No longer a newbie, but with an even more urgent question
I was recently asking Richard Faust, the administrator of this website, about multiparametric MRI-guided biopsies and in his answer he linked me to this article about it from the Cleveland Clinic, which he said explained it very well:
https://my.clevelandclinic.org/health/diagnostics/16382-mri-guided-prostate-biopsy
Richard, and the linked article, both said that it wasn't exactly an MRI-guided biopsy, rather, they would do an MRI to precisely locate suspicious sites on the prostate and then use those results to perform the usual TRUS biopsy. It's called a fusion biopsy, and they employ all sorts of clever techniques to create a fusion between the MRI information and the TRUS.
That's all correct, but now comes a surprising wrinkle. One of the websites I've gone to in recent days says they do a LIVE multiparametric MRI biopsy-- without using fusion! (A fusion biopsy requires TWO steps-- first the MRI is done, then they fuse the results of the recent MRI with the TRUS biopsy, and it's the TRUS that is done live.) Here is the link to this website, it's the SperlingProstateCenter website, where they lay out the pros and cons of the parametric MRI biopsy vs the fusion biopsy:
https://sperlingprostatecenter.com/mri-guided-biopsy-vs-fusion-whats-difference/#
So my more urgent question is: How do they even do a LIVE biopsy while someone is having an MRI and is it really superior to a fusion, as this website intimates?
I spoke with Sperling after my mpMRI came back PIRADS 3
My sense is: 1) he does a lot of biopsies and the in-bore method sounds like an advance, but how much is unclear; 2) he’s a business man as much as a physician, so he’s making $$$
In the end, I felt very comfortable with my experience onc at UCSF who convinced me that fusion is effectively standard of care. I’m lucky to live so close to a premier hospital. My philosophy has always been find the best docs at the finest facilities possible. There are obviously some incompetents out there, but if you ask the right questions, you can generally sort them out.
Good luck!Yes, ajeffrey10, fusion has, I believe, replaced TRUS as standard of care in Europe and with very good reason!
And with fusion there is, of course, a crucial time interval between the multiparametric MRI and the subsequent Ultrasound (to provide an opportunity for the information garnered by the MRI to be fused with the ultrasound to allow for a precise targeting of suspicious areas of the prostate-- something a plain old TRUS can't do).
My understanding is that the Sperling MO does NOT involve two different, time-separated procedures, which makes me wonder how much actual guidance the performer of the biopsy is getting from the MRI. Is even the most knowledgeable doctor genuinely able, IN REAL TIME, to instantly make delicate decisions about where to insert the biopsy needles? I know I'd prefer to have a skilled urological oncologist peruse the MRI images of the prostate, and then, additionally, have those images fused with the ultrasound before he undertakes my biopsy.
As I understand it, PIRADS 3 isn't too bad at all, especially given the alternatives (PIRADS 3 has a low risk of clinically significant cancer, at least one study showed) I hope your actual biopsy was, similarly, not too dire.I think your understanding of fusion vs in bore is right on. I had mpMRI 12/8/21 and biopsy 4/13/22. Got the results last week and 18 benign cores! Phew
My oncologist indicated that a few month interval between MRI and biopsy is not a risk factor, which seems to make sense. If anything, if any cancer is growing, it would probably be easier to see on subsequent fusion biopsy.
In all cases, one is reliant on the skill of the clinician reading the MRI. That’s the biggest risk, regardless of technique, imoThank you! It was indeed a good weekend in my house.
The biopsy was uneventful, other than the expected blood in stool and urine which lasted for a few days, and blood in ejaculate that still hasn’t entirely cleared up. It was a transrectal biopsy, and I took 100 mg Cefopodoxine the night before and the day of. There was no other antibiotic. The pills were standard medications, swallowed whole.
My onc mentioned that excellent rectal cleansing w/an enema the day of improved his visibility and further lowered chance of infection, fwiw.Hi Richard. Since you are an omnivorous consumer of all things prostatical (a word not yet recognized by the linguistic world, but I like it anyway!), I thought you might be interested in how the Sperling Prostate Center does THEIR MRI- guided biopsy. I just spoke at length to one of their nurse-educators who laid it all out for me.
First, it turns out that their claim that it's a LIVE MRI-guided biopsy is not EXACTLY correct. It is live and it is MRI-guided, but the two adjectives don't apply simultaneously. Their procedure is to do an mpMRI of the prostate and then process the images with AI and create a grid-- while the subject relaxes for about 40 minutes. (Meanwhile, another patient is in the MRI-- they don't waste time at this place!) Then, when the grid has been prepared, the patient undergoes the TRUS biopsy-- though of course he's not in the MRI at that time, so we can all put aside our visions of a doctor having to crawl into the tube with the patient! As a matter of fact, though a technician is standing next to the patient, he is not actually performing the biopsy. That is done robotically, directed or overseen by Dr. Sperling, from a control room some distance away.
So it turns out that all these mpMRI-guided biopsies are similar: they all rely on a two-step procedure, where the mpMRI first takes sophisticated images that are used to discern the most cancer-suspicious areas of the prostate, which are then targeted in the second step-- the actual biopsy. Whether it's 'fusing' that information with the ultrasound, or creating a grid with the information, as at the Sperling Prostate Center, or using the info in some other way, as with the In-bore technique, they're all essentially doing the same thing, but in slightly different ways.
And, just to be clear, Sperling's MRI produces a PI-RADS score, just as the others do.
Thanks. I’m not sure one can conclude anything from a 1.5T mpMRI. 3T is the standard, and centers like Sperling won’t even offer a second opinion based on a 1.5T scan
