In-office MRI/TRUS fusion imaging and prostate biopsies

Readers interested on a the potential future of office-based prostate cancer imaging (for the conduct of biopsies and perhaps for other purposes too) may be interested in an article published today on the HealthDay web site. The article addresses the use of TRUS/MRI fusion imaging, i.e., a way to look at the prostate using the best elements of transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI), right in a community physican’s office (just like he or she uses TRUS imaging today to conduct TRUS-guided biopsies).

TRUS/MRI fusion imaging and related MRI-guided biopsies can actually be conducted in a number of ways, but a company called Invivo Corp. (a division of Philips Healthcare) is now manufacturing and selling this equipment (the UroNav Fusion Biopsy System) — although only five centers in the US have purchased it to date. Major academic centers and hospitals have been using the MRI/TRUS fusion technique for some time (by combining images generated by earlier types of equipment MRI and ultrasound equipment). However, the new equipment developed by Invivo Corp. is designed specifically to image and conduct prostate biopsies in a physician’s office with greater accuracy than has been the case in the past.

When biopsies are done using this type of process they are actually “targetable” to areas of the prostate that appear suspicious for prostate cancer under MRI. Traditional TRUS-guided biopsies are usually done in a “systematic” manner, with samples being taken from pre-specified ares of the prostate. It seems likely that, with the development of office-based TRUS/MRI fusuin equipment, we may see a movement toward biopsy processes that take 8 to 12 systematically pre-specified cores and then a variable number of “targeted” cores that are from areas that look suspicious under MRI.

On the up-side, however, this type of equipment may help us to cut back on the over-use of prostate biopsies — because if the patient is given an MRI with this equipment prior to the biopsy, and there is no visible evidence of any area that is suspicious for cancer, it may be possible to avoid the biopsy altogether. We’re going to need more data to see how this plays out over time … and there is, of course, a cost factor that needs to be taken into account.

The other question that is going to be relevant is whether the Invivo system is as good as some of the other systems, such as the multiparametric MRI fusion system being used at places like the National Cancer Institute’s Clinical Center in Bethesda and elsewhere.

2 Responses

  1. No promotion of this type of equipment should be stated without saying what the cost of it would be. MRI equipment is very costly and the overabundance of the equipment is directly related to the overuse of it in the US. Disappointed that this site mentions it by name with nothing more than a passing comment about cost.

  2. Bob:

    (1) We are not “promoting” anything … merely informing people of its existence.

    (2) If you click on the link to the HealthDay article you will find information about the cost of the equipment, but we have no data about the cost of a biopsy carried out using this technology.

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