What is a prostate biopsy?
A biopsy is the only way to confirm is cancer is present when it is suspected. It is essential because prostate cancer may not show early symptoms, though certain warning signs indicate increased prostate cancer risk:
- An elevated or rising PSA blood test result
- An abnormal digital rectal exam (DRE)
- A family history of prostate cancer or breast cancer
- Being of African-American descent
- Exposure to certain cancer-causing toxins, e.g. Vietnam vets exposed to Agent Orange
- In later stages, prostate cancer may show symptoms such as urinary difficulties, blood in urine, pelvic or back pain, and bone pain
How is a biopsy performed?
Prostate biopsy utilizes a small, hollow needle to sample tissue from the gland. These samples are sent to a laboratory where a pathologist analyzes them, assessing cancer cell lines, tumor size & location, and aggressiveness—all essential information for making the best treatment decisions for each patient.
There are three approaches to prostate biopsy:
- Transrectal ultrasound (TRUS) guided biopsy uses ultrasound guidance to place needles through the rectal wall into the gland, typically under a local anesthetic and utilizing 10-12 needles, half from each side of the gland.
- Transperineal mapping biopsy (TMB) uses ultrasound to guide needles placed in a rigid grid into the gland through the transperineum (skin between scrotum and anus). It is done under general anesthesia. Samples are taken every 5mm apart, up to 40-60 samples. This biopsy is not commonly done because general anesthesia requires an operating room facility.
- Magnetic resonance imaging (MRI) guided biopsy uses advanced imaging to reveal the tumor location, size and shape so a doctor can guide a minimum number of needles through the rectal wall into the core of the tumor. It is usually done under a local anesthetic. The doctor can “see” and therefore target needles into the tumor.
What is 3T mpMRI BlueLaser™-Guided Biopsy?
For the last two decades, transrectal ultrasound (TRUS) guided biopsy has been used to diagnose prostate malignancy based on what’s been referred to as a “blind” procedure. Specific prostate tumors, especially very small ones, cannot always be distinguished by ultrasound due to its poor resolution of soft tissue. In addition, TRUS biopsies based on a “systematic” (grid) approach tend to target the peripheral aspects of the gland and are likely to miss 30-40% of prostate cancer located in the anterior, midline transition zone, or apex. This is called sampling error. To attempt to overcome it, TRUS biopsies typically average 10-14 needles; “saturation” biopsies use as many as 24 needles. Unfortunately, the greater the number of needles, the greater the risk of discomfort, infection, and urinary or sexual side effects and tumors continued to be missed.
A Better Solution: Advanced 3T Technology with Powerful Imaging Results
The 3T Multi-Parametric MRI – BlueLaser™ is the latest technology in both detecting and treating prostate tumors. Our 3T multi-parametric MRI scan of the prostate gland does not use an endorectal coil. It is a non-invasive, high definition, 360-degree visual analysis of the prostate gland in its entirety. Our scanner has a magnetic field that is twice as powerful as ordinary 1.5 Tesla (1.5T) magnets. It is over 10 times as powerful as open MRI scanners, and produces exceptional imaging details.
Patients want clear, reliable information that can only come from an accurate diagnosis. If a man is diagnosed with prostate cancer, the choice of Active Surveillance or treatment will depend on many factors, especially the nature of the prostate cancer identified during a patient’s biopsy.
By having the highest quality imaging of your prostate gland, Dr. Sperling is able to examine your prostate gland with the most advanced technology available. Our 3T Multi-Parametric MRI – BlueLaser™ scan may even eliminate the need for a biopsy when no suspicious areas are detected.
Our next generation, 3T Multi-Parametric MRI – BlueLaser™ high-resolution 3D images distinguishes normal from diseased tissue to precisely pinpoint cancerous cells within the prostate. The result gives better ability to identify, characterize and target prostate malignancy, especially important in today’s diagnosis of smaller, lower risk tumors.
Because our MRI-Guided Biopsy performed in Florida and New York City is highly targeted to the area seen on 3T Multi-Parametric MRI – BlueLaser™, patients find it more comfortable than traditional TRUS biopsies. Also, the risks of infection and side effects are greatly reduced.
An MRI-Guided Biopsy is highly targeted to select tissue revealed by the MRI imaging. That means physicians and patients have the confidence that any tissue samples come from locations identified as having the most likely chance of containing cancer. The result is a targeted approach vs. the “blind” approach of a TRUS biopsy.
Advanced Laboratory Analysis
The biopsy tissue samples are analyzed in top laboratory facilities by expert specialists called pathologists. Depending on individual risk factors, further analysis can be done to evaluate molecular markers and new gene sequence tests. When indicated, we utilize genomic testing for the most thorough results. The findings are the final confirmation of prostate tumors when correlated with MRI images. A tumor identified at a low-to-moderate risk level may qualify for a focal treatment.
Questions Patients Ask Us
I’ve had a previous negative biopsy, but my PSA is still high. I don’t want another biopsy. Any suggestions?
We recommend scheduling a 3T Multi-Parametric MRI – BlueLaser™ scan of your prostate. A high PSA is not specific for prostate cancer. It can signal noncancerous conditions such as inflammation, infection, and benign age-related enlargement. A scan is the best next step to rule prostate cancer in or out. If a biopsy proves necessary, an MRI-Guided Biopsy is less invasive and more accurate.
I’ve had a positive biopsy. Can I trust the information from the lab?
Conventional TRUS biopsies are inaccurate at least 30% of the time because ultrasound guidance can’t distinguish between healthy prostate tissue vs. tumors. Thus, the tissue samples sent to the lab for analysis under a microscope may not tell the whole story. If you would like to know if you qualify for Active Surveillance, or focal laser ablation (FLA) with very low risk of side effects, our Center offers a precisely targeted 3T Multi-Parametric MRI – BlueLaser™-Guided Biopsy into the tumor’s center. You can be confident that our biopsy method gives the most accurate information.
Can MRI alone diagnose my prostate cancer?
Research shows that today’s 3T multiparametric MRI reveals prostate cancer tumors. Our 3T Multi-Parametric MRI – BlueLaser™ allows image-based analysis of suspicious areas. However, only laboratory analysis under a microscope can give cellular, even molecular, information about the actual tissue samples.
The Sperling Prostate Center Advantage
Our philosophy is to match the treatment with the disease. Our 3T Multi-Parametric MRI – BlueLaser™ guided biopsy method as the most responsible and accurate way to know your disease before making a treatment decision. We help patients avoid the risk of under-treating aggressive disease, or over-treating insignificant disease that can safely be monitored. We pride ourselves on having attained international recognition for excellence in real-time MRI-guided prostate cancer diagnosis.
The latest news
Sperling Prostate Center Joins MR-Guided Focused Ultrasound Clinical Study. Find out more »
Dr. Sperling speaks at the WPBF 25 Health and Safety Festival with Dr. Mehmet Oz Find out more & watch video »
Dr. Sperling included as featured expert on Prostate.net. See Dr. Sperling's articles »
New article co-authored by Dan Sperling, M.D., on Focal Laser Ablation for prostate cancer with powerful clinical trial results. Read it now »