• Gold Coast Urologist

MRI Stratified pathway for prostate cancer detection

Detection rates of clinically significant prostate cancer with Magnetic Resonance Imaging pathway vs TRUS biopsy.

When prostate cancer is suspected in men a Transrectal ultrasound guided prostate biopsy (TRUS) has been the common diagnostic standard. Over the years, there have been multiple studies showing a more advanced method in detection of prostate cancer in comparison to TRUS. “MRI stratified pathway” for detection of clinically significant prostate cancer is proving to have higher detection rates to that of TRUS and “is anticipated to improve detection and risk stratification”.

Dr Elmes utilises the MRI stratified pathway for patients who have suspected prostate cancer where patients presented with abnormal PSA levels or have an abnormal rectal examination. With the use of MRI offering improved visualisation and “aid targeting prostate biopsies to abnormal areas“, Dr Elmes is able to perform multiple biopsies in the area of interest with the use of the Artemis device resulting in improved detection rates of clinically significant prostate cancer while reducing clinically insignificant prostate cancer.

The Artemis is a computer-targeted device that fuses the pre-operative MRI images with the intra-operative ultrasound image. It overlays the two and effectively lines up precisely where biopsies should be taken, thus mitigating human error. This is a significant advancement as TRUS entails guesswork in taking suspicious specimens and therefore runs the risk that “TRUS-Bx undersamples a significant portion of clinically significant PCa, which potentially can progress, metastasize, and result in cancer-related mortality.”

This digital overlay of an MRI image onto ultrasound, allows Dr Elmes to obtain both systematic and targeted biopsies; in addition, biopsy sites are recorded for later repeat targeting. “The relative detection rate of the MRI stratified pathway was 1.45, meaning that it detected approximately 50% more clinically significant prostate cancer than the systematic TRUS-Bx pathway”.

Find out more about the Artemis here https://www.goldcoasturologist.com.au/prostate-biopsy

Reference: Woo S, Suh CH, Eastham JA, Zelefsky MJ, Morris MJ, Abida W, Scher H, Sidlow R, Becker AS, Wibmer AG, Hricak H & Vargas HA, (2019), Comparison of Magnetic Resonance Imaging-stratified Clinical Pathways and Systematic Transrectal Ultrasound-guided Biopsy Pathway for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials, European Urology Oncology, vol. 2, Issue 6, pp 605-616, https://euoncology.europeanurology.com/article/S2588-9311(19)30071-9/fulltext