Fusion Biopsy Improves Detection of Prostate Cancer

The TopLine

  • Fusion-guided biopsy combines MR images with real-time ultrasound images to create a better target for the biopsy
  • The technology can help lower the risk of missing aggressive tumors and can avoid future unnecessary biopsies

An innovative technology called MR/ultrasound fusion prostate biopsy is allowing Fox Chase physicians to take a much more targeted approach to the collection of tissue samples from patients undergoing prostate biopsies. Currently, patients with low-risk prostate cancer often choose a strategy of active surveillance, the recommended course to avoid overtreatment. Yet there is a risk of disease progression, especially if the cancer is more aggressive than initially thought. Fox Chase uses the most up-to-date clinical tools available, including cancer biomarkers and genomic profiling, to ensure that risk stratification is accurate and treatment decisions are informed. Fusion-guided biopsy is the newest tool in this arsenal.

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Fusion biopsy technology allows for correlation of real-time ultrasound imaging (top left) with high-definition multi-parametric MRI information, matched and paired using different imaging perspectives—axial perspective (bottom left) and sagittal perspective (top right). The result is a real-time 3-D construct (bottom right). The red and green circles highlight the sampling focus; the yellow line represents successful biopsy and sampling of the target.

“Fusion-guided biopsy combines MR images of the prostate with real-time ultrasound images, giving us a better target to aim for during the biopsy,” says urologic surgical oncologist David Y.T. Chen, MD, FACS, director of the Society of Urologic Oncology Fellowship Program at Fox Chase. In addition to patients on active surveillance, the technique is also useful for people who have had biopsies that came up negative yet still are strongly suspected of harboring cancer.

Fox Chase, one of the first places to employ fusion-guided biopsy technology outside of clinical trials, has already performed biopsies on more than 60 patients. For a few of these patients, the technology has uncovered aggressive cancers that would not have been recognized otherwise. According to Chen, the technique can “increase the likelihood of finding significant cancer by two- or three-fold.”

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This technology allows for an accurate record of the biopsies taken throughout the prostate, including both samples from a target site (yellow) and non-directed template biopsy; the location of 14 cores is marked on this image.
Images courtesy of Art Rastinehad, DO

A recent study in the Journal of the American Medical Association found that, while MR/ultrasound fusion biopsy detected 17 percent fewer low-risk cancers than a regular biopsy, it detected 30 percent more high-risk cancers. In the study, fusion biopsy also allowed physicians to more accurately distinguish between low-risk and high-risk forms of the disease.

“It’s a very promising technology that helps patients potentially avoid future unnecessary biopsies and, at the same time, lowers the risk of missing aggressive tumors,” says urologic surgical oncologist Alexander Kutikov, MD, FACS. “Fox Chase has long had a robust active surveillance program and this technology allows us to provide patients on active surveillance an extra level of comfort that we won’t miss aggressive tumors if they develop in a hard-to-reach area of the prostate.” Temple Health, of which Fox Chase is a part, is one of the first health systems in the region to offer this technology.