The treatment outcomes for men with prostate cancer are directly linked to how early they are diagnosed. The earlier a man with prostate cancer is diagnosed, the better his outcomes. Therefore, screening methods such as prostate biopsies, digital rectal examinations, PSA testings, prostate ultrasonography, and prostate perfusion dynamic MRIs are all very important in determining which patients are at risk of having cancer.
When a man is noted to be at risk of having prostate cancer, tissue samples need to be obtained to confirm the diagnosis and to be able to determine the stage and grade of his cancer. The sampling of the prostate for the presence of cancers is called a prostate biopsy. To learn more about prostate biopsies, or to schedule an appointment with the Comprehensive Urology of LA, please contact us today!
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Traditional Prostate Biopsy Techniques
Traditionally, during a prostate biopsy a urologist places an ultrasound probe into the patient’s rectum. Since the prostate is located just in front of the rectum, the prostate can be seen and evaluated in this manner. With the guidance of the ultrasound probe, the prostate can then be biopsied.
For some time this has been the most technologically advanced means of performing biopsies for men.
However, this approach has many shortcomings, including the following:
1. Most prostate cancers are not identifiable with an ultrasound.
In essence, a urologist is doing a relatively blind biopsy of the prostate, making it unlikely that the cancer will be correctly identified and biopsied, as compared to new advances such as MRI-guided fusion biopsies.
2. The procedure can be uncomfortable.
Many urologists attempt to anesthetize or numb the area before a prostate biopsy is performed. Although it can make the procedure more comfortable, this approach can be quite limited, and, in many circumstances, the procedure can be quite uncomfortable. When a patient is uncomfortable during the procedure, the urologist is typically not able to perform as detailed of an evaluation and the resulting biopsy may be more limited, thereby not providing all the information necessary to correctly diagnose and make correct treatment recommendations. For this reason we highly recommend and routinely perform prostate biopsies with mild sedation, making the procedure completely painless and more accurate because of the ability to more thoroughly assess the prostate.
Advanced Prostate Biopsy Techniques
There have been three major advances in the field of prostate biopsies over the past several decades. These advances include improvements in the following three categories:
Advances in Anesthesia for Prostate Biopsies
By providing better anesthesia during prostate biopsies, a patient is much more comfortable during the procedure, and in turn the physician is able to perform a much more thorough and detailed biopsy.
The Comprehensive Urology of LA perform prostate biopsies with a new approach that makes the biopsy a pain free experience. First, we provide a patient intravenous sedation. With sedation, the experience is quite pleasant as no discomfort is felt and our patients are very calm during the biopsy. After providing the sedation, the pain fibers of the prostate are blocked with an anesthetic, so that even after the biopsy is completed, our patients remain comfortable. As a result of providing better prostate anesthesia for our patients, we can perform a more detailed and thorough biopsy evaluation.
Prostate Imaging and Ultrasound Biopsy
The most important advance for prostate biopsies has been in the form of improved imaging technology. Advances in MRI imaging now allow the Comprehensive Urology of LA to identify many prostate cancers with unprecedented accuracy.
During an actual prostate biopsy, however, ultrasound (not MRI) is used to guide the urologist. The difficulty to date has been how to translate the information from an MRI to the urologist who is using an ultrasound to perform the biopsy.
Advances in medical imaging technology now allow the Comprehensive Urology of LA to use the MRI images and overlay them on the ultrasound images in real time (MRI fusion biopsy). That means that we are able to use the MRI as a real-time map when doing an ultrasound evaluation of the prostate. We are therefore no longer performing relatively blind biopsies, but in fact are able to have very targeted, precise prostate samplings.
This technological advance has been revolutionary. At the time of the biopsy, the Comprehensive Urology of LA can now see the lesions and accurately biopsy them. This leads to more precise diagnoses and fewer repeat biopsies for patients.
The following are some examples of how an ultrasound biopsy can easily miss significant prostate cancers:
1. By missing the actual mass of the cancer and only hitting the side of the cancer, doctors can be fooled in to believing that the cancer is quite small when in reality it is quite sizable and potentially life-threatening.
2. Depending on the location of the prostate cancer or the size of the cancer, an unguided biopsy can miss the cancer altogether. In this situation, a patient is erroneously told that they are cancer-free while there is a dangerous cancer growing in their prostate, unknowingly. These lesions will typically present in a much more advanced stage where the overall prognosis for patient can now be quite limited. The importance of an MRI fusion biopsy cannot be overstated.
To be able to deliver focal prostate cancer therapy, we need to be able to reliably identify the location of the cancer. This is now possible due to the advances in imaging, as well as new biopsy techniques. By using the UroNav system for our biopsies, we can record the locations of the positive biopsies in a three dimensional manner and correlate that information with the tissue biopsy findings.
By being able to identify the location of the cancer, the Comprehensive Urology of LA can deliver focal therapy to the involved areas, thereby treating the cancer, while preserving normal, healthy prostate tissue.