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The prostate is a very difficult organ to image. The urology community has used the ultrasound for years with moderate success in visualizing abnormalities, but it has always been a challenge to see the minimally suspicious lesions in the prostate. Fortunately, the last 10 years changed all of that. The MRI has become much more powerful, and with that power came the ability to see abnormal areas in the prostate. Read more about the prostate MRI here (insert prostate MRI section) If an abnormal area is seen on the MRI, a fusion biopsy may be just what the doctor ordered.
Traditionally, men undergoing a regular biopsy will undergo an ultrasound-guided biopsy without the help of a previous MRI. This entails using the ultrasound probe to target multiple areas of the prostate using a 12-zone pattern. If there are abnormal areas in those zones, those will be targeted at that time with the ultrasound. The small specimens are then sent to the pathologist to be evaluated for cancer. People referred to these as “random” biopsies, but they are not truly random as they target specific zones of the prostate. Unfortunately, the ultrasound has limitations and many cancers can be missed with ultrasound guidance alone.
A fusion biopsy incorporates the MRI that has already been completed prior to the patient coming to the clinic. The MRI images are then fused with the live ultrasound images, and a “fused image” is made. This is only possible if an abnormal lesion is found on the MRI. Assuming a lesion is found on the MRI, the fused image is created, and the lesion is marked and targeted in a more precise fashion to evaluate whether the abnormal MRI lesion is cancerous. This can be tricky and depends on the quality of the MRI as well as ensuring the two images have fused together correctly. Dr. Rich Bevan-Thomas has one of the highest experience rates with the technology, dating back to 2012. He currently uses the inVivo and Dynacad platform by Philips.
Routinely, the local anesthesia takes care of any major discomfort. 2% lidocaine is injected around the prostate to minimize any issues; however, Dr. Rich Bevan-Thomas and Urology Partners currently offer nitrous oxide (i.e., laughing gas) for patients concerned about any pain and anxiety. Although there is an added cost to the patient for the nitrous oxide, many feel it helps with any anxiety that may be associated with the biopsy procedure.
Fusion biopsy is well tolerated by most men. As with any procedure, however, there are risks and possible side effects. The most common (although not all) side effects include: