Understanding the complexities of MRI-targeted biopsies


A recent video-discussion on the OncLive web site addresses the complexities in the evolution of application of multiparametric MRI scanning and MRI/TRUS fusion biopsies in the diagnosis of early stage prostate cancers.

The video-discussion, led by Dr. Raul Concepcion, but involving a number of well-respected urologists with specific experience in the use of this technology, makes it clear that the use of this technology here in the USA is a “work in progress” (and that its application is currently more advanced in some European countries).

Problems associated with the application of this technology here in the USA include the availability of the necessary equipment, the cost of MRI scans, the relative lack of experience of the majority of radiologists in reading prostate MRI scans, the lack of standardization of the process, and the lack of consensus about when and in which patients it is really wise to be using this type of technology.

From a patient perspective, it is important to understand that, yes, there are certainly a relatively small number of centers that have developed a high level of expertise in the use of these techniques. If you live relatively near to (or can afford to travel to) such a center, fine. However, such centers, at this time, are still the exception rather than the rule. Most community urologists do not have access to this type of technology, and they are unlikely to have access to it in the near future either. And then there is the question of whether your insurance will cover the costs of this type of biopsy.

It is also important to appreciate that the greatest value of this technology at present is probably in the evaluation of patients who have relatively small amounts of lower risk prostate cancer, and who are trying to make determinations about whether active surveillance or some form of focal therapy may be appropriate for them.

2 Responses

  1. The panel strikes me as more apology than insight. The major technology components are much more available than the speakers indicated. The critical items are the fusion accessory for the common TRUS unit and the training to use it.

    Both of those could be lifted over the regulatory hurdles, given concerted organizational action. Patients more than practitioners need to have available every likely assist to diagnosis and evaluation of prostate cancer.

    Bill,

    Still happy with my decision; feeling for men still on the other side.

  2. Dear Bill:

    This is not a regulatory issue in any way. The technology is certainly available, and there is no regulatory barrier to its use. That doesn’t mean that: (a) urology practices can afford to acquire the technology, or (b) the technology to carry out appropriate multiparametric, diffusion weighted MRIs is easily accessible, or (c) the available MRI data can be interpreted with accuracy, or (d) payers are willing to cover the costs.

    At present I’d be surprised if there were enough experienced uroradiologists available in the country to interpret with accuracy all the mpMRIs of the prostate that could be carried out today (even if the patients were able to get those mpMRIs done). I am also aware that while the requisite technology is easy to gain access to in some parts of the country (e.g., Southern California), it is near to completely inaccessible in other parts of the country (e.g., West Virginia).

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