3D MRI- GUIDED FUSION BIOPSY
Multiparametric MRI scans have given us far superior guidance as to the location of tumours within the prostate. Big tumours can be easily targeted by experienced clinicians like Mr Dudderidge. However smaller lesions or lesions within large prostates may not so easily be accurately targeted. Furthermore with so called “cognitive” fusion biopsy, where the clinician uses their spacial awareness of the prostate and their experience to hot the target, there is no record of where the needle was deployed.
HOW DOES THE PROCEDURE WORK?
Using software to link the contoured MRI images, marking out the prostate and any lesions, to the live ultrasound, biopsy can be deployed straight into the target and a record of the location can be recorded for future review. If you would like to understand more about 3D Fusion Biopsy visit https://www.smarttarget.co.uk
Multiparametric magnetic resonance imaging – or MP-MRI- is the most advanced imaging for localised prostate cancer we have. Mr Dudderidge was a significant contributor to the PROMIS study, which showed that the scan was about 90% accurate in the detection of important disease and that at least 25% of men could avoid a biopsy when trying to detect clinically significant disease.
WHAT IS MRI SCANNING?
MRI was once used for testing men whose biopsies showed cancer. Now Mr Dudderidge uses MP-MRI prior to any invasive testing and in many men biMultiparameticopsies can be avoided completely after having this scan.
MRI scanning requires high quality equipment, experienced and skilled radiographers and specialist radiological interpretation. The team at the Spire use the latest Siemens MRI scanner and it has been optimised to deliver prostate MRI scans that meet the stringent European Society of Uro-Radiologists guidelines for MP-MRI.
Dr Ken Tung and Dr James Smart both reported MRI scans for the PROMIS study and have had specialist training in assigning PIRADS scores to patients scans. This score helps define the risk of cancer on the scan and helps Mr Dudderidge to decide who needs a biopsy.
WHAT HAPPENS IF I NEED AN MRI?
The MP-MRI takes 45 minutes and requires an injection of contrast. Mr Dudderidge sees many men who present with high PSA and will typically try and get a scan the same day. Please ask ahead of your initial visit if you think you may need a scan and we can book you in. Some patients are not suitable fro MRI scans so please let me know if you have any metal implants or if you are claustrophobic.
URODYNAMIC STUDIES (UDS)
Mr Dudderidge may request urodynamic studies if you have urinary symptoms. Many men with symptoms can be managed based upon interpretation of your symptoms, your urine flow rate, your bladder ultrasound after urination and your bladder diary. However in cases where there is uncertainty or a need for proof prior to invasive procedures the urodynamics test the bladder pressure during bladder filling and emptying.
HOW DOES THE PROCEDURE WORK?
The test involves placing a small tube (a catheter) in the bladder and the rectum. The bladder tube fills the bladder with fluid and both tubes measure pressure and allows a calculation of the work of the bladder muscle, the detrusor.
The aim is to detect the presence of obstruction, bladder instability and the type of any urinary incontinence identified. The procedure is performed in clinic and you can go home soon after the test is done.
This type of prostate biopsy obtains samples from all sectors of the prostate with a sampling density ranging from 4 biopsies per sector (24 in total) to every 5mm throughout the gland. The latter approach is the most accurate and was the biopsy used in the PROMIS study that proved the value of MRI scanning in diagnosis.
WHAT ARE THE RISKS?
This type of biopsy has a high risk of side effects so its not usually employed by Mr Dudderidge. The more limited sampling still covers all areas of the gland with less intensive biopsies to the transition zone where cancers are less frequent. Any areas of abnormality on the MRI scan are specifically targeted.