Better Prostate Biopsy – new study

Share Button

New Study from JAMA shows a better prostate biopsy is gaining momentum


Takeaway First

JAMA study suggests men undergoing a prostate biopsy to check for cancer should look for a targeted MR/ultrasound fusion biopsy (or, more simply, a “targeted biopsy”) which can find deadly cancer more accurately than a standard ultrasound-guided prostate biopsy (more simply, a “standard biopsy”)

Study Details

  • Participants were 1003 men undergoing both targeted and standard biopsy concurrently from 2007 through 2014 at the National Cancer Institute in the United States.
  • The primary goal was to compare targeted and standard biopsy approaches for detection of high-risk prostate cancer (Gleason 7 (4+3) or higher)
  • The secondary goal focused on detection of low-risk prostate cancer (Gleason score 3 + 3 or Gleason 7 – (3 + 4)] and the biopsies’ ability to predict the risk of disease after prostate removal and observed by a pathologist.
  • Targeted biopsies diagnosed 30% more high-risk cancers than standard biopsies (Siddiqui et al., 2015).

My Take On Prostate Biospies

At this point, the notion that you can get a better prostate biopsy with the MR/Ultrasound technology is a no brainer. Men who suspect they have prostate cancer should only be looking for cancer that could kill them. (That’s the more important kind.) For all others, say a Gleason score of six or less, we should “let sleeping dogs lie” as the saying goes.

The rub is that it is difficult to find physicians who perform targeted biopsies in the U.S or in the rest of the world. Community physicians are particularly unlikely to perform this newer form of test because there is a relatively steep learning curve, not to mention higher costs, associated with MR/US fusion biopsies. Also, targeted biopsies are a team effort among urologist, radiologist and pathologist. As it pertains to radiologists, the training in performing MRIs and interpreting the images requires a specialized skill specific to prostate doctors. In other words, radiologist who typically looks for cancerous lesions of the breast may be underqualified to find lesions of the prostate.

What Should You Do if you need a Prostate Biospy?

If you are able to travel and get the right type of prostate biopsy (MR/US guided prostate biopsy), then do so. A regular ultrasound prostate biopsy is, frankly, antiquated right now and may either miss potentially deadly prostate cancer cells (a false negative) or find insignificant non-deadly cancer cell that are not worth worrying about. A cancer diagnosis of indolent cells, while still better than deadly cells, still provokes anxiety. And an anxious life is no way to live.

Current sites that do targeted MR/US guided prostate biopsy include:

NYU Smilow Comprehensive Prostate Cancer Center, New York – CLICK HERE

National Cancer Institute department of Urology, Maryland – CLICK HERE

UCLA Urology, Los Angeles – CLICK HERE

Dr. Steve Scionti, Sarasota, Florida – CLICK HERE

This list is incomplete as I am still learning about groups performing MR/US fusion prostate biopsies.

If you are a physician reading this and you perform MR/US fusion prostate biopsy please let us know down at the comment section.

Share Button

by Dr. Geo

15 comments… add one
  • mark saunders 02/04/2015, 9:31 AM

    Dr. Geo,

    Please add Dr. Emilia Ripoll at Choices ( in Health in Boulder, Colorado to the list of urologists/urologic oncologists who are using MRI fusion prostate biopsies.



    • Dr. Geo 02/04/2015, 9:33 AM

      Thanks, Mark. Regards to you and Dr. Ripoll.

      • Michael Zangwill 02/04/2015, 10:14 AM

        Hi Geo,

        Two weeks ago I had an MRI of the prostate at Park Ave. Radiologists. Last week Dr. David Samadi did a MRI guided biopsy. in his office. The anticipation was much worse than the procedure which took only about fifteen minutes and was not at all painful. I saw Dr. Samadi yesterday and all my markers were clean. What a relief. I told Dr. Samadi that I had seen you. He wants to recruit you to Lennox Hill. Hope you get a raise.

        • Dr. Geo 02/04/2015, 12:55 PM

          Ha. Thanks Michael. Dr.Samadi is very kind. I’m glad your biopsy outcome went well.

  • Dan 02/04/2015, 5:26 PM

    Dr Geo,

    I’d like to mention Dr. Stepehen Scionti. He performs the target biopsy

    • Dr. Geo 02/05/2015, 9:39 AM

      Dr. Scionti I know well as we worked together for a while here at NYU. He is an amazing diagnostician and focal therapy expert. Thanks, Dan.

  • Scott Berliner 05/06/2015, 9:53 AM

    Good morning Dr. Geo
    Dr. Ehdaie is running a study at Sloan on MRI guided biopsies. I am his patient and I am going for the MRI next week. I can’t say anything more about him at this time as I’ve only seen him once. The biggest issue with the guided biopsy is they still take samples from all regions of the prostate besides the suspicious ones as there isn’t enough data to limit it so my biopsy will be 15 samples.

    • Dr. Geo 05/08/2015, 9:21 AM

      Great point, Scott. Targeted biopsy are better, no doubt, but they are still learning what methods works best.

  • John 05/29/2015, 1:04 PM

    The Inspire web site maintains a list of 3TMRI facilities.

  • Larry Jones DDS 05/29/2015, 3:19 PM

    This week had I was a patient at Desert Medical Imaging for M/P MRI guided forcal laser ablation of a ,7×1.0x1.3cm malignant tumor (Gleason 7, 3plus4) in my prostate, which had been identified with a targeted biopsy several months ago..The proceedure went very well… with no after effects at all .This year I recieve follow up exams….Really impress with this conservative treatment….need to catch these things early……find an office that will do the multi parametric MRI..

  • Ronnie Ratliff 08/23/2017, 6:55 AM

    Do you know of any Dr’s in Oklahoma or North Texas that use this method ? I fear letting the VA hospital here do mine. My PSA is 12.76

    • Dr. Geo 09/16/2017, 10:39 AM

      Ronnie, Unfortunately I don’t know anyone in that particular area. I sent you and email. I hope you get it. Let me know how me and my team can help.

  • Andrew 10/01/2017, 2:30 PM

    Dr. Geo — Thank you for your site. It would be helpful if you could set the blog and comments to show dates, since I have no idea if I’m looking at info from recent or three years ago or more. As you know, this makes a difference.

    Also, I’ve been hearing about Dr. Dan Sperling’s center near New York City. Should he/they not be on your list above? My understanding is that they do MR/US-guided biopsy as well as 3TMRI.

    Lastly, the larger problem, as you no doubt know, is getting the insurance companies on board with this newer protocol. Mine wouldn’t pay for the 4K Score and wants me to go straight from PSA to TRUS biopsy! (4K = 9%)


    • Dr. Geo 12/04/2017, 2:15 PM

      Hi Andrew, Thank you for the “show dates” comment. I will do that. Dr. Sperling is in Florida now ( he used to be on NYC). Your 4K looks good.
      What is the update?

  • Warren 03/22/2018, 6:44 PM

    Dr. Geo,
    My urologist want me to Get an MRI and says it cannot be done without contrast. I am concerned with recent concern over gadolinium deposition possibility with questionable side effects. I am 68 my psa went from 3.5-4.9 in one years time and 4k is “on the high side”. Are you aware of another option/test other than mri that could be helpful to determine if biopsy is necessary? Thank you!


Leave a Comment

Next Post:

Previous Post: