MRI-guided biopsy hits the Wall Street Journal

And if there was any doubt that there was controversy about the routine use of MRI-guided biopsies are at this time, read this article. Even Leonard Marks, MD (an “early adopter” of MRI-guided biopsies) notes that “about 20 percent of MRI scans which appear to be normal end up having a serious but treatable cancer.”

3 Responses

  1. The tone of your post is misleading as it suggests Dr. Marks at UCLA had some serious reservations about 3 T mpMRI as a tool for diagnosis and treatment of prostate cancer.

    The actual article and the opinions expressed by Dr. Marks therein were actually very favorable regarding the use if of mpMRI in the diagnosis and treatment of prostate cancer — now and in the future. The major reservation expressed in the article lamented the limited number of practitioners adequately trained to read and interpret the imaging.

    Some in the urology community seek to embrace MRI/TRUS fusion as a way to stay in the game. While this represents an improvement over established practice, I believe this MRI/TRUS fusion adds an unnecessary extra step or two to the process. Biopsy, and tumor ablation if appropriate, can be accomplished near simultaneously under MRI guidance alone.

    The better model for the urology community would be to follow the path of the cardiology community. The cardiologists drew interventional radiologists into their practices and revamped cardiology training to incorporate angiography, angioplasty, and other interventional procedures now accomplished in cath labs for treatments of conditions that formerly required major surgery, significant mortality and days, if not weeks, of hospitalization and post-op recovery. A large portion of the urological patient population will reap significant benefits from avoidance of unnecessary procedures or the utilization of truly minimally invasive procedures when required. Insurers will also reap a major financial benefit as this technology is embraced.

    I am not a medical professional. I was treated using MRI-guided focal laser ablation for an organ-contained, Gleason 8 lesion this past May. I am looking forward to my 6-month follow-up in a few weeks. The procedure was done on an outpatient basis under light sedation and I had virtually no discomfort save for a minor oomph! during pre- and post-procedure placement and removal of the catheter. Procedural side effects were limited to about 2 weeks of hematuria starting 10 days post-ablation and maybe 2 months of hematospermia. No ED and no leakage to speak of — some increase in rate of flow and urgency.

  2. Dear Joseph:

    You appear to be missing the point of Dr. Marks’ comment referred to above. What Dr. Marks is pointing out is that 3-T MRI scanning and related biopsy as a method of diagnosing prostate cancer alone is associated with a false negative rate of 20%. In other words, one in five men who have a negative diagnosis on the basis of 3-T MRI scanning will later be found to have clinically significant prostate cancer. Furthermore, Dr. Marks and his colleagues at UCLA are among the leading advocates for the MRI/TRUS-guided biopsies that you appear to be rejecting. Why? Because this technique allows for an initial biopsy that combines a standard systematic 12-core biopsy with removal of additional biopsy cores targeted to suspicious lesions evident on the basis of the MRI scan.

    The fact that your personal decisions about diagnosis and treatment appear to have been effective doesn’t change the fact that there is a 20% false negative rate that has been well documented in men undergoing MRI-guided biopsy. And you would probably have a very different view of the situation if you had been treated and then discovered 3 monthsd later than your PSA had never gone to zero because an unidentified tumor was still growing in your prostate.

    The potential of MRI scanning in the diagnosis and management of prostate cancer is considerable. On that matter almost everyone (except a few diehards) is in full agreement. The use of MRI scanning and MRI-guided biopsy alone is a far more controversial issue. Very few of the “early adopters” of MRI scanning and MRI-guided biopsy techniques now appear to think that it is good enough to completely replace the systematic biopsy. This is why leaders in this field (such as the groups at UCLA and at the NCI Clinical Center are now regular users of MRI/TRUS-fusion processes.

  3. And Joseph … as confirmation of the comments immediately above, you might like to look at this report on MRI-guided biopsy processes that refers to two papers just published in the November issue of the Journal of Urology.

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