI-ultrasonography fusion technology.
Jayadevan R, Felker ER, Kwan L, et al. Magnetic Resonance Imaging–Guided Confirmatory Biopsy for Initiating Active Surveillance of Prostate Cancer. JAMA Netw Open. Published online September 11, 20192(9):e1911019. doi:10.1001/jamanetworkopen.2019.11019
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