Prostate biopsy
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Prostate biopsy | |
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ICD-9-CM | 60.11-60.12 |
Prostate biopsy is a procedure in which small hollow needle-core samples are removed from a man's
The most frequent side effect of the procedure is blood in the urine (31%).[2] Other side effects may include infection (0.9%) and death (0.2%).[2]
Ultrasound-guided prostate biopsy
The procedure may be performed transrectally, through the
Extended biopsy schemes take 12 to 14 cores from the prostate gland through a thin needle in a systematic fashion from different regions of the prostate.[5]
A biopsy procedure with a higher rate of cancer detection is template prostate mapping (TPM) or transperineal template-guided mapping biopsy (TTMB), whereby typically 50 to 60 samples are taken of the prostate through the outer skin between the rectum and
MRI-guided targeted biopsy
MRI-US fusion biopsy | |
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Since the mid-1980s, TRUS biopsy has been used to diagnose prostate cancer in essentially a blind fashion because prostate cancer cannot be seen on ultrasound due to poor soft tissue resolution. However, multi-parametric
Two methods of MRI-guided, or "targeted" prostate biopsy, are available: (1) direct "in-bore" biopsy within the MRI tube, and (2) fusion biopsy using a device that fuses stored MRI with real-time ultrasound (MRI-US). Visual or cognitive MRI-US fusion have been described.[13]
When MRI is used alone to guide prostate biopsy, it is done by an
In the fusion MRI-US prostate biopsy, a prostate MRI is performed before biopsy and then, at the time of biopsy, the MRI images are fused to the ultrasound images to guide the
MRI-guided prostate biopsy appears to be superior to standard TRUS-biopsy in prostate cancer detection. Several groups in the U.S.,[15][16] and Europe,[17][18] have demonstrated that targeted biopsies obtained with fusion imaging are more likely to reveal cancer than blind systematic biopsies. In 2015, AdMeTech Foundation, American College of Radiology and European Society of Eurogenital Radiology developed Prostate Imaging Reporting and Data System (PI-RADS v2) for global standardization of image acquisition and interpretation, which similarly to BI-RADS standardization of breast imaging, is expected to improve patient selection for biopsies and precisely-targeted tissue sampling.[19][20] PI-RADS v2 created standards for optimal mpMRI image reporting and graded the level of suspicion based on the score of one to five, with the goal to improve early detection (and exclusion) of clinically significant (or aggressive) prostate cancer.[21] The higher suspicion on mpMRI and the higher PI-RADS v2 score, the greater the likelihood of aggressive prostate cancer on targeted biopsy. Considerable experience and training is required by the reader of prostate mpMRI studies.
Up to 2013, indications for targeted biopsy have included mainly patients for whom traditional TRUS biopsies have been negative despite concern for rising PSA, as well as for patients enrolling in a program of active surveillance who may benefit from a confirmatory biopsy and/or the added confidence of more accurate non-invasive monitoring.[15] Increasingly, men undergoing initial biopsy are requesting targeted biopsy, and thus, the use of pre-biopsy MRI is growing rapidly.
Clinical trials of mpMRI and PI-RADS v2, including NIH-funded studies are underway to further clarify the benefits of targeted prostate biopsy.[22]
Side effects
Side effects of a TRUS or TPM biopsy include:[23][6][24]
- rectal pain or discomfort (very common)
- burning when passing urine (very common)
- bruising (very common with TPM only)
- bloody urine for 2–3 days (very common)
- bloody semen for ~3 months (30% with TRUS; ~100% with TPM)
- poor erections for ~8 weeks (30% with TRUS; ~100% with TPM)
- infection of skin or urine (1–8%)
- infection of skin or urine requiring hospitalisation and intravenous antibiotics (1–4%)
- difficulty urinating (1% with TRUS; >5% with TPM)
Gleason score
The tissue samples are examined under a microscope to determine whether cancer cells are present, and to evaluate the microscopic features (or
Tumor markers
Tissue samples can be stained for the presence of PSA and other tumor markers in order to determine the origin of malignant cells that have metastasized.[25]
References
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- ^ a b PROMIS - Prostate MRI Imaging Study. An evaluation of multi-parametric magnetic resonance imaging in the diagnosis and characterisation of prostate cancer. (UK) Medical Research Council - Clinical Trials Unit - PROMIS Trials Office. MRC: PR11, 2 February 2012
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- ^ "AdMeTech". www.admetech.org. Retrieved 2015-09-28.
- ^ "Prostate Imaging Reporting and Data System (PI-RADS) - American College of Radiology". www.acr.org. Retrieved 2015-09-28.
- PMID 26427566.
- ^ "Search of: prostate mri biopsy - List Results - ClinicalTrials.gov". www.clinicaltrials.gov.
- PMID 28007492.
- ^ "Five Tips for a Safe Endocavity Biopsy". EDM Medical Solutions. 21 September 2018.
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