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In particular, patients whose PSA levels continue to rise despite a negative biopsy and the suspicion of cancer persists benefit from MRI-guided biopsy.
Diagnosis without a biopsy? Patients with suspected prostate cancer are repeatedly told that a tissue biopsy is unnecessary today. Instead, a magnetic resonance imaging (MRI) of the prostate is sufficient to confirm the suspicion of cancer, they say. "A mistake that can sometimes have fatal consequences," says Dr. Pedram Derakhshani, urologist at the West German Prostate Center: because even in areas that appear inconspicuous in the MRI, prostate carcinomas are found in up to 30 percent of cases, says the Cologne urologist. "That is why a tissue sample must always be taken in addition." So if there is a suspicion of prostate cancer due to increased PSA values, a conspicuous ultrasound and/or palpation findings, only a biopsy can still provide clarity. "To date, prostate biopsy is the only way to clearly identify prostate cancer and determine its spread and malignancy," Derakhshani explains.
Combination of MRI and ultrasound offers highest diagnostic safety
"However, in order to obtain a more precise assessment of tumor localization, it is advantageous to scan the patient's prostate with an MRI prior to the actual biopsy." This creates a kind of "map" in which tumor-suspicious areas are marked, which the urologist can then use to orientate himself precisely when removing the tissue. The actual biopsy then takes place in a second step under the control of a high-resolution transrectal ultrasound. "By combining the two diagnostic procedures, we increase the hit rate and can spare the patient possible further biopsies," Derakhshani says. As recent studies show, the detection rate of prostate cancer in a biopsy assisted with a 3 Tesla MRI after tissue has already been removed is 41 percent, significantly higher than the 10 to 20 percent for a biopsy performed under transrectal ultrasound.
State-of-the-art imaging in the diagnosis of prostate cancer
However, the accuracy of the MRI findings always depends on the experience of the examiner and the technical equipment. For the so-called MRI-assisted biopsy, the Cologne urologists, in cooperation with the radiology department of the KLINIK am RING, use the currently most modern imaging procedure and combine it with the punch biopsy. While most facilities have magnetic resonance tomographs with a field strength of 1.5 Tesla, the clinic in Cologne can boast one of the most modern, high-resolution MRIs, the 3 Tesla MRI.
"This allows us to detect prostate carcinomas with a significantly higher sensitivity and speci-fity than is possible with the standard transrectal ultrasound (TRUS)," Derakhshani is pleased to say. "Especially for patients whose PSA levels continue to rise despite a negative biopsy and the suspicion of cancer remains, the MRI-guided biopsy is a useful and important addition to the diagnostic spectrum," says the urologist.
