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Prostate Fusion Biopsy

Prostate Fusion Biopsy

The standard treatment for patients with prostate cancer is a TRUS biopsy. However, the 25–39% of prostate cancer that appears to be isoechoic, the difficulty in obtaining samples from the targeted lesions using TRUS, and the noncompliance of biopsies with the specimens from radical prostatectomy all point to the need for additional techniques to improve the accuracy of TRUS biopsy. According to studies, a TRUS biopsy does not provide enough details about the prostate cancer diagnosis, the tumor's location, size, or extent. It was acknowledged that tumors, particularly those located in the central lobe and prostatic apex, cannot be diagnosed by a TRUS biopsy. The traditional TRUS biopsy occasionally requires additional biopsies. When such repeated biopsy approaches were used, more saturated biopsies were initially performed. However, more focused biopsies have grown common in recent years. Today, targeted biopsies are performed based on the findings of MP-MRI for patients whose TRUS biopsy results are negative but for whom suspicions still exist. This technique started to seriously compete with saturation biopsy.


Targeted biopsy techniques

Using a combination of MRI and US images, three distinct fusion biopsies were determined;

  • Brain-fusion biopsy
  • Fusion biopsy in conjunction with MRI (In-Bore)
  • biopsy with MR-TRUS fusion


Cognitive fusion biopsy; This is accomplished by using Mp-MRI to identify questionable spots, roughly identifying these areas with TRUS, and then performing the biopsy operation. Other than the conventional USG instrument, cognitive fusion biopsy does not call for any additional equipment. It is a useful and affordable strategy. However, MP-MRI, USG expertise, and 3-D cognitive skills are needed. Targeting is challenging in anterior and apical lesions that are tiny.

Fusion biopsy accompanied by direct MRG (In-Bore); this procedure involves obtaining live biopsy samples from worrisome lesions while they are being imaged by an MRI machine. Targeted lesions require a 60 to 90 minute biopsy procedure. As a result, systematic biopsy cannot be performed concurrently with in-bore biopsy. Other drawbacks of this procedure include price, the difficulty of the job, and the requirement for two MRIs.

Mp-MRI/TRUS fusion biopsy; MRI images are transmitted to a unique USG-based device in the Mp-MRI/TRUS fusion biopsy procedure. Various software will be used to segment the prostate, and TRUS pictures will be used for the fusion process. The biopsy will be performed on the lesion indicated in the MRI under the guidance of ultrasonography on images from the MRI and TRUS that are superimposed or scanned side by side in real-time.

Advantages of Mp-MRI/TRUS fusion biopsy over cognitive fusion:

  • more accuracy in sampling based on lesion
  • size being able to clearly observe the location where the sample was taken (if the device allows that)
  • more homogeneity in systematic biopsy

Advantages of Mp-MRI/TRUS fusion biopsy over In-bore biopsy;

  •  It permits systematic biopsy in addition to target sample collection.
  • quicker biopsy (more practical in a clinical setting)
  • an increase in patient comfort

The drawbacks of MRI/TRUS fusion biopsy include a steep learning curve, the need for lengthy segmentation processes prior to the biopsy, issues with using several devices, and other factors.

Prostate cancer screenings; DRE and a PSA blood test could be part of it (digital rectum examination). Transrectal ultrasound can be used to perform a TRUS biopsy if the DRE or PSA testing are abnormal. The patient can have routine PSA screenings if the biopsy results are negative. However, prostate biopsy guided by fusion is an alternative for advanced screening and diagnosis if the patient has a positive DRE or has a constantly rising PSA and negative TRUS biopsy results.

Who should receive fusion biopsy?

An MRI fusion biopsy should be performed if a patient's prostate cancer suspicions persist despite the results of a negative prostate biopsy. Since one in four people with negative biopsy results develops prostate cancer within the next 20 years, according to study. This is also advised for those who exhibit abnormalities on digital rectum exams or have elevated PSA levels.

How is fusion biopsy done?

For patients awaiting a biopsy, a multi-parametric MRI of the prostate will be performed. The suspicious spots for cancer will be identified using the MRI pictures, and those locations will be noted on the images. The patient will be given sedation while an ultrasound probe is inserted into the patient's rectum to scan the prostate. The ultrasound pictures from the rectum probe will be overlaid with 3D multi-parametric MRI images of the prostate. This is the basis for the term "fusion biopsy" Once the targeted location has been reached with the biopsy needle, the sample collection procedure will be finished.

Number of samples to be taken from the suspicious lesion with the Mp-MRI/TRUS fusion biopsy
The prostate cancer guidelines from the EAU and AUA do not specify how many samples should be taken from the lesions identified by Mp-MRI. According to studies, this number may vary; nonetheless, it is crucial to collect at least two samples from the worrisome lesion.

What are the advantages of fusion biopsy over conventional prostate biopsy?

  •  The biopsy needle is directed to the regions that are thought to be malignant using a three-dimensional map of the prostate created using the fusion approach. A fusion biopsy is more likely to detect aggressively spreading prostate tumors than a traditional biopsy in patients who get that treatment.
  • Despite the precautions, there is a substantial risk of infection and septic complications after a traditional biopsy depending on how many tissues are removed. Because only the target is used in this fusion biopsy, there will be fewer samples taken, which lowers the chance of infectious problems.

In summary, it is useful because;

  •  It will accurately identify the suspicious locations that require further inspection.
  • It may lessen the requirement for tissue samples. less uncomfortable, less chance of bleeding and infection

What preparations are required before the biopsy?

Antibiotics will be given for a few days prior to the procedure in order to lower the chance of infection. Aspirin and other blood thinners shouldn't be used by the patient. If the patient has been taking such medication, it is crucial that they cease using it for one week while being closely monitored by a doctor. The patient must refrain from eating for the past six hours before to the surgery. Patients who experience constipation may need to use laxatives since the rectum needs to be emptied during the surgery.

How long does the procedure take?

The procedure takes 15 to 25 minutes.

Will the procedure be painful?

Thanks to anesthetic medication patients usually do not feel any pain during fusion biopsy.

What is the post-biopsy procedure?

Blood may be present in the urine, feces, and semen for three months following the biopsy for one week. There is no cause for concern, as the bleeding will stop on its own. The most recent EAU guideline advises using oral or intravenous antibiotics prior to the biopsy and suggests quinolone antibiotics as the first line of treatment. However, it's also important to consider the local antibiotics' resistance. A doctor should be called if fever is felt during this time (it is rarely noticed).

What should the patient do after the biopsy?

To prevent constipation after the treatment, the patient needs to drink a lot of water and consume foods high in fiber.

Is transrectal method the only way to carry out fusion biopsy of prostate?

Instead of the transrectal area, the biopsy can be performed transperineally on eligible patients (the region between the testicles and the rectum). This further reduces the chance of infection.

  • the needing being inserted through the rectum wall (transrectal biopsy). This prostate biopsy technique is the most popular.
  • Transperineal biopsy (insertion of the needle via the skin between the rectum and the scrotum). To get a tissue sample, a small incision will be made in the skin between the rectum and scrotum. The biopsy needle will then be inserted within the incision and directed toward the interior of the prostate. The process will be directed by MRI screening.

What are the possible side effects of the biopsy?

The most frequent side effect following a prostate biopsy is hematuria (blood in the urine), which often disappears completely after a few days.

Hematochezia, or blood in the rectum, is another frequent symptom that affects 2 to 22 percent of patients. A clinically inconsequential issue known as hematospermy—blood in the ejaculate—occurs in 50% of people after the procedure and may last for a few months. Antibiotics are a simple solution for the majority of infectious problems. However, cases of deadly sepsis following prostate biopsy have been reported.