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‘Low-Risk’ Prostate Cancer? Image-Guided Biopsy: Maybe Not

May 29, 2014
Written by: , Filed in: Diagnostic Imaging, Interventional Radiology
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A new, more precise type of prostate biopsy, guided by both MRI and ultrasound, showed that more than a third of prostate cancer patients enrolled in a “watchful waiting” program should have been receiving more aggressive treatment, according to a UCLA study.

Senior author Leonard Marks, a UCLA urology professor, directs the university’s prostate cancer active surveillance program, which encompasses nearly 400 patients. He said the study has changed the program’s approach:

We are hesitant now to enroll men in active surveillance until they undergo targeted biopsy. Fusion biopsy will tell us with much greater accuracy than conventional biopsy whether or not they have aggressive disease.

Dr. Marks was quoted in a UCLA news release. An article about the study was published last week in The Journal of Urology.

Active surveillance involves forgoing therapy while monitoring the tumor with PSA tests, digital rectal exams, and ultrasound scans. Such a “watchful waiting” regimen is appropriate only for those with slow-growing cancers, as determined by a biopsy.

The new study suggests that a traditional unguided biopsy is not sufficient for determining the aggressiveness of prostate cancer. UCLA’s new method, which the university has been exploring since 2009, involves something called the Artemis Device. It fuses MRI images of the prostate with real-time, three-dimensional ultrasound, allowing the urologist to precisely target MRI-flagged lesions during the biopsy.

“Prostate cancer is difficult to image because of the limited contrast between normal and malignant tissues within the prostate,” Dr. Marks said. “With the Artemis, we have a virtual map of the suspicious areas placed directly onto the ultrasound image during the biopsy. When you can see a lesion, you’ve got a major advantage of knowing what’s really going on in the prostate.”

Of 113 men in the new study, the guided biopsy, also known as fusion biopsy, determined that 41 (36 percent) had more aggressive cancer than initially thought, meaning they actually should have been receiving treatment rather than surveillance.

“These findings are important, as active surveillance is a growing trend in this country,” said Dr. Marks. “It’s an excellent option for many men thought to have slow-growing cancers. But we show here that some men thought to be candidates for active surveillance based on conventional biopsies really are not good candidates.”

Related CME seminar (up to 25.25 AMA PRA Category 1 credits™): UCSF Interventional Radiology Review

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