A fusion biopsy is a procedure that combines a real-time ultrasound image with an earlier MRI scan. The advantage of this procedure is that cancer requiring treatment is more likely to be detected and patients will receive treatment more quickly. Fewer tissue samples are required, which will also spare patients from any associated side effects.
Prostate cancer is diagnosed through an examination of the patient combined with tissue samples taken from the prostate via the rectum. Biopsies have traditionally been performed with the aid of an ultrasound image transmitted onto a screen. The problem with this procedure is that the tissue samples have to be taken systematically from several places – ‘taking a shot in the dark’ as it were – because ultrasound cannot detect smaller cancerous foci. Some clinically significant cancerous foci that require treatment may therefore remain undetected.
In recent years, the accuracy of MRI scans has significantly increased and they can now detect even the smallest suspected cancerous foci. By combining an earlier MRI with a real-time ultrasound image, tissue samples can be accurately taken from selected areas.
Description of the procedure
- The procedure requires an MRI of the prostate. A radiologist will mark any suspicious areas on the MRI image.
- Fusion biopsies are performed at Meilahti Hospital’s urology polyclinic.
- Antibiotics are taken orally about 1–2 hours before the procedure.
- The procedure takes about 15–20 minutes.
- A total of 2–3 tissue samples are taken per area.
- If there are several suspicious areas in the prostate, targeted samples can be taken from all these areas.
- Tissue sampling is not painful. An anaesthetic is administered to the prostate, and painkillers and a numbing gel are also used if necessary.
- Patients should temporarily stop taking anticoagulant medication (Marevan, Plavix, Eliquis, etc.) in accordance with separate guidelines.
Adequacy and complementary examinations
Taking targeted tissue samples with the aid of fusion biopsy is more accurate than systematic biopsies. However, in certain circumstances systematic biopsies can complement fusion biopsies. If prostate cancer is diagnosed during a fusion biopsy, other imaging examinations may be required to determine its stage.
Advantages and side effects
The advantage of fusion biopsy lies in its greater sensitivity and accuracy in investigating suspicious changes compared to systematic biopsies. As a result, clinically significant prostate cancers are detected more often and non-significant prostate cancers less often.
The most common side effects of a fusion biopsy are blood in the urine, faeces and semen. Infection is one rare side effect that may occur in spite of the antibiotics used. However, as fewer samples are taken than when using a systematic approach, there is a lower incidence of side effects.
Bleeding from the rectum or blood in the urine may occur for a few days. Semen may be discoloured for several weeks.
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