Prof. Dr. Mustafa SOFİKERİM | Urology

MR-TRUS Fusion Biopsy

MR-TRUS fusion biopsy is a “smart biopsy” method with high sensitivity and accuracy in prostate cancer diagnosis. It is based on the idea that the magnetic resonance (MR) images on prostate are processed through a special software and integrated with real-time transrectal ultrasonography (TRUS) image. Thanks to advanced MR technology potentially cancer inflected points in the prostate are marked; the prostate images obtained from the Prostate MR-TRUS Fusion device during the biopsy are turned into 3d format again in the same device, then MR and TRUS images are interlaced to perform “fusion” process. Then, biopsy needle is directed to potentially cancer inflected MR points by means of navigation feature and ultrasonography thus launching the biopsy process aimed at target. However, biopsy samples are also obtained from standard points by using the classical method accompanied with transrectal ultrasound. The rate of cancer in patients with normal examination results and high PSA is 25-30%. Classical biopsy can only diagnose 70-75% of existing cancers. Depending on the number of particles obtained from the body, the risk of infection and septic complication is high despite preventive measures. By using MR-TRUS fusion biopsy, it is possible to diagnose 95% of existing cancers. Thanks to MR-TRUS fusion biopsy, it is now possible to diagnose the incidence of clinically significant cancers in patients with no tumor, persistent PSA elevation and recurrent prostate biopsies. It allows for biopsy from areas that cannot be visualized by ultrasound, which are technically difficult to sample.

How Prostate Fusion Biopsy is made?

Biopsy is usually performed with regional local anesthesia. An antibiotic is given to reduce the risk of infection before the procedure. Multiparametric MRI is performed before the patients undergo a fusion biopsy. The limits and size of the prostate gland are determined by fusion biopsy ultrasonography. Multiparametric MRI is used to mark areas of high tumor risk. These images and TRUS-guided images are overlapped and the 3D model of the prostate is created.

With this method, a prostate biopsy is performed by targeting the suspected areas of MRI in the prostate rather than taking blind biopsies. In this method, the patient's previously taken Mp MR images are matched with real time transrectal ultrasonography images on a ultrasound device with sensors that are placed on the ultrasound probe and a special equipment and software containing the electromagnetic apparatus following the movement of these sensors. Thus, in MR imaging, biopsies are taken from suspected points of real-time USG images to prevent biopsy recurrence and to detect clinically important prostate cancer cases. However, in some cases, the standard biopsy technique (especially in patients without previous biopsy) continues to be applied in addition to the samples taken from the target, as clinical significant cancer can also be bypassed in the targeted biopsy.