Prostate biopsy for the interventional radiologist

Abstract

Prostate biopsies are usually performed by urologists in the office setting using transrectal ultrasound (US) guidance. The current standard of care involves obtaining 10-14 cores from different anatomic sections. Biopsies are usually not directed into a specific lesion because most prostate cancers are not visible on transrectal US. Color Doppler, US contrast agents, elastography, magnetic resonance (MR) imaging, and MR imaging/US fusion are proposed as imaging methods to guide prostate biopsies. Prostate MR imaging and fusion biopsy create opportunities for diagnostic and interventional radiologists to play an increasingly important role in the screening, evaluation, diagnosis, targeted biopsy, surveillance, and focal therapy of patients with prostate cancer.

Published by Elsevier Inc.

Figures

Figure 1

Normal anatomy of prostate on axial (a) and sagittal (b) view. Peripheral zone is indicated by arrows.

Figure 1

Normal anatomy of prostate on axial (a) and sagittal (b) view. Peripheral zone is indicated by arrows.

Figure 2

Coronal view of standard extended 12-core prostate biopsy scheme, dots estimate planned biopsy sites.

Figure 3

Axial image demonstrating central calcifications and a hypoechoic lesion (cursors)

Figure 4

Hypoechoic lesion (cursors) on axial view (a), and ultrasound probe was rotated to show lesion (arrows) on sagittal view (b)

Figure 4

Hypoechoic lesion (cursors) on axial view (a), and ultrasound probe was rotated to show lesion (arrows) on sagittal view (b)

Figure 5

Region of the left base peripheral zone demonstrates hypervascularity (arrow).

Figure 6

MRI of the prostate in a 63-year-old male with prostate cancer. Axial T2W image demonstrates a right sided low signal intensity lesion at the peripheral zone (arrow) (a), the lesion demonstrates diffusion restriction on corresponding apparent diffusion coefficient map of DWI MRI (b) (arrow); lesion shows increased enhancement on axial T1W DCE-MR image, whereas color coded kep map delineates the lesion (arrow) (d). MR spectroscopy demonstrates increased choline to citrate ratio within the right peripheral zone lesion (e). This lesion was biopsied under TRUS/MRI fusion system guidance and was found to include Gleason 8 (4+4) tumor.

Figure 7

MRI registered with ultrasound visualized in the axial plane (a) and sagittal plane (b). A biopsy target is located in the left apical mid area of the prostate and visualized in red. Needle trajectory is shown by the red dots, and the orange line maps the biopsy location for archiving and later use.

Figure 8

Cancer detection rates for biopsy cores were compared between standard 12-core TRUS biopsy alone and MRI/US fusion guided biopsy alone (Reproduced with permission from Pinto et al. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol 2011; 186:1281–5)