The diagnosis of prostate cancer has traditionally relied on measuring PSA levels in the blood and performing a digital rectal exam. When the PSA level was elevated or an abnormal digital rectal exam was detected, a blind ultrasound-guided biopsy was performed. Currently, more advanced diagnostic methods exist to assess whether a man has prostate cancer and determine its severity. This is the case with fusion biopsy , which uses magnetic resonance imaging (MRI), providing, for the first time, images of solid prostate tumors, and fuses it with ultrasound to perform targeted biopsies.

Fusion biopsy, the evolution of diagnostic tests

When prostate cancer is suspected, a multiparametric magnetic resonance imaging (mpMRI) scan of the prostate is performed. This high-resolution imaging test plays a crucial role in performing the biopsy because, by fusing this information with the real-time ultrasound image, it allows for sampling of suspicious areas and a detailed analysis of the prostate's condition.

For the first time, it is possible to see the tumor inside the prostate gland , which allows us not only to know its situation at the local level (size, location, involvement of capsules or periprostatic structures), but also to direct the taking of biopsies to those lesions.

But we can go even further in performing fusion biopsies thanks to PET-MS-PSMA (positron emission tomography). While mpMRI of the prostate helps in the static anatomical identification of areas suspected of malignancy, PET-MS-PSMA allows us to see dynamic areas of tumor activity . Previously invisible tumors can be diagnosed , even with a PSA level below 1.

Of all the diagnostic tools available, this is the one that provides the most definitive information and allows for greater precision in taking samples that will later be analyzed by a specialized pathologist.

Obtaining all these details will allow us to plan a focal therapy for prostate cancer , meaning treating only the area affected by the tumor plus a safety margin, resulting in a less invasive treatment. For this, we use the Toumai and da Vinci robotic systems , which translate the surgeon's movements, improving ergonomics and reducing tremor. Furthermore, they provide a true three-dimensional view of the surgical field with high-quality images that guarantee clarity and precision of detail.

 How is a fusion biopsy performed?

Fusion biopsy is performed in the operating room. After a short sedation, the needle is inserted through the perineal area for greater precision and a lower infection rate. Once the sample is extracted, it is sent to the pathologist.

The test lasts about half an hour. Two hours after the procedure, the patient can go home. It is normal to feel slight discomfort in the perineum for the first few hours, which can be relieved with cold compresses and anti-inflammatory medication.