mpMRI-fusion prostate biopsies
What is it?
MRI fusion prostate biopsy is a procedure that involves taking tissue samples from the prostate gland in particular suspicious areas detected by Multiparametric Magnetic Resonance Imaging (mpMRI) using a special needle. Over the last few years the mpMRI of the prostate has proven to be an extremely accurate method in detecting the presence of prostate neoplasia. The value of mpMRI lies in its ability to identify mainly those prostate tumors defined as "clinically significant", i.e. potentially life-threatening and requiring radical treatment. In contrast, the tumors that MRI cannot identify are generally of low aggressiveness (i.e. clinically insignificant or negligible) and not life-threatening. The current trend, in fact, is to omit prostate biopsy in case of mpMRI negativity (PIRADS ≤ 2) given the high negative predictive power of this method.
When is this exam indicated?
Patients with a previous diagnosis of prostate neoplasia in surveillance or suspicion of prostate neoplasia, who have had a mpMRI of the prostate for diagnostic purposes, that was positive for suspicious lesions (with PIRADS score ≥3).
How is it performed?
Prostate needle biopsy is performed using images from an endorectal ultrasound probe as a guide. The biopsy can be performed using an endorectal approach (transrectal biopsies) or a direct access through the skin of the perineum, i.e. the area located between the rectum and the scrotum (transperineal biopsies). Thanks to the combination of ultrasound and MRI images, it is possible to perform targeted biopsies of prostate areas suspected for cancer. The biopsy procedure is usually performed by first taking targeted biopsy samples (2-5 samples) and then random samples with sextant technique (12-20 samples). All tissue is sent to the anatomic pathology laboratories for histological analysis. The number of samples to be taken is defined according to anamnestic, clinical and biochemical data (usually varying between 12 and 24 total prostate samples), optimizing the number of samples to obtain a valid sampling, limiting the risk of potential adverse events. For patients with previous negative prostate biopsies, performing targeted sampling only may be considered.
Prostate biopsy is an outpatient procedure and does not require hospitalization. For a number of patients, due to the presence of a particularly low pain threshold or the presence of severe cardiovascular disease, anesthesia may be recommended. In the latter case, receiving anesthesiological assistance and performing the procedure under sedation, hospitalization and/or Day Surgery is required.
Contraindications
In case of ongoing anticoagulant/antiaggregant therapy or coagulopathies there could be an increased risk of bleeding related to the procedure. Therefore, appropriate measures shall be taken to limit the risk.
Where do we treat it?
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