Magnetic Resonance Imaging-Guided Prostate Biopsy: How We Do It

Abstract

Introduction: Prostate biopsy is typically performed under transrectal ultrasound (TRUS) guidance. However, even after multiple negative TRUS biopsies, the considerable risk of prostate cancer (PCa) remains due to undersampling.1,2 Magnetic resonance imaging (MRI) is increasingly used in clinical practice to guide prostate biopsies.3,4 In this video, we describe how we perform in-bore MRI-guided prostate biopsy and present an overview of this biopsy technique. The runtime of this video is 5:08 min. Materials and Methods: The biopsy procedure is illustrated by a clinical case of a 61-year-old male with a high clinical suspicion of PCa referred to our institution after six negative TRUS biopsy sessions. On preceding multiparametric MRI, a cancer suspicious region was identified at the left ventral transition zone. Targeted biopsy of this lesion was performed in a transrectal approach on a 3 T MR system using an MR-compatible biopsy device. In total, two biopsy cores were obtained from the suspicious region. Results and Conclusions: The illustrated case was performed in 26 minutes. On histopathology, a Gleason score 4+3 = 7 adenocarcinoma was present in, respectively, 8% and 50% of biopsy specimen volumes. In our institutional experience, an MRI-guided prostate biopsy in patients with previous negative TRUS biopsies achieved PCa detection rates in the order of 41%–59% using a median of three to four cores.5,6 Of detected cancers, 87%–93% was clinically significant. Median procedure time was 30–44 minutes. Urosepsis occurred in 0.4% of patients. Minor complications were observed in 1%–1.5% of patients. Overall, MRI-guided biopsy achieves high diagnostic performance, detecting more and predominantly clinically significant cancers using less cores than TRUS biopsy.7 Complication rates between both biopsy techniques are comparable.7 However, longer procedure times and limited general availability are limitations of the MRI-guided biopsy method. In conclusion, we feel that in-bore MRI-guided biopsy is an accurate and safe diagnostic tool to detect clinically significant PCa in patients with previous negative TRUS biopsies. C.O., J.B., D.Y.: Nothing to disclose; J.F.: Consultancy for Invivo, Schwerin, Germany. Runtime of video: 5 mins 8 secs