Why is MR-TRUS Fusion Biopsy Necessary?

According to 2020 data, prostate cancer is the second most common cancer after lung cancer. In addition, it ranks 5th in the list of the deadliest cancers. Early diagnosis is very important in prostate cancer, which is one of the completely treatable cancer types today. For this reason, it is recommended that patients over the age of 45 be screened for prostate cancer at the urology outpatient clinic once a year. Some procedures need to be performed to determine whether the patient is at risk of prostate cancer. These;

Digital Rectal Examination

Digital rectal examination is a physical examination method performed in prostate cancer screening. In this method, your doctor directly examines the prostate gland by entering it through the rectum with his index finger. In this method, the prostate gland is evaluated in terms of hardness and asymmetry. It also provides information about the spread of prostate cancer outside the organ. If there are abnormal findings on rectal examination, a prostate biopsy can be planned regardless of the prostate specific antigen (PSA) level.

Prostate Specific Antigen

Prostate-specific antigen is a protein secreted from cells in the prostate gland. Its main function is to liquefy semen. For this reason, while it is predominantly found in semen, a small amount can also be measured in blood. A PSA level in the blood above 4 ng/ml is considered suspicious for prostate cancer. However, PSA is a prostate-specific protein and not prostate cancer-specific! For this reason, inflammations caused by the prostate gland, ejaculation, etc. In some cases, PSA may increase. For this reason, your doctor will also ask you for the free form of PSA in your blood. If the free and total PSA ratio is below 20%, the suspicion of prostate cancer becomes stronger.

Multiparametric MRI (MpMR)

It is widely used in patients with suspected prostate cancer after rectal examination and PSA tests. With MpMR, foci in the prostate gland that are suspicious for cancer can be detected with high accuracy. In addition, with this imaging method, cancerous areas within the prostate can be detected due to blood clots, inflammation, etc. can be distinguished more clearly from pathologies. Thus, with MpMR, the necessity of prostate biopsy is determined more precisely and unnecessary biopsies are avoided.

If you suspect prostate cancer as a result of screening tests, your doctor will recommend a prostate biopsy. Tissue sampling from the prostate gland can be done in 2 ways. The first is a transrectal ultrasound-guided prostate biopsy . In this standard biopsy method, 6-12 pieces are systematically taken from the prostate gland and sent for pathological examination. However, with this method, clinically significant cancer can be missed in approximately 30% of patients. For this reason, if clinical suspicion persists in patients without detected cancer, it may be necessary to perform a repeat biopsy.

In addition to the possibility of missing an aggressive cancer with the standard biopsy method, there is also the possibility of detecting clinically insignificant cancers that will not cause lifelong problems for the patient. For this reason, today there are smart biopsy methods that provide very precise tissue sampling by superimposing areas suspicious for prostate cancer seen in MpMR imaging with real-time ultrasound images using special computer software. This smart biopsy method, also known as targeted biopsy or MR-TRUS fusion biopsy, has been successfully applied in our institution since 2016. With this method, sampling is performed with zero error from suspicious areas detected in prostate MRI imaging. In this way, prostate cancer is diagnosed at the earliest possible stage and appropriate treatment is started without delay.

How is MR-TRUS Fusion Biopsy Done?

• The patient’s MpMR images are examined and the target is determined.
• The determined target is loaded into the software of the smart biopsy robot and a three-dimensional mapping of the prostate is made.
• Targeted biopsy can be performed under local or general anesthesia .
• Thanks to the robotic arm used by the targeted biopsy system, tissue sampling is performed from the target determined in MpMR with zero error.
• The areas sampled in the biopsy are recorded in accordance with their coordinates to facilitate treatment.   

What are the Advantages of MR-TRUS Fusion Biopsy?

• It locates and diagnoses cancers that cannot be diagnosed with standard biopsy.
• It increases the rate of detection of aggressive, high-risk prostate cancer.
• The detection rate for clinically insignificant prostate cancer is low. In this way, it protects the patient from unnecessary treatments and the risks they pose.
• By performing three-dimensional mapping of the prostate gland, it allows biopsies to be taken from areas that are technically difficult to sample with zero error.

Multidisciplinary Approach to Prostate Cancer Treatment

The medical condition of every patient who applies to us due to prostate cancer is discussed in multidisciplinary meetings attended by radiation and medical oncology units. Thus, the most appropriate and up-to-date treatment method is planned for the patient. The most appropriate treatment approach for organ-confined prostate cancer is radical prostatectomy. In our clinic, this surgery is performed with robotic surgery. With Robotic Surgery, which broke new ground in medicine with developing technology and was used in our institution for the first time in Turkey, the treatment of kidney and prostate cancers is carried out with high success, and Florence Urology continues to be a regional and international leading institution in this regard. Robotic surgery systems help the surgeon; It provides many advantages such as 3D and 10 magnification images and easy access to all directions that the wrist cannot normally turn. In the postoperative period, in addition to standard imaging methods, state-of-the-art imaging methods (Gallium-68 PSMA PET/CT, PET/MRI, PET/CT, etc.) are planned in coordination with the radiology clinic.