Stereotactic Transperineal Prostate Biopsies using MRI-based targeting by Fusion guidance
Cambridge Urology Partnership offer the most advanced technology in prostate cancer diagnosis. Mr Kastner and Mr Saeb-Parsy work in team with our radiologists Tristan Barrett and Brendan Koo. Using close feedback they have perfected the 3T MRI assessment and use cutting edge software to fuse high precision imaging (3 Tesla MRI) with live ultrasound to target lesions in the prostate. This technique is called MRI-US fusion guided transperineal prostate biopsies (M-TTP). We are the first centre in the UK to offer this purpose-built technology.
Evidence and experience of over 1000 patients in Cambridge has already established that this technology has a far higher detection rate of cancer present in the prostate (sensitivity), both in newly presenting patients and patients who had previous negative standard prostate biopsies. It also appears to give a most accurate picture of the extent and location of cancer. This is crucial for the patient and their doctor when deciding on the right treatment, especially when considering active monitoring or focal treatments.
We are now one of the few centres in the country that are able to offer PSMA PET scan in patients who have been diagnosed with prostate cancer for more accurate staging and detection of potential spread of cancer. Accuarate staging of prostate cancer is crucial in choosing the right treatment.
In patients whose targeted biopsy does not show cancer, our evidence confirms that using our assessment pathway will give patients more certainty for a number of years.
The Cambridge Urology Partnership team feel that this new pathway helps put an end to the uncertainty of many patients who are worried about a raised PSA or the possibility of prostate cancer. If you are worried, then feel free to contact us or ask your GP for a referral.
In many men the journey to the diagnosis of prostate cancer can be long and treacherous with sometimes years of uncertainty, yet, this technology allows urologists at Cambridge Urology Partnership to bring men faster and more safely to a diagnosis.
In most men this journey starts when they are found to have a raised PSA blood test.
If an abnormality is found, common practice is to perform a biopsy of the prostate with access from the rectum (TRUS biopsy). Yet, only about 50% of patients will gain certainty by either being reassured with a normal finding or being given a diagnosis of prostate cancer. The remainder are patients whose PSA blood test continues to rise or whose biopsy tissue contains suspicious changes, which suggest the presence of cancer. These patients may undergo several further TRUS biopsies over years with potentially increasing side-effects and the possibility of any cancer present becoming more advanced over time.
Christof Kastner and Kasra Saeb-Parsy of Cambridge Urology Partnership give these patients access to a new pathway. Initially they offer a special detailed scan of the prostate, called multi-parametric MRI, before any biopsy is performed. This allows them to identify potentially cancerous areas in the prostate which are not seen by common ultrasound. Under a short general anaesthesia the prostate can then be visualised using high-precision ultrasound. The MRI can be laid over the live ultrasound image and biopsy samples can be taken from the abnormal looking areas and from those parts of the prostate, which are out of reach of the standard biopsy approach. The combination of scan and biopsy technique, allows the biopsy to be precisely aimed, and thus limits the number of biopsies being taken. This protects patients from side-effects encountered in other available techniques which randomly take biopsies from the entire prostate.
The samples are then assessed by the pathology team lead by Anne Warren, one of the world leading prostate cancer pathologists.
Given the superior expertise all along the pathway patients can be assured to receive the best possible prostate cancer assessment achieving certainty and accuracy.