Better Prostate Biopsy – new study

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.