Making a diagnosis of prostate cancer has long been a problem for doctors and their male patients.
Prostate biopsy is the most reliable way to confirm a malignancy, but even though we have significant improvement in our ultrasound pattern, the problem of establishing the best place to do the needle biopsy and to try to limit the number of painful needle sticks has been an ongoing problem.
For example, a patient I saw last year had developed elevated PSA in 1999 and had five prostate biopsies, all of which were negative. Finally, his sixth biopsy in 2013 established he had prostate cancer. But by this time, the cancer had moved into the patient’s bones.
Fortunately, there is the developing technology of MRI spectroscopy, which permits the high probability of prostate cancer being accurately localized and decreasing significantly the number of needles that have to be put into the prostate.
This technology has not been fully approved but is available and should be used, in my opinion, if a man needs a prostate biopsy.
This technique goes back to the way MRI was initially used to be able to identify the pattern of various chemicals in tissue samples. In the future with MRI spectroscopy, it may be possible to avoid completely the need for needle biopsy to confirm the cancer. At the present time, the accuracy of MRI spectroscopy is 93 percent.
Another technology that is developing is what is called Pro Fuse, which is the ability to fuse the images from the ultrasound and MRI to increase the accuracy of prostate biopsy.
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