Three Dimensional Prostate Biopsy Mapping

Sun, 05 Jun 2011 16:06:48 MDT

Since the discovery of Prostatic Specific Antigen (PSA) in 1979, advances in Transrectal Ultrasonography (TRUS), and the spring loaded biopsy gun, there has developed significant advances in the diagnosis of early stage Prostate Cancer. It has been demonstrated that increasing the number of targeted sites within the Prostate increases the cancer detection rate. Most Urologists now obtain 12 Transrectal Ultrasound guided biopsies of the prostate as standard protocol. However, despite these previous advancements, many men with significant clinical suspicion of Prostate Cancer will continue to have persistently benign or atypical prostate biopsy findings. Individuals with rising PSA levels and multiple previous negative biopsies remain a diagnostic and follow up challenge. The development 3D templated transperineal mapped biopsies of the prostate adds a new dimension and advancement making this the most comprehensive and sophisticated biopsy technique available. This technique is performed under anesthetic sedation with the biopsies performed through the perineum. The biopsies are guided via ultrasound and a template guides the biopsy needle to systematically sample every part of the prostate, thereby creating a three dimensional map of the gland. Although this procedure may not be recommended for all patients in need of prostate biopsies, the following are some potential situations which would be benefitted by this advanced technique: • Rising PSA despite a negative previous prostate biopsy. • A previous prostate biopsy with atypical glands or similar pathology which places the patient at increased risk for Prostate Cancer. • A patient with only 1-3 positive biopsies for Prostate Cancer interested in definitive staging of the gland to determine the extent of the cancer and potential treatment options. • A rising PSA in a patient after Radiation Therapy for local curative therapy now a concern for possible recurrence and need for additional therapy. The ultimate goal is to determine as best as possible the pathologic grade and stage of the disease to develop the ideal treatment plan for each patient. The performance of this biopsy technique for the proper indications will give both the patient and the physician the confidence and reassurance necessary for developing the optimal treatment course and outcome. The accuracy of the mapping biopsies allows us to accurately choose which individual is a candidate for active surveillance /watchful waiting, while at the same time minimize unnecessary overtreatment. For those men deemed candidates for definitive local curative therapy and have a biopsy mapping which reveals only a small zone of Prostate Cancer may be offered Focal Cryotherapy as a treatment option.