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Combination of MRI/Ultrasound Imaging Enhances Prostate Cancer Detection, Treatment

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A powerful combination of MRI-ultrasound imaging system can lead to fewer biopsies and overall improved treatment decisions for prostate cancer patients.

The technology, called UroNav®, merges images from magnetic resonance imaging (MRI) with ultrasound to construct a detailed, three-dimensional view of the prostate. This enhanced view aids physicians in performing biopsies with much higher precision, and increases prostate cancer detection, according to Loyola University Medical Center prostate cancer surgeon Gopal Gupta, MD. Loyola is the first hospital in Illinois to employ such a system.

"This is revolutionizing how we diagnose prostate cancer and make treatment decisions. When prostate cancer is suspected due to results of a PSA blood test or digital rectal exam, a physician performs a prostate biopsy. This typically involves sticking a needle into 12 different areas of the prostate. However, this traditional method can miss a tumor. Consequently, the physician either will falsely conclude the patient does not have cancer, or will perform one or more additional biopsies to find the suspected tumor,” said Gupta.

In the new fusion technique, the patient receives a MRI exam prior to undergoing a biopsy. The MRI can detect lesions in the prostate that may be cancerous. During the biopsy, the MR image is merged with ultrasound imaging. The system applies GPS-type technology to guide the biopsy needle to the lesions detected by the MRI, leading to considerably fewer needle biopsies.ultrasound mri combo

"Compared with traditional biopsy techniques that randomly sample the prostate, the new technology helps prevent physicians from missing hard-to-find and often aggressive prostate cancers. This potentially will help provide greater certainty regarding the extent and aggressiveness of the disease. And it could enable patients to avoid multiple and unnecessary repeat prostate biopsies,” notes Gupta.

“Traditional biopsies lack precision, which can lead to either too much treatment or not enough treatment. For example, if the biopsy fails to identify an aggressive tumor, the patient may be under treated. Conversely, a patient may undergo surgery or radiation for a tumor that likely would grow too slowly to endanger the patient during his expected lifetime,” Gupta added.

Biopsies guided by MRI/ultrasound fusion will allow physicians and patients to opt for active observation, when suitable. Under active observation, the patient avoids having surgery or radiation and instead undergoes periodic digital rectal exams, PSA tests and ultrasounds to see whether the cancer is growing.

“MRI/ultrasound fusion is the next generation of MRI evaluation in the fight against prostate cancer," said Loyola radiologist Ari Goldberg, MD, PhD.

"These leading-edge imaging technologies will improve patient care by enabling physicians to detect and characterize abnormalities at the earliest possible stages. The techniques also will give physicians better insight into whether, for example, a cancer has spread, and how effective a treatment has been,” said chair of Loyola's Department of Radiology, Scott Mirowitz, MD.

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