By Carlos R. Hamilton III, M.D.
There are some instances in life when knowing less is more, but when it comes to your health it’s better to be armed with information and a clear diagnosis. MRI-guided biopsy is the key when it comes to prostate cancer. MRI is what enables healthcare providers to see more and provide an accurate diagnosis.
Prostate MRI allows for direct visualization of prostate cancers so that we are able to biopsy specimens specifically from a suspicious area. Until recently, only ultrasound guidance has been available to guide prostate biopsies in a procedure called a TRUS biopsy (transrectal ultrasound). There are many shortcomings involved with TRUS biopsy. One such disadvantage of a TRUS biopsy as compared to MRI-guided biopsy is that while the ultrasound shows the location of the prostate gland, it does not show the internal architecture of the prostate gland. A TRUS biopsy is a blind biopsy of the prostate, which explains why up to 40% of cancers can be missed, and of those found, about 40% are understaged. Another limitation of TRUS biopsy is that only the posterior (back side) of the prostate gland is accessible, so any cancers in the anterior (front) of the prostate are missed. Another downside of TRUS biopsy is that if the biopsy is negative but clinical suspicion of prostate cancer remains, subsequent biopsies do not have a higher rate of detecting the cancer.
Since MRI-guided vs. TRUS biopsy is such a visual concept, we thought it would be best conveyed through these illustrations.